Plasma citric and fatty acid alteration linked to optimal weight loss after sleeve gastrectomy in people with morbid obesity.

BACKGROUND

Targeted metabolomic profiling uncovers metabolic adaptations after bariatric surgery, but data in Asian populations remain limited.

OBJECTIVES

To investigate postoperative plasma metabolite changes and identify metabolic signatures associated with weight loss after sleeve gastrectomy (SG).

SETTING

A tertiary university hospital in Korea.

METHODS

We prospectively enrolled 49 Korean patients with severe obesity who underwent laparoscopic SG. Plasma samples were collected before and 6 months after SG. Targeted metabolomic profiling (liquid/gas chromatography-tandem mass spectrometry) quantified 101 metabolites-including amino acids, organic acids, fatty acids and nucleosides. Patients were categorized as optimal weight loss (OWL; total body weight loss [TBWL] ≥25%, n = 26) and suboptimal weight loss (SWL; TBWL< 25%, n = 23). Statistical comparisons and pathway enrichment analyses were performed.

RESULTS

Seventy-eight metabolites exhibited significant postoperative changes (false discovery rate< .05). Citric acid significantly increased after SG (Δ = 1.14 ng/μL, P < .001), with a greater increase in OWL than SWL (Δ = 1.98 vs. .19 ng/μL, P = .017), and was positively correlated with TBWL (r = .40, P = .005). Five fatty acids decreased significantly after SG. Two monounsaturated fatty acids-myristoleic and palmitoleic-decreased more in OWL, correlating negatively with TBWL (r = -.33 and -.28, respectively). In contrast, long/very-long-chain saturated fatty acids-eicosanoic, docosanoic, and tetracosanoic-decreased more in SWL, correlating positively with TBWL (r = .32, .44, and .39, respectively). Pathway enrichment highlighted tricarboxylic acid cycle and fatty acid degradation as key altered pathways.

CONCLUSION

SG induced distinct changes in plasma citric and fatty acid levels associated with weight-loss outcomes, suggesting mitochondrial adaptation and rebalanced fatty acid metabolic homeostasis during postoperative recovery.