Tove Fall

Tove Fall works on large-scale studies of the gut microbiome and cardiometabolic disease. Her research uses national registers and population cohorts to examine the long-term consequences of antibiotic exposure.

Professor of Molecular Epidemiology

Department of Medical Sciences at Uppsala University

tove.fall@medsci.uu.se

Tove Fall's group site

Research focus and interests

  • Gut microbiome composition and diversity in population-based cohorts
  • Antibiotic exposure as a determinant of long-term gut microbiota composition
  • Antibiotics as a tool for causal inference in microbiome research
  • Microbiome diversity and cardiometabolic disease
  • Large-scale register-based and molecular epidemiology

Research expertise and methodologies

  • Large population-based cohort studies, including SCAPIS, MOS and SIMPLER
  • Register-based epidemiology using Swedish national health registers
  • Shotgun metagenomics for gut microbiome profiling
  • Genome-wide association studies
  • Proteomics and metabolomics profiling
  • Mendelian randomization and instrumental variable analyses

Ongoing research projects

My research focuses on large-scale molecular epidemiology of the gut microbiome and cardiometabolic disease. I lead the ERC-funded GUTSY project investigating the systemic effects of the gut microbiota on metabolism and atherosclerosis.

Antibiotic exposure is a central part of my work. In nationwide register-based sibling analyses, we have shown that early childhood antibiotic treatment for respiratory tract infections is associated with increased risk of type 1 diabetes.

In a forthcoming study in Nature Medicine, we investigate long-term consequences of oral antibiotic use on gut microbiota composition in 14,979 adults from the Swedish population-based cohorts SCAPIS, MOS and SIMPLER. We show that commonly prescribed antibiotics such as clindamycin, fluoroquinolones and flucloxacillin are associated with reduced gut microbiota diversity and altered species abundance up to 4 to 8 years after exposure.

I am also Principal Investigator of the Swedish Research Council project “Antibiotic exposure and a blood test to assess the impact of gut microbiome diversity on cardiometabolic disease”. In this project, antibiotic treatment is used as an instrumental variable for reduced microbiome diversity to strengthen causal inference regarding cardiometabolic risk. We will also develop and validate a blood-based metabolite assay, the GutsyTest, to measure microbiome diversity and assess its association with cardiovascular outcomes in large biobanks.

Key Publications

  1. Early Childhood Antibiotic Treatment for Otitis Media and Other Respiratory Tract Infections Is Associated With Risk of Type 1 Diabetes: A Nationwide Register-Based Study With Sibling Analysis Diabetes Care, 2020. https://doi.org/10.2337/dc19-1162
  2. An online atlas of human plasma metabolite signatures of gut microbiome composition Nature Communications, 2022. https://doi.org/10.1038/s41467-022-33050-0
  3. Genome-wide association analyses highlight the role of the intestinal molecular environment in human gut microbiota variation. Nature Genetics, 2026. https://doi.org/10.1038/s41588-026-02512-2
  4. Antibiotic use and gut microbiome composition links from individual-level prescription data of 14,979 individuals. Nature Medicine, 2026. https://doi.org/10.1038/s41591-026-04284-y
  5. Streptococcus Species Abundance in the Gut Is Linked to Subclinical Coronary Atherosclerosis in 8973 Participants From the SCAPIS Cohort Circulation, 2023. https://doi.org/10.1161/CIRCULATIONAHA.123.063914

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