Interpretable Machine Learning Reveals Complementary Age-Related Signatures in the Oral and Gut Microbiome

Abstract

Whether combining microbiome data from multiple body sites improves prediction, and whether different sites carry complementary or redundant information, are distinct questions that most studies conflate into a single accuracy metric. This work makes two contributions, one methodological and one biological, using paired stool and oral cavity microbiome samples from 44 subjects across two age groups, healthy adults and newborns (Ferretti et al., 2018). Methodologically, we show that a subject-matched fusion design combined with SHAP-based (SHapley Additive exPlanations) site attribution can detect complementary information between body sites even when no measurable accuracy gain results. This is a pattern that conventional model comparison would misread as a null result. Gut (stool) composition alone achieved near-perfect classification (area under the receiver operating characteristic curve, AUC = 1.00), and combined stool-oral models never exceeded this ceiling. A null baseline, bootstrap confidence intervals, and preprocessing sensitivity checks confirmed that this ceiling reflects genuine biological signal rather than an artifact. Despite the flat accuracy curve, SHAP analysis of the fused model showed that oral cavity features carried more total feature importance than stool features (58.1% versus 41.9%), indicating that the model draws on real, non-redundant information from both sites. Biologically, the taxa driving this pattern include Malassezia restricta, Staphylococcus epidermidis, and Prevotella melaninogenica. These taxa behave in a manner consistent with their established roles as early colonizers of the neonatal gut, skin, and oral cavity, once their model-specific behavior is verified directly against abundance data rather than inferred from the literature alone. An independent, substantially larger paired-cohort study using a different analytical method reports a compatible pattern. Together, these results support a model of oral-gut microbiome maturation as two distinct, complementary processes, and demonstrate that detecting this kind of relationship requires examining a model's internal reasoning rather than its accuracy alone.