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Fecal metagenomics and metabolomics reveal gut microbial changes after bariatric surgery

      Highlights

      • Significant changes in fecal microbiome and metabolites were found after RYGB or SG.
      • Alpha-diversity and bacteria with aero-tolerant, probiotic, or anti-inflammatory/anti-diabetic properties (e.g., A. municiphila) were increased, while Bacteroides were decreased.
      • Some butyrate-producing bacteria (e.g., Prevotella) showed time-varying changes at 1 week, 1 month, and 3 months after surgery.
      • Significantly changed beta-diversity and fecal metabolites were also observed.

      Abstract

      Background

      Evidence from longitudinal patient studies regarding gut microbial changes after bariatric surgery is limited.

      Objective

      To examine intraindividual changes in fecal microbiome and metabolites among patients undergoing Roux-en-Y gastric bypass or vertical sleeve gastrectomy.

      Setting

      Observational study.

      Methods

      Twenty patients were enrolled and provided stool samples before and 1 week, 1 month, and/or 3 months after surgery. Shallow shotgun metagenomics and untargeted fecal metabolomics were performed. Zero-inflated generalized additive models and linear mixed models were applied to identify fecal microbiome and metabolites changes, with adjustment for potential confounders and correction for multiple testing.

      Results

      We enrolled 16 women and 4 men, including 16 white and 4 black participants (median age = 45 years; presurgery body mass index = 47.7 kg/m2). Ten patients had Roux-en-Y gastric bypass, 10 had vertical sleeve gastrectomy, and 14 patients provided postsurgery stool samples. Of 47 samples, median sequencing depth was 6.3 million reads and 1073 metabolites were identified. Microbiome alpha-diversity increased after surgery, especially at 3 months. Significant genus-level changes included increases in Odoribacter, Streptococcus, Anaerotruncus, Alistipes, Klebsiella, and Bifidobacterium, while decreases in Bacteroides, Coprocosccus, Dorea, and Faecalibacterium. Large increases in Streptococcus, Akkermansia, and Prevotella were observed at 3 months. Beta-diversity and fecal metabolites were also changed, including reduced caffeine metabolites, indoles, and butyrate.

      Conclusions

      Despite small sample size and missing repeated samples in some participants, our pilot study showed significant postsurgery changes in fecal microbiome and metabolites among bariatric surgery patients. Future large-scale, longitudinal studies are warranted to investigate gut microbial changes and their associations with metabolic outcomes after bariatric surgery.

      Key words

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      • Comment on: Fecal metagenomics and metabolomics reveal gut microbial changes after bariatric surgery
        Surgery for Obesity and Related DiseasesVol. 16Issue 11
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          Metabolomics and metagenomics are analytical methods that are becoming more prevalent in the scientific literature and are playing an increasing role in how we understand obesity, diabetes, and weight loss. Metabolomics is a high-throughput technique that measures thousands of metabolites in a single sample [1]. Obviously, this represents a marked improvement compared with measuring just a few metabolites within a single sample and even allows for quantification of flux through metabolic pathways when coupled with stable isotopic methods [2].
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