Obesity duration is linked to bariatric surgery outcomes via adipose tissue response

Bariatric surgery (BS) is the most effective treatment for obesity and its related comorbidities, resulting in significant adipose tissue (AT) loss and functional recovery. However, the molecular mechanisms in the AT that drive these health benefits remain poorly understood, and predictive factors for adequate weight loss are currently needed. This study aimed to identify the proteomic signature of subcutaneous AT (SAT) linked to BS-induced weight loss and metabolic improvement, and to determine potential predictors of individual response. Sequential window acquisition of all theoretical mass spectra (SWATH-MS) proteomics was performed on paired abdominal SAT samples from individuals with obesity before and after BS. Bioinformatic and correlation analyses were conducted between proteomic data and changes in anthropometric and clinical parameters. In addition, the effect of sera from BS participants on subcutaneous adipocytes was assessed in vitro. The SAT response to BS was characterised by an up-regulation of mitochondrial metabolism and a down-regulation of inflammation, which correlated with different anthropometric and circulating markers. Notably, obesity duration was associated with BS-induced weight loss. Individuals with short-standing obesity (SSO) exhibited greater proteomic remodelling, weight reduction, and clinical improvement post-BS than those with long-standing obesity (LSO). Furthermore, a regulatory axis involving miR-223-3p, glucose metabolism, and cytoskeleton reorganisation in adipocytes might be connected to the positive effects of BS in LSO. Overall, our results indicate that obesity duration is related to BS-induced weight loss through SAT proteomic remodelling. Addressing this relationship could help develop new strategies to enhance weight management and metabolic health in people living with obesity.