Abstract Introduction Metabolic Bariatric surgery (MBS) is an effective treatment for children and adolescents living with obesity however, the mechanisms of its successful weight loss are unexplored. This systematic review and meta-analysis aimed to evaluate the short- and long-term effects of MBS on the paediatric metabolome, providing insights into the metabolic pathways that contribute to surgical weight loss and associated improvements in health. Methods This prospectively registered systematic review (PROSPERO ID: CRD42024607784) was performed in accordance with PRISMA guidelines. Meta-analysis was undertaken on pre-defined post-operative weight and metabolic parameters in paediatric patients (aged 5–19 years) following MBS. Outcomes were reported as weighted or standardised mean difference with 95 percent confidence intervals from random effects modelling. Quality scoring and quantitative assessment of bias were also performed. Results Twelve studies with 451 patients across 5 countries (mean age 16.9 years) were included. The quality of included studies was rated as high and there was substantial between-study heterogeneity for most outcomes included in the meta-analysis (I2 0% to 97%). The median follow-up period was 12 months, with the longest extending to 96 months post-surgery. Patients underwent either Roux-en-Y gastric bypass (RYGB; n = 275) or laparoscopic sleeve gastrectomy (LSG; n = 140), with no other bariatric procedures reported. Most studies relied on serum and urine measurements as biological assays, while two studies additionally included tissue analysis. MBS was associated with significant long-term weight reduction, with a mean BMI decrease of −14.4 kg/m² (95% c.i.: −17.5 to −11.3) and %TWL of 25% (95% c.i.: 18.6 to 32.2). Metabolic improvements were observed, particularly in lipid metabolism, including reductions in cholesterol (−10 mg/dL, 95% c.i.: −21 to −1.0), LDL (−14.6 mg/dL, 95% c.i.: −23.6 to −5.7), and triglycerides (−33.3 mg/dL, 95% c.i.: −46.3 to −20.3), alongside an increase in HDL (8.0 mg/dL, 95% c.i.: 1.7 to 14.3). Significant enhancements were noted in glycaemic, pancreatic and insulin regulation, evidenced by a decrease in HOMA-IR (−4.1, 95% c.i. −5.0 to −3.3) and reduction in C- peptide following surgery (−1.8 ng/ml, 95% c.i.: −2.9 to −0.8). Liver function parameters improved, with reductions in ALT (−14.4 U/L, 95% c.i.: −23.5 to −5.2), AST (−5.4 U/L, 95% c.i.: −8.8 to −2.0), and GGT (−9.6 U/L, 95% c.i.: −13.5 to −5.8) and there was a notable reduction in inflammatory cytokines, including IL-6 (−12.2 pg/mL, 95% c.i.: −22.8 to −1.6) and TNF-α (−54 pg/mL, 95% c.i.: −97.4 to −10.5) following surgery. Conclusion This systematic review and meta-analysis identifies a metabolic signature associated with MBS in children and adolescents. Our findings highlight the significant benefits of MBS, including marked improvements in cardiovascular, glycaemic, and liver health markers, alongside a reduction in systemic inflammation. These results underscore the efficacy of MBS as a therapeutic.
Mitra et al. (Thu,) studied this question.