Baseline adipokine profiles have limited predictive value for weight-loss outcomes after laparoscopic sleeve gastrectomy: a prospective longitudinal cohort study

Bariatric surgery is the most effective treatment for severe obesity, yet postoperative weight-loss outcomes vary considerably between individuals and reliable preoperative predictors remain lacking. Adipokines regulate energy homeostasis, inflammation, and insulin sensitivity, making them promising candidates for predicting surgical outcomes. Here, we evaluated whether baseline circulating adipokine profiles predict weight-loss magnitude, weight-loss velocity, and weight-loss plateau after laparoscopic sleeve gastrectomy (LSG). We performed a prospective longitudinal study of 83 patients with severe obesity undergoing LSG. Clinical and metabolic parameters together with a panel of eight circulating adipokines were assessed before surgery and during 12 months of follow-up. Associations with postoperative outcomes were evaluated using multivariable regression and survival analyses with false-discovery-rate correction and bootstrap validation. LSG induced substantial improvements in anthropometric and metabolic parameters accompanied by marked remodeling of circulating adipokines. However, baseline adipokines showed limited and inconsistent predictive value for postoperative weight loss. Higher baseline adiponectin was independently associated with lower percentage total weight loss only at 6 months, whereas no adipokine consistently predicted long-term weight loss or weight-loss plateau after correction for multiple testing. In contrast, baseline HDL cholesterol demonstrated a stable inverse association with postoperative weight loss across multiple follow-up time points, outperforming all adipokines as a preoperative predictor. These findings suggest that routine preoperative adipokine profiling has limited clinical utility for predicting weight-loss outcomes after LSG and that conventional metabolic markers may provide greater prognostic value.