Role of pre-surgical gut microbial diversity in Roux-en-Y gastric bypass weight-loss response: A cohort study.

INTRODUCTION: Roux-en-Y gastric bypass substantially alters the gut microbial composition which could be associated with the metabolic improvements seen after surgery. Few studies have been conducted in Latin American populations, such as Mexico where obesity prevalence is above 30% in the adult population. Thus, the aim of this study was to characterize the changes in gut microbiota structure in a Mexican cohort before and after Roux-en-Y gastric bypass and to explore whether surgery-related changes in the microbial community were associated with weight loss.

METHODS: Biological samples from patients who underwent Roux-en-Y gastric bypass were examined before and 12 months after surgery. Fecal microbiota characterization was performed through 16S rRNA sequencing.

RESULTS: Twenty patients who underwent Roux-en-Y gastric bypass showed a median excess weight loss of 66.8% 12 months after surgery. Surgery increased alpha diversity estimates (Chao, Shannon index and observed operational taxonomic units (OTUs), p<0.05), and significantly altered gut microbiota composition. Abundance of four genera were significantly increased after surgery: Oscillospira, Veillonella, Streptococcus, and an unclassified genus from Enterobacteriaceae family (PFDR<0.1). The change in Veillonella abundance was associated with lower excess weight loss (rho=-0.446, p=0.063) and its abundance post-surgery with a greater BMI (rho=0.732, P=5.4x10-4). In subjects without type 2 diabetes lower bacterial richness and diversity before surgery were associated with a greater Veillonella increase after surgery (p<0.05), suggesting that a lower bacterial richness before surgery could favor the bloom of certain oral-derived bacteria that could negatively impact weight loss.

CONCLUSION: Pre-surgical microbiota profile may favor certain bacterial changes associated with less successful results.