Mohammadzadeh Nima, Razavi Shabnam, Shahriari Mahla, Ebrahimipour Gholamhossein
Department of Microbiology and Microbial Biotechnology, Faculty of Life Sciences and Biotechnology, Shahid Beheshti University, Tehran, Iran.
Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Indian J Gastroenterol. 2025 Apr 12. doi: 10.1007/s12664-025-01763-x.
Obesity is a multi-factorial disease linked to various metabolic disorders, including insulin resistance, type-2 diabetes (T2D) and cardiovascular diseases. Traditional treatments often show limited long-term success, while bariatric surgery has emerged as the most effective intervention for sustained weight loss and comorbidity improvement. Alterations in gut microbiota may significantly contribute to these metabolic improvements.
This systematic review was aimed at evaluating changes in gut microbiota composition before and after bariatric surgery and their association with clinical outcomes, including weight loss, insulin sensitivity and lipid metabolism.
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search of PubMed, Scopus, Web of Science and clinicaltrials.gov databases was conducted for studies published between 2004 and 2024. Keywords included "bariatric surgery," "gut microbiota" and "obesity." Inclusion criteria focused on human studies with pre and post-surgical microbiota analysis. Non-human studies, pediatric populations and studies without microbiota assessment were excluded. Data extraction covered microbiota profiles, metabolic outcomes and clinical markers.
Total 27 articles and 28 clinical trials met the inclusion criteria. Pre-surgery, obese patients exhibited dysbiosis characterized by reduced microbial diversity and imbalances in key bacterial phyla. Post-surgery, especially after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), patients showed increased microbial diversity, reduced Firmicutes and elevated beneficial bacteria such as Akkermansia muciniphila and short-chain fatty acid (SCFA) producing bacteria. These microbiota changes were correlated with significant improvements in weight loss, insulin sensitivity and lipid profiles. However, some studies reported inconsistent or modest microbiota changes.
Bariatric surgery leads to significant gut microbiota alterations that are closely linked to metabolic improvements, including enhanced glucose control and lipid metabolism. However, the long-term sustainability of these microbial changes remains unclear. Longitudinal studies are essential to determine whether these alterations persist over time and how they continuously impact metabolic health. Further research should explore targeted microbiota interventions to maintain beneficial microbial profiles post-surgery.
肥胖是一种多因素疾病，与多种代谢紊乱相关，包括胰岛素抵抗、2型糖尿病（T2D）和心血管疾病。传统治疗方法往往长期效果有限，而减肥手术已成为实现持续体重减轻和改善合并症的最有效干预措施。肠道微生物群的改变可能对这些代谢改善有显著贡献。
本系统评价旨在评估减肥手术前后肠道微生物群组成的变化及其与临床结局的关联，包括体重减轻、胰岛素敏感性和脂质代谢。
按照系统评价和Meta分析的首选报告项目（PRISMA）指南，全面检索了PubMed、Scopus、科学网和ClinicalTrials.gov数据库中2004年至2024年发表的研究。关键词包括“减肥手术”“肠道微生物群”和“肥胖”。纳入标准侧重于对手术前后微生物群进行分析的人体研究。排除非人体研究、儿科人群和未进行微生物群评估的研究。数据提取涵盖微生物群概况、代谢结局和临床标志物。
共有27篇文章和28项临床试验符合纳入标准。术前，肥胖患者表现出微生物群失调，其特征为微生物多样性降低和关键细菌门类失衡。术后，尤其是在 Roux-en-Y胃旁路术（RYGB）和袖状胃切除术（SG）后，患者的微生物多样性增加，厚壁菌门减少，有益菌如嗜黏蛋白阿克曼氏菌和产生短链脂肪酸（SCFA）的细菌增多。这些微生物群变化与体重减轻、胰岛素敏感性和脂质谱的显著改善相关。然而，一些研究报告的微生物群变化不一致或变化较小。
减肥手术导致肠道微生物群发生显著改变，这些改变与代谢改善密切相关，包括增强血糖控制和脂质代谢。然而，这些微生物变化的长期可持续性尚不清楚。纵向研究对于确定这些改变是否随时间持续存在以及它们如何持续影响代谢健康至关重要。进一步的研究应探索有针对性的微生物群干预措施，以在术后维持有益的微生物谱。
