Abstract Body: Background: The heterogeneous response in cardiometabolic outcomes following obesity treatment, such as bariatric surgery, is well documented, yet the underlying environmental contributors remain unclear. One potential factor is the chemical exposome which can have an obesogenic effect. To date, no prior studies have examined the longitudinal changes in chemical exposures after obesity treatment and their influence on cardiometabolic outcomes. This study aimed to assess the associations between chemical exposome trajectories and blood pressure after bariatric surgery among adolescents.
Methods: We quantified the plasma chemical exposome in 5 classes (polycyclic aromatic hydrocarbons (PAHs), per- and polyfluoroalkyl substances (PFAS), phthalates, pyrethroid pesticides and other pesticides) in plasma collected prior to surgery and post-surgery at 6-months, 1 year and 3 years using gas and liquid chromatography with high-resolution mass spectrometry. The cohort included 149 adolescents from the prospective Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study. Outcomes were systolic and diastolic blood pressure measurements (SBP, DBP), mean arterial pressure (MAP) and pulse pressure at 3 years and 5 years following surgery. We used linear mixed models with random intercepts and slopes to estimate exposure trajectories, and model-based clustering based on each chemical exposure trajectories to generate aggregate exposure trajectory profiles. Linear regression was used to assess the associations of these profiles with blood pressure, adjusting for baseline age, race, sex, parents’ annual income, BMI and blood pressure medications.
Results: Two distinct exposure trajectory profiles were generated based on longitudinal changes in individual chemicals. Profile 1 (100 participants) showed a decrease in pesticides and an increase in phthalates. Profile 2 (49 participants) showed the opposite trend. Compared with profile 1, profile 2 was statistically significantly lower for the association in MAP (b = -3.91 mmHg, 95%CI: -7.41, -0.41) and DBP (b = -3.41 mmHg, 95%CI: -6.68, -0.14) three years after bariatric surgery. The associations with blood pressure at five years were weaker.
Conclusion: This study identified chemical exposome trajectory profiles after bariatric surgery and highlighted how longitudinal changes in these exposures may play an important role in explaining the heterogeneity in cardiometabolic outcomes after bariatric surgery.