Abstract
CONTEXT: Although steroid metabolism is altered in individuals with obesity, comprehensive profiles of steroid metabolites remain unexplored, some of which may be related to weight loss after metabolic surgery. OBJECTIVE: We aimed to characterize comprehensive steroid profiles in individuals with class II/III obesity (body mass index ≥35 kg/m(2)) and identify metabolite(s) related to weight loss outcomes after laparoscopic sleeve gastrectomy (LSG). METHODS: Using liquid chromatography-tandem mass spectrometry, we measured 27 plasma steroid metabolites in individuals with class II/III obesity (n = 93), healthy controls (n = 15), and those after LSG (n = 20). RESULTS: Discriminant analysis revealed distinct steroid profiles between individuals with class II/III obesity and healthy controls, with statistical significance for 9 metabolites in men (n = 53) and 11 in premenopausal women (n = 44). One year after LSG, the insufficient and sufficient weight loss groups (percent total weight loss (%TWL) < 20%; n = 10 and %TWL ≥ 20%; n = 26) showed distinct preoperative steroid profiles. Preoperative 17α-hydroxypregnenolone (17α-OHPreg) levels, which were lower in individuals with class II/III obesity, were the most significant factor contributing to this distinction, and remained significantly lower in the insufficient weight loss group even after adjusting for confounders (P = .012). The 17α-OHPreg levels significantly increased postoperatively in men (n = 9, P = .024). CONCLUSION: This study is the first detailed analysis of comprehensive steroid profiles in individuals with class II/III obesity and suggests that lower preoperative 17α-OHPreg levels are associated with insufficient weight loss after LSG.