Publication: Evolución de la calidad de vida, hábitos alimentarios y microbiota intestinal en pacientes sometidos a cirugía bariátrica
Authors
Martínez Sánchez, María Antonia
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Escuela Internacional de Doctorado
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Ruiz Alcaraz, Antonio José ; Ramos Molina, Bruno ; Queipo Ortuño, María Isabel
Publisher
Universidad de Murcia
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DOI
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info:eu-repo/semantics/doctoralThesis
Description
Abstract
Objetivo de la tesis
La obesidad constituye un problema de salud pública de creciente preocupación debido a su elevada prevalencia y a la asociación con múltiples comorbilidades, como diabetes tipo 2, enfermedades cardiovasculares y hepáticas, y ciertos tipos de cáncer. A pesar de los avances en intervenciones conductuales, farmacológicas y quirúrgicas, una proporción significativa de pacientes con obesidad sometidos a cirugía bariátrica presenta resultados subóptimos a largo plazo. Esta tesis doctoral tiene como objetivo identificar los factores clínicos, bioquímicos, antropométricos, dietéticos, funcionales y microbiológicos que condicionan la respuesta de pacientes con obesidad a la cirugía bariátrica, con el fin de mejorar la selección de candidatos y optimizar los resultados terapéuticos.
Metodología
Se llevó a cabo un estudio prospectivo en pacientes con obesidad severa (grado III) atendidos en el Hospital Clínico Universitario Virgen de la Arrixaca (Murcia, España), entre 2020 y 2023. Se incluyeron individuos con un índice de masa corporal (IMC) ≥40 kg/m² o ≥35 kg/m² con comorbilidades asociadas, con seguimiento a 6, 12 y 24 meses tras bypass gástrico. El estudio integró evaluaciones clínicas detalladas (IMC, composición corporal mediante bioimpedancia), capacidad funcional (test de marcha de seis minutos), perfil bioquímico completo, análisis dietético (cuestionario de frecuencia alimentaria validado), calidad de vida (cuestionario SF-36), niveles plasmáticos de ácidos grasos de cadena corta (SCFAs) mediante LC-MS y caracterización metagenómica de la microbiota intestinal mediante secuenciación del gen ARNr 16S.
Resultados
Los resultados mostraron una pérdida de peso significativa tras la intervención, acompañada de una mejoría en los parámetros metabólicos, la capacidad funcional, los hábitos dietéticos y la calidad de vida a los 6 y 12 meses posteriores a la cirugía. Sin embargo, nuestro estudio prospectivo con seguimiento a 24 meses indicó que, pese a esta mejoría inicial, se observó un declive en la salud mental de los pacientes, así como un empeoramiento de los hábitos dietéticos en comparación con el punto de seguimiento a los 12 meses. Además, se identificaron cambios relevantes en la composición de la microbiota intestinal y en los niveles circulantes de SCFAs tras la cirugía, observándose perfiles específicos asociados con la magnitud de la pérdida de peso y la mejoría metabólica.
Conclusiones
En conjunto, esta tesis pone de manifiesto que la respuesta a la cirugía bariátrica es multifactorial y que la integración de indicadores clínicos, funcionales y moleculares puede contribuir a una medicina más personalizada para el tratamiento de la obesidad severa. Además, resalta el potencial de los SCFAs y la microbiota intestinal como biomarcadores pronósticos y dianas terapéuticas. Los hallazgos sugieren que intervenciones dirigidas al eje intestino-metabolismo podrían potenciar la eficacia de la cirugía bariátrica, promoviendo resultados más duraderos.
Thesis aim Obesity is an increasingly concerning public health issue due to its high prevalence and its association with multiple comorbidities, such as type 2 diabetes, cardiovascular and liver diseases, and certain types of cancer. Despite advances in behavioral, pharmacological, and surgical interventions, a significant proportion of patients with obesity who undergo bariatric surgery exhibit suboptimal long-term outcomes. This doctoral thesis aims to identify the clinical, biochemical, anthropometric, dietary, functional, and microbiological factors that influence the response of patients with obesity to bariatric surgery, in order to improve candidate selection and optimize therapeutic outcomes. Methodology A prospective study was conducted in patients with severe obesity (class III) treated at the Virgen de la Arrixaca University Clinical Hospital (Murcia, Spain) between 2020 and 2023. Participants included individuals with a body mass index (BMI) ≥40 kg/m², or ≥35 kg/m² with associated comorbidities, who were followed up at 6, 12, and 24 months after undergoing gastric bypass surgery. The study incorporated comprehensive clinical assessments (BMI, body composition via bioelectrical impedance), functional capacity (six-minute walk test), full biochemical profiling, dietary analysis (validated food frequency questionnaire), quality of life (SF-36 questionnaire), plasma levels of short-chain fatty acids (SCFAs) assessed by LC-MS, and metagenomic characterization of the gut microbiota using 16S rRNA gene sequencing. Results The results showed a significant weight loss after the intervention, accompanied by improvements in metabolic parameters, functional capacity, dietary habits, and quality of life at 6- and 12-months post-surgery. However, our prospective 24-month follow-up revealed that, despite the initial improvements, a decline in patients' mental health and a deterioration in dietary habits were observed compared to the 12-month follow-up point. In addition, significant changes were identified in the composition of the gut microbiota and in circulating SCFA levels after surgery, with specific profiles associated with the extent of weight loss and metabolic improvement. Conclusions Overall, this thesis highlights that the response to bariatric surgery is multifactorial and that the integration of clinical, functional, and molecular indicators may contribute to a more personalized approach for the treatment of severe obesity. Furthermore, it underscores the potential of SCFAs and gut microbiota as prognostic biomarkers and therapeutic targets. The findings suggest that interventions targeting the gut–metabolism axis could enhance the efficacy of bariatric surgery and promote more sustainable outcomes.
Thesis aim Obesity is an increasingly concerning public health issue due to its high prevalence and its association with multiple comorbidities, such as type 2 diabetes, cardiovascular and liver diseases, and certain types of cancer. Despite advances in behavioral, pharmacological, and surgical interventions, a significant proportion of patients with obesity who undergo bariatric surgery exhibit suboptimal long-term outcomes. This doctoral thesis aims to identify the clinical, biochemical, anthropometric, dietary, functional, and microbiological factors that influence the response of patients with obesity to bariatric surgery, in order to improve candidate selection and optimize therapeutic outcomes. Methodology A prospective study was conducted in patients with severe obesity (class III) treated at the Virgen de la Arrixaca University Clinical Hospital (Murcia, Spain) between 2020 and 2023. Participants included individuals with a body mass index (BMI) ≥40 kg/m², or ≥35 kg/m² with associated comorbidities, who were followed up at 6, 12, and 24 months after undergoing gastric bypass surgery. The study incorporated comprehensive clinical assessments (BMI, body composition via bioelectrical impedance), functional capacity (six-minute walk test), full biochemical profiling, dietary analysis (validated food frequency questionnaire), quality of life (SF-36 questionnaire), plasma levels of short-chain fatty acids (SCFAs) assessed by LC-MS, and metagenomic characterization of the gut microbiota using 16S rRNA gene sequencing. Results The results showed a significant weight loss after the intervention, accompanied by improvements in metabolic parameters, functional capacity, dietary habits, and quality of life at 6- and 12-months post-surgery. However, our prospective 24-month follow-up revealed that, despite the initial improvements, a decline in patients' mental health and a deterioration in dietary habits were observed compared to the 12-month follow-up point. In addition, significant changes were identified in the composition of the gut microbiota and in circulating SCFA levels after surgery, with specific profiles associated with the extent of weight loss and metabolic improvement. Conclusions Overall, this thesis highlights that the response to bariatric surgery is multifactorial and that the integration of clinical, functional, and molecular indicators may contribute to a more personalized approach for the treatment of severe obesity. Furthermore, it underscores the potential of SCFAs and gut microbiota as prognostic biomarkers and therapeutic targets. The findings suggest that interventions targeting the gut–metabolism axis could enhance the efficacy of bariatric surgery and promote more sustainable outcomes.
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