{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T17:29:06Z","timestamp":1788974946831,"version":"build-2803163510"},"reference-count":29,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2020,7,30]],"date-time":"2020-07-30T00:00:00Z","timestamp":1596067200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aspenjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Parenter Enteral Nutr"],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>More than half of patients who undergo Roux\u2010en\u2010Y gastric bypass (RYGB) can experience type 2 diabetes (T2D) remission, but the systemic and gastrointestinal (GI) metabolic mechanisms of this improvement are still elusive.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Paired samples collected before and 3 months after RYGB from 28 women with obesity and T2D were analyzed by metabolomics with gas chromatography coupled to mass spectrometry. Samples include plasma (n = 56) and biopsies of gastric pouch (n = 18), gastric remnant (n = 10), duodenum (n = 16), jejunum (n = 18), and ileum (n = 18), collected by double\u2010balloon enteroscopy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After RYGB, improvements in body composition and weight\u2010related and glucose homeostasis parameters were observed. Plasma\u2010enriched metabolic pathways included arginine and proline metabolism, urea and tricarboxylic acid (TCA) cycles, gluconeogenesis, malate\u2010aspartate shuttle, and carnitine synthesis. In GI tissue, we observed alterations of ammonia recycling and carnitine synthesis in gastric pouch, phenylacetate metabolism and trehalose degradation in duodenum and jejunum, ketone bodies in jejunum, and lactose degradation in ileum. Intermediates molecules of the TCA cycle were enriched, particularly in plasma, jejunum, and ileum. Fluctuations of dicarboxylic acids (DCAs) were relevant in several metabolomic tests, and metabolite alterations included aminomalonate and fumaric, malic, oxalic, and succinic acids. The product\/substrate relationship between these molecules and its pathways may reflect a compensatory mechanism to balance metabolism.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>RYGB was associated with systemic and GI metabolic reprogramming. DCA alterations link \u03c9 and \u03b2 fatty acid oxidation to homeostatic mechanisms, including TCA cycle improvement.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jpen.1960","type":"journal-article","created":{"date-parts":[[2020,7,11]],"date-time":"2020-07-11T21:44:00Z","timestamp":1594503840000},"page":"1417-1427","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Type 2 Diabetes Metabolic Improvement After Roux\u2010en\u2010Y Gastric Bypass May Include a Compensatory Mechanism That Balances Fatty Acid \u03b2 and \u03c9 Oxidation"],"prefix":"10.1002","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2514-9050","authenticated-orcid":false,"given":"Natasha","family":"Mendon\u00e7a Machado","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Faculdade de Medicina da Universidade de S\u00e3o Paulo  S\u00e3o Paulo SP 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