Metabolic Improvements and Weight Trajectories After Metabolic-Bariatric Surgery in Women with Polyendocrine Metabolic Ovarian Syndrome

Abstract

Obesity in women with Polyendocrine Metabolic Ovarian Syndrome (PMOS) is associated with substantial metabolic and reproductive burden. metabolic-bariatric surgery (MBS) is effective for weight loss, yet postoperative responses vary considerably. Identifying distinct weight loss trajectories and their associated metabolic outcomes may enable individualized postoperative management. In this prospective study, women with obesity and PMOS who underwent sleeve gastrectomy were followed at 1, 3, 6, and 12 months postoperatively. Group-based trajectory modeling (GBTM) based on percentage total weight loss (%TWL) was used to identify distinct patterns of weight loss. Longitudinal changes in anthropometric and metabolic parameters were compared between the identified trajectory groups. A total of 111 women were included. Significant improvements in anthropometric and metabolic parameters were observed over 12 months, with the most pronounced changes occurring within the first three months. Median BMI decreased from 38.5 kg/m. 2 preoperatively to 26.7 kg/m2 at 12 months (median %TWL 30.1%; %EWL 83.9%), and HbA1c improved from 5.8% to 5.2%. GBTM identified two distinct %TWL trajectories: an accelerated-decline group (57.7% of patients) and a normal-decline group (42.3%). Despite comparable baseline characteristics between the two groups, patients in the accelerated-decline group demonstrated consistently superior metabolic outcomes, including lower fasting insulin, C-peptide, and LDL-cholesterol at various postoperative time points. MBS yields substantial metabolic improvements in women with obesity and PMOS, with two distinct weight loss trajectories. Greater weight loss after MBS is associated with more pronounced metabolic benefits, yet preoperative characteristics do not distinguish between trajectory groups, underscoring the heterogeneity in surgical response and the need for further research into the determinants of differential outcomes. Significant improvements in HbA1c, fasting glucose, and HDL-C were observed within 3 months after MBS and sustained at 12 months. Two distinct %TWL trajectories were identified: an accelerated-decline group (57.7% of patients) and a normal-decline group (42.3%). Despite comparable baseline characteristics between the two groups, the accelerated-decline group demonstrated superior metabolic outcomes, including lower fasting insulin, C-peptide, and LDL-cholesterol.