The overall brain functional connection of morbid obese participants did not change significantly when the rapid decline of body weight after bariatric surgery

The overall brain functional connection of morbid obese participants did not change significantly when the rapid decline of body weight after bariatric surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The overall brain functional connection of morbid obese participants did not change significantly when the rapid decline of body weight after bariatric surgery jinquan bai, miao han, xu wu, chao gao, kang yu, chunhui qin, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8318590/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background It is reported that the micro-functional connections of obese patients are abnormal and vary greatly after bariatric surgery. However the effect and change of the overall brain functional connection remain uncertain. Materials and Methods This study included 38 participants who had undergone sleeve gastrectomy (SG). The study aimed to analyze changes of body weight (BW), laboratory tests, and resting-state functional connectivity (rs-FC) of the whole brain conducted before surgery and 6 months after bariatric surgery. Results Following a rapid weight loss within 6 months of surgery, there was a concurrent decrease in BW, adipose tissue, some clinical and laboratory indicators. The recovery of metabolic fatty liver disease (MAFLD) is accompanied by a recovery in liver function and a rapid decrease in liver fat, followed by a decrease in visceral fat. But the average rs-FC between 6 major networks and 400 brain regions has not changed 6 months after bariatric surgery. Conclusion The clinical and laboratory indicators of morbid obese patients have improved significantly after bariatric surgery, but the overall rs-FC has not changed significantly, which shows that the overall rs-FC will remain stable and coordinated. obesity bariatric surgery fMRI resting-state functional connectivity Figures Figure 1 Figure 2 Figure 3 Introduction Obesity is a worldwide health issue. Excessive body fat not only affects metabolic health, but also increases the risk for cognitive decline. The latest research published in “Nature” shows that obesity will affect the functional connection and cognitive function of adults, and losing weight can partially reverse the cognitive damage of obesity to the brain [1]. Previous studies were mostly limited to the difference of functional connection between different seed points in brain functional areas, and the functional connection of brain returned to normal after bariatric surgery, but the research results were all different [2-5]. In these research results of obese patients after bariatric surgery, the seed points of brain resting functional connection were mainly concentrated in 6 major networks, which include reward network (RN), default mode network (DMN), central execution network (CEN), salience network (SN), sensory movement network (SMN) and limbic network (LN), and the differences in the results of these microscopic brain functional connections may be influenced by many factors, but they are not all taken into account for analysis [6]. Some scholars believe that these differences are caused by head movement during data acquisition [7]. In a word, it is difficult to generalize these microscopic differences as common results. Based on the coordination and integrity of human brain functional areas, it is more meaningful for us to understand the differences of these previous research results and follow-up related research from the overall macro perspective. Conservative treatment options including behavioral therapy often do not yield the desired weight loss, especially in morbid obese patients. Here, bariatric surgery is a viable option to rapidly induce weight loss and improve metabolic status [8]. At present, bariatric surgery, particularly laparoscopic SG, is currently the primary treatment option for morbid obesity to achieve successful long-term weight loss and reduce related complications [9,10]. Bariatric surgery can reduce total adipose tissue, visceral adipose tissue (VAT), while increasing insulin sensitivity, all of which are expected to improve systemic glucose metabolism [11]. Furthermore, bariatric surgery reduces lipid levels in the liver [12]which can be quantified by ultrasound. Resting-state functional magnetic resonance imaging (rs-fMRI) is a technique to capture the dynamic tissues of the brain, and it is an option to solve these problems of brain behavior. Functional connection networks, that is, brain regions with related neural activities over time, are anatomically consistent with specific brain networks involved in cognitive processes, including attention and executive control. Reward network deals with hedonic value and internal motivation. Default Mode Network (DMN) is a high-order network, which involves internal feelings and control of the transformation between internal and external processes [7]. They can reflect the changes of brain connection function after bariatric surgery. The purpose of this study is to observe whether the brain functional connection has changed from a macro perspective 6 months after bariatric surgery in morbid obese patients, when the clinical and laboratory indicators have improved significantly. Methods The study is based on the principles of the Declaration of Helsinki. This study was approved by the Medical Ethics Committee of our hospital and written informed consent was obtained from all volunteers. Study Design and Participants From May 2024 to October 2025, 38 morbid obese participants (BMI ≥37.5 kg/m 2 ) considering bariatric surgery were recruited to participate in a prospective longitudinal observational study conducted at our hospital. Obese patients were divided into three BMI groups based on presurgical BMI values (28–32.5, 32.5–37.5, ≥37.5) according to BMI grading in Chinese population [13,14]. The indications of bariatric surgery mainly include individuals with BMI ≥37.5 kg/m 2 forsimple obesity [15]. The study included participants who were morbid obese Chinese adults aged ≥18 years, were considering bariatric surgery, and were willing to participate in follow-up. Participants with a history of postoperative use of antihypertensive, lipid-lowering, or hypoglycemic drugs, a history of alcohol or drug use leading to liver disease, and those who were absent from follow-up MRI or ultrasound were excluded from the study. Fig. 1 provides a detailed flowchart. A total of 38 participants who completed the postoperative review were finally included (72 participants completed bariatric surgery, 20 participants missed some laboratory tests and 34 participants missed MRI reexaminations. A total of 38 participants completed the all reexamination 6 months after bariatric surgery). Clinical and Laboratory Indicator Collection For all participants, the following demographic, preoperative, and postoperative data were recorded: sex, age, blood pressure, BW, height, and BMI. Body composition analysis includes body fat mass, body fat percentage, visceral fat area, waist-hip ratio, which were assessed by human body composition analyzer using bioelectrical impedance technology (InBody Co., Ltd. South Korea) . Resting-state functional connectivity (rs-FC) of the whole brain were assessed by MRI examination. Laboratory indicators included aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea, creatinine, uric acid (UA), triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL), and high-density lipoprotein (HDL), Glycosylated hemoglobin A1c (HbA1c), fasting blood glucose (FBG), fasting insulin (FI). As an alternative method for evaluating insulin resistance, homeostatic model assessment for insulin resistance (HOMA-IR) is calculated by the formula: HOMA-IR = FBG (mmol/L) × fasting insulin (μU/mL) / 22.5 [16]. Liver fat was quantified by ultrasound. We adopted a unified measurement method and standard for all indicators before and after the surgery. MRI Data Acquisition A 3.0 T magnetic resonance scanner (Ingenia, Philips, Holland) was used. Data were obtained during an 9-min scan using rs-fMRI with a gradient echo planar imaging (EPI) sequence (repetition time (TR) = 2000 ms; echo time (TE) = 30 ms; slices = 62; slice thickness = 2 mm; field of view (FOV) = 224×224 mm 2 ; flip angle = 90 ◦ ; matrix = 112 × 112; voxel size = 2×2×2 mm 3 . Each section contained 150 volumes. 3D-T1WI images of whole brain were acquired for coregistration purposes (TR = 2530 ms; TE =, 2.98 ms; FOV = 256×256 mm 2 ; flip angle, 7 ◦ ; slices = 160; slice oversampling = 33.3%; voxel size = 1×1×1 mm 3 . All participants were instructed to close their eyes, and not to think of anything. Foam pads and earplugs were used to minimize head movement and noise. MRI Data Analysis The available data for rs-fMRI working on MATLAB R2018b platform (MathWorks, Inc., Natick, MA, USA) was used to preprocess neuroimaging data. Preprocessing was conducted as follows: the first 5 brain volumes of the rs-fMRI were discarded to minimize the instability of initial scanning. The remaining 145 volumes were slice timing-corrected, realigned, and co-registered to 3D-T1WI. Spatial normalization of images was performed in a standard EPI template of the Montreal Neurological Institute, and then the images were resampled to a resolution voxel size of 2×2×2 mm 3 . All functional images were smoothed using a Gaussian kernel of 6 mm full width at half-maximum. A temporal filter (0.01–0.08 Hz) was applied to reduce the effect of low frequency drift and high frequency noise. Finally each rs-fMRI dataset was selected for further analysis of the rs-FC between 6 obese-related networks and 400 brain regions ( Fig. 2, 3 ). Statistical Analysis All statistical analyses were performed using SPSS (version 25; IBM Corp), R software (version 4.2.2; R Foundation for Statistical Computing), and GraphPad (version 8.0.2; GraphPad Software, Inc). A normal analysis of the data was performed using the Shapiro–Wilk test. Normally distributed variables are expressed as mean (SD). For variables with nonnormal distributions, data are expressed as the median and interquartile range. Categorical data are presented as the number and percentage of cases in each category. Student’s t -test was used for normally distributed variables, and a paired t -test was used to analyze the differences in both clinical and MRI results among all participants before and after surgery. The Mann‒Whitney U test was used for nonnormally distributed variables. The chi-square test was used for categorical variables. P < 0.05 (double-tailed) was considered statistically significant. Results Baseline characteristics A total of 38 participants (16 males and 22 females) were included in this study, with an average age of 31.49 (SD 9.50) years. The average preoperative BW was 137.30 (SD 26.30) kg and the average body mass index (BMI) was 45.97 (SD 7.01) kg/m 2 . The weight loss was very fast in the 6 month after bariatric surgery. The average weight loss at M6 was 39.51 kg. The BMI displays a significant reduction compared with the presurgery levels (32.73, SD 5.50 kg/m 2 vs. 45.97, SD 7.01 kg/m 2 , P < 0.001 ). The systolic blood pressure decreased significantly at 6 months after the surgery ( P < 0.001 ), but the diastolic blood pressure had no significant change. BF and VFA decreased significantly at 6 months after surgery ( P < 0.001 ), but the WHR had no significant change(Table 1 ). TC, TG, LDL, FBG, GHb, FI, HOMA-IR, and AST, ALT, Urea, UA decreased significantly at 6 months after surgery ( P < 0.05 ), CREA showed a decreasing trend at 6 months after surgery. There were statistical differences in the increase of HDL at 6 months after surgery ( P < 0.001 ) (Table 2 ). Liver ultrasound showed that all 38 patients were moderate to severe fatty liver, of which severe fatty liver accounted for 68.4%, they turned to mild to moderate fatty liver 6 months after bariatric surgery, and only two cases remained moderate to severe fatty liver. Table 1 Results of clinical variables before and after bariatric surgery Variable M0(N = 38) M6 (N = 38) P value BW (kg) 137.30 ± 26.30 97.79 ± 20.17 < 0.001 BMI (kg/m 2 ) 45.97 ± 7.01 32.73 ± 5.50 < 0.001 SBP(mmHg) 131 ± 7.7 123 ± 6.4 < 0.001 DBP( mmHg) 77.1 ± 8.9 75.8 ± 7.1 0.0598 BFM(kg) 66.62 ± 15.05 41.58 ± 10.02 < 0.001 BF (%) 48.35 ± 4.13 42.56 ± 5.91 < 0.001 WHR( %) 1.05 ± 0.08 0.97 ± 0.07 0.112 VFA (cm 2 ) 257.49 ± 26.80 182.97 ± 38.43 < 0.001 Values are shown as ± standard deviation or the median (quartile). M0: pre-operation, M6: 6 months of post-operation. BW body weight, BMI body mass index, SBP systolic blood pressure, DBP diastolic blood pressure, BFM body fat mass, BF body fat, WHR waist-to-hip ratio, VFA abdominal visceral fat area. Table 2 Results of laboratory variables before and after bariatric surgery Variable M0(N = 38) M6 (N = 38) P value TC (mmol/L) 4.81 ± 0.80 4.30 ± 0.78 < 0.001 TG (mmol/L) 1.94 ± 0.87 1.74 ± 0.65 < 0.001 HDL mmol/L) 1.03 ± 0.18 1.20 ± 0.12 < 0.001 LDL (mmol/L) 3.25 ± 0.99 3.09 ± 0.89 < 0.001 FBG (mmol/L) 7.17 ± 3.52 5.13 ± 0.55 < 0.001 GHb (%) 6.72 ± 1.86 5.60 ± 0.66 < 0.001 FI (pmol/L) 306.41 ± 220.08 151.79 ± 73.77 < 0.001 HOMA-IR 14.75 ± 17.60 4.97 ± 2.51 < 0.001 AST (U/L) 34.63 ± 29.52 23.84 ± 5.65 < 0.001 ALT (U/L) 53.76 ± 39.68 23.61 ± 8.90 < 0.001 Urea (mmol/L) 5.50 ± 4.17 3.96 ± 0.99 0.029 CREA (µmol/L) 64.41 ± 16.92 58.87 ± 9.38 0.081 UA (µmol/L) 488.95 ± 108.08 384.06 ± 85.36 < 0.001 Values are shown as ± standard deviation or the median (quartile). M0: pre-operation, M6: 6 months of post-operation. HDL high-density lipoprotein, LDL low-density lipoprotein, TC Total cholesterol, TG triglycerides, AST aspartate aminotransferase, ALT alanine aminotransferase, FBG Fasting blood glucose, GHb Glycosylated Hemoglobin, FI Fasting Insulin, HOMA-IR Homeostatic Model Assessment of Insulin Resistance, CREA Creatinine, UA Uric Acid. MRI Indicators The average rs-FC did not change significantly between 6 major networks and 400 brain regions before and after bariatric surgery. The RN was from 0.32 (SD 0.20) to 0.36 (SD 0.19), the DMN was from 0.38 (SD 0.17) to 0.36 (SD 0.19), the CEN was from 0.39 (SD 0.14) to 0.40 (SD 0.17), the LIM was from 0.28 (SD 0.16) to 0.31 (SD 0.19), the SMN was from 0.52 (SD 0.18) to 0.45 (SD 0.21), the SN was from 0.49 (SD 0.19) to 0.42 (SD 0.22), all P > 0.05 . (Table 3 ) Table 3 The average rs-FC between 6 major networks and 400 brain regions before and after bariatric surgery Variable NC(N = 18) M0(N = 38) M6 (N = 38) P value RN 0.32 ± 0.20 0.36 ± 0.19 0.362 DMN 0.38 ± 0.17 0.36 ± 0.19 0.701 CEN 0.39 ± 0.14 0.40 ± 0.17 0.637 LN 0.28 ± 0.16 0.31 ± 0.19 0.435 SMN 0.52 ± 0.18 0.45 ± 0.21 0.179 SN 0.49 ± 0.19 0.42 ± 0.22 0.051 Values are shown as ± standard deviation or the median (quartile). M0: pre-operation, M6: 6 months of post-operation. RN reward network, DMN default mode network, CEN central execution network, LN limbic network, SMN sensory movement network, SN salience network. The average rs-FC did not change significantly between 6 major networks before and after bariatric surgery. The RN-DMN was from 0.25 (SD 0.18) to 0.26 (SD 0.18), the RN-CEN was from 0.23 (SD 0.18) to 0.29 (SD 0.19), the RN-LIM was from 0.29 (SD 0.18) to 0.32 (SD 0.17), the RN-SMN was from 0.30 (SD 0.23) to 0.33 (SD 0.23), the RN-SN was from 0.41 (SD 0.19) to 0.40 (SD 0.17), the DMN-CEN was from 0.75 (SD 0.13) to 0.74 (SD 0.12), the DMN-LIM was from 0.21 (SD 0.16) to 0.25 (SD 0.16), the DMN-SMN was from 0.24 (SD 0.20) to 0.27 (SD 0.18), the DMN-SN was from 0.34 (SD 0.21) to 0.32 (SD 0.19), the CEN-LIM was from 0.25 (SD 0.19) to 0.31 (SD 0.12), the CEN-SMN was from 0.23 (SD 0.19) to 0.27 (SD 0.20), the CEN-SN was from 0.24 (SD 0.17) to 0.25 (SD 0.17), the LIM-SMN was from 0.21 (SD 0.16) to 0.24 (SD 0.15), the LIM-SN was from 0.23 (SD 0.17) to 0.21 (SD 0.14), the SMN-SN was from 0.51 (SD 0.22) to 0.48 (SD 0.24), all P > 0.05 . (Table 4 ) Table 4 The average rs-FC between 6 major networks before and after bariatric surgery Variable NC(N = 18) M0(N = 38) M6 (N = 38) P value RN-DMN 0.25 ± 0.18 0.26 ± 0.18 0.771 RN-CEN 0.23 ± 0.18 0.29 ± 0.19 0.226 RN-LN 0.29 ± 0.18 0.32 ± 0.17 0.391 RN-SMN 0.30 ± 0.23 0.33 ± 0.23 0.573 RN-SN 0.41 ± 0.19 0.40 ± 0.17 0.963 DMN-CEN 0.75 ± 0.13 0.74 ± 0.12 0.696 DMN-LN 0.21 ± 0.16 0.25 ± 0.16 0.356 DMN-SMN 0.24 ± 0.20 0.27 ± 0.18 0.504 DMN-SN 0.34 ± 0.21 0.32 ± 0.19 0.700 CEN-LN 0.25 ± 0.19 0.31 ± 0.12 0.168 CEN-SMN 0.23 ± 0.19 0.27 ± 0.20 0.413 CEN-SN 0.24 ± 0.17 0.25 ± 0.17 0.783 LN-SMN 0.21 ± 0.16 0.24 ± 0.15 0.350 LN-SN 0.23 ± 0.17 0.21 ± 0.14 0.725 SMN-SN 0.51 ± 0.22 0.48 ± 0.24 0.517 Values are shown as ± standard deviation or the median (quartile). M0: pre-operation, M6: 6 months of post-operation. RN reward network, DMN default mode network, CEN central execution network, LN limbic network, SMN sensory movement network, SN salience network. Discussion In this study, all morbid obese participants lost body weight and fat rapidly after bariatric surgery. As BW changes, the fat liver and VFA significantly decreased 6 months after bariatric surgery. BG, TG, liver and kidney function indicators were significantly improved 6 months after surgery. This may be because of the improvement in fat metabolism caused by the recovery of liver function after surgery [ 17 ]. MAFLD is a metabolic liver disorder characterized by a range of liver dysfunctions [ 18 ]. Studies have shown that the accumulation of TGs in the liver or an increase in fatty acid oxidation damages liver function [ 19 ], and the recovery of liver enzymes to a normal level may reflect a decrease in liver fat content [ 20 ]. As components of human adipose tissue storage, Visceral adipose tissue can function as endocrine organs to secrete adipokines that play a key role in regulating energy metabolism and maintaining systemic homeostasis [ 21 ]. Exploring the changes in visceral adipose tissue before and after bariatric surgery is crucial to identify the role of surgery in reducing adipose tissue reserve [ 22 ]. As the portal drainage of visceral fat provides direct hepatic access to free fatty acids secreted by visceral adipocytes, early body fat mobilization is mainly caused by more active visceral adipose tissue [ 23 ]. These show that bariatric surgery has a significant therapeutic effect on morbid obese patients with metabolic syndrome. On the microscopic scale, human brain networks can analyze the connections between brain regions within or between networks. However, on the macroscopic scale of neuroimaging data, there is some statistical measure of the relationship between networks or between networks and the whole brain. In order to define brain regions, automatic anatomical markers are used to divide the whole brain into 400 cortical regions of interest.[ 24 ]. Previous studies have shown that there is a connection between obesity and changes in brain function. Cognitive function has improved after bariatric surgery. At rest-state fMRI also shows the changes of brain functional connections at the micro level in different brain regions. Including several areas involved in inhibition and executive control, especially in regard to areas where reward mechanisms are located. Specific research results are mentioned in the latest review[ 25 ], decreased functional connectivity in the dorsolateral prefrontal cortex[ 3 ], increased functional connectivity between dorsolateral prefrontal cortex to anterior cingulate gyrus[ 26 ], reduced rs-FC within frontoparietal networks[ 27 ], increased functional connectivity between the hippocampus and insula[ 28 ]. In summary, the results of previous studies are different. From a macroscopic point of view, we analyzed the brain functional connection of the related brain regions studied in the past, and found that there was no significant difference in the average rs-FC between 6 obesity related networks and 400 brain regions in the whole brain 6 months after bariatric surgery. Gaps remain in our understanding of the impact of weight loss on neurologic changes following bariatric surgery. The existing literature also lacks proof that the observed changes are due to weight loss itself or the result of surgical operation. Studies directly comparing matched cohorts of individuals who have lost the same amount of weight through different means are needed. Additionally, current studies examining the neurologic benefits of bariatric surgery are limited in the heterogeneity of the samples that are mixed regarding sex, and a combination of Roux-en-Y Gastic Bypass (RYGB) and SG surgeries. In addition to the surgeries we highlight here, there is also a general lack of information on ethnicity and thorough postsurgery MRI paired with measurements of metabolic changes and how they may be perceived through health evaluations. Lastly, to our knowledge there are no data on endoscopic procedures such as the SG and its role in inducing changes in the brain. Limitations This study has some limitations. This study only pays attention to the overall functional connection strength of 6 major brain functional networks after significant changes in clinical and laboratory indicators in morbid obese patients 6 months after bariatric surgery. Because of the small sample size, there is no further detailed grouping analysis according to variables such as gender, age and obesity complications, because the brain function is complex and varies from person to person, and the changes are affected by many factors, so the next step of detailed grouping analysis is our research focus. The data in this study were from a single institution, which may also have a certain impact on the results. Conclusion The clinical and laboratory indicators of morbid obese patients have improved significantly after bariatric surgery, and the restoration of MAFLD is accompanied by a recovery of the liver function and a rapid decrease in the liver fat, followed by a decrease in visceral fat. However the overall rs-FC has not changed significantly, which shows that the overall rs-FC will remain stable and coordinated. Abbreviations BMI Body mass index BW Body weight CEN Central execution network DMN Default mode network LN Limbic network MAFLD Metabolic fatty liver disease MRI Magnetic resonance imaging RN Reward network RYGB Roux-en-Y Gastic Bypass SG Sleeve gastrectomy SMN Sensory movement network SN Salience network VAT Visceral adipose tissue Declarations Author Contribution TZ, JB designed the study. CG, CQ, KY were responsible for the recruitment of subjects and acquisition of data. MH, XW, YB performed the experiments and analyzed the data. JB, MH contributed to drafting the manuscript, CG contributed to the setting of MRI scanning scheme, MZ contributed to statistical analysis, XW, XZ, CL contributed to the collection and follow-up of subjects. TZ made the final correction of the manuscript. All authors reviewed the manuscript. References Zhang, D., Shen, C., Chen, N. et al. Long-term obesity impacts brain morphology, functional connectivity and cognition in adults. Nat. Mental Health. 2025 3, 466–478. Wang J, Li G, Hu Y, et al. Habenular and mediodorsal thalamic connectivity predict persistent weight loss after laparoscopic sleeve gastrectomy. Obesity (Silver Spring). 2022;30(1):172-182. Li G, Ji G, Hu Y, et al. Bariatric surgery in obese patients reduced resting connectivity of brain regions involved with self-referential processing. Hum Brain Mapp. 2018;39(12):4755-4765. 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J Neurol 2020;267:1931–40. Mallio CA, Spagnolo G, Piervincenzi C, et al. Brain functional connectivity differences between responders and non-responders to sleeve gastrectomy. Neuroradiology 2023;65:131–43. Zhang Y , Ji G, Li G, et al. Ghrelin reductions following bariatric surgery were associated with decreased resting state activity in the hippocampus. Int J Obes 2019;43:842–51. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8318590","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":564330348,"identity":"520aabf4-43af-4112-bde0-a98a265711a1","order_by":0,"name":"jinquan bai","email":"","orcid":"","institution":"Fourth Affiliated Hospital of Harbin Medical University","correspondingAuthor":false,"prefix":"","firstName":"jinquan","middleName":"","lastName":"bai","suffix":""},{"id":564330349,"identity":"062147c0-ed31-4d58-bda9-38363edff332","order_by":1,"name":"miao han","email":"","orcid":"","institution":"The 962th Hospital of the People's Liberation Army Joint Service Support Force","correspondingAuthor":false,"prefix":"","firstName":"miao","middleName":"","lastName":"han","suffix":""},{"id":564330350,"identity":"d5f5df1e-4a92-4fde-8110-2629bba0f70a","order_by":2,"name":"xu wu","email":"","orcid":"","institution":"Fourth Affiliated Hospital of Harbin Medical University","correspondingAuthor":false,"prefix":"","firstName":"xu","middleName":"","lastName":"wu","suffix":""},{"id":564330351,"identity":"fd50a5b9-9339-417d-9870-f58ac5342043","order_by":3,"name":"chao gao","email":"","orcid":"","institution":"Fourth Affiliated Hospital of Harbin Medical University","correspondingAuthor":false,"prefix":"","firstName":"chao","middleName":"","lastName":"gao","suffix":""},{"id":564330354,"identity":"52c6414f-8718-4b7e-9fd0-4ca9e60c7076","order_by":4,"name":"kang yu","email":"","orcid":"","institution":"Fourth Affiliated Hospital of Harbin Medical 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1","display":"","copyAsset":false,"role":"figure","size":111606,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart showing the inclusion and exclusion criteria for the study population.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8318590/v1/83c87c89d034aefe1480f266.png"},{"id":100388219,"identity":"723560d7-da35-4892-a7e5-871407f768c6","added_by":"auto","created_at":"2026-01-16 11:17:19","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":649329,"visible":true,"origin":"","legend":"\u003cp\u003ers-FC\u003cstrong\u003e \u003c/strong\u003ediagram between reward network (RN) and 400 brain regions\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8318590/v1/9913a97b6fecef1d5bcc8efa.png"},{"id":100388182,"identity":"427eb581-c34a-40a2-8be3-5df2b6b1cc27","added_by":"auto","created_at":"2026-01-16 11:17:10","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":410203,"visible":true,"origin":"","legend":"\u003cp\u003ers-FC\u003cstrong\u003e \u003c/strong\u003ediagram between reward network (RN) and limbic network (LN)\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8318590/v1/2d299ab901c0e8a7923946f2.png"},{"id":106960411,"identity":"b6a09b58-95ac-47fe-8c46-dc4ddc4495d4","added_by":"auto","created_at":"2026-04-15 09:20:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2053218,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8318590/v1/98fe6e40-9662-4bfc-bb27-6d9e8a784854.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The overall brain functional connection of morbid obese participants did not change significantly when the rapid decline of body weight after bariatric surgery","fulltext":[{"header":"Introduction","content":"\u003cp\u003eObesity is a worldwide health issue. Excessive body fat not only affects metabolic health, but also increases the risk for cognitive decline. The latest research published in “Nature” shows that obesity will affect the functional connection and cognitive function of adults, and losing weight can partially reverse the cognitive damage of obesity to the brain [1]. Previous studies were mostly limited to the difference of functional connection between different seed points in brain functional areas, and the functional connection of brain returned to normal after bariatric surgery, but the research results were all different [2-5]. In these research results of obese patients after bariatric surgery, the seed points of brain resting functional connection were mainly concentrated in 6\u0026nbsp;major\u0026nbsp;networks, which include reward network (RN), default mode network (DMN), central execution network (CEN), salience network (SN), sensory movement network (SMN) and limbic network (LN), and the differences in the results of these microscopic brain functional connections may be influenced by many factors, but they are not all taken into account for analysis [6]. Some scholars believe that these differences are caused by head movement during data acquisition [7]. In a word, it is difficult to generalize these microscopic differences as common results. Based on the coordination and integrity of human brain functional areas, it is more meaningful for us to understand the differences of these previous research results and follow-up related research from the overall macro perspective.\u003c/p\u003e\n\u003cp\u003eConservative treatment options including behavioral therapy often do not yield the desired weight loss, especially in morbid obese patients. Here, bariatric surgery is a viable option to rapidly induce weight loss and improve metabolic status [8]. At present, bariatric surgery, particularly laparoscopic SG, is currently the primary treatment option for morbid obesity to achieve successful long-term weight loss and reduce related complications [9,10]. Bariatric surgery can reduce total adipose tissue, visceral adipose tissue (VAT), while increasing insulin sensitivity, all of which are expected to improve systemic glucose metabolism [11]. Furthermore, bariatric surgery reduces lipid levels in the liver [12]which can be quantified by ultrasound. Resting-state functional magnetic resonance imaging (rs-fMRI) is a technique to capture the dynamic tissues of the brain, and it is an option to solve these problems of brain behavior. Functional connection networks, that is, brain regions with related neural activities over time, are anatomically consistent with specific brain networks involved in cognitive processes, including attention and executive control. Reward network deals with hedonic value and internal motivation. Default Mode Network (DMN) is a high-order network, which involves internal feelings and control of the transformation between internal and external processes [7]. They can reflect the changes of brain connection function after bariatric surgery.\u003c/p\u003e\n\u003cp\u003eThe purpose of this study is to observe whether the brain functional connection has changed from a macro perspective 6 months after bariatric surgery in morbid obese patients, when the clinical and laboratory indicators have improved significantly.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe study is based on the principles of the Declaration of Helsinki. This study was approved by the Medical Ethics Committee of our hospital and written informed consent was obtained from all volunteers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Design and Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom\u0026nbsp;May 2024 to October 2025, 38\u0026nbsp;morbid obese participants (BMI ≥37.5 kg/m\u003csup\u003e2\u003c/sup\u003e)\u0026nbsp;considering bariatric surgery were recruited to participate in a prospective longitudinal observational study conducted at our hospital. Obese patients were divided into three BMI groups based on presurgical BMI values (28–32.5, 32.5–37.5, \u0026nbsp;≥37.5) according to BMI grading in Chinese population [13,14]. The indications of bariatric surgery mainly include individuals with BMI ≥37.5 kg/m\u003csup\u003e2\u0026nbsp;\u003c/sup\u003eforsimple obesity [15]. The study included participants who were morbid obese Chinese adults aged ≥18 years, were considering bariatric surgery, and were willing to participate in follow-up. Participants with a history of postoperative use of antihypertensive, lipid-lowering, or hypoglycemic drugs, a history of alcohol or drug use leading to liver disease, and those who were absent from follow-up MRI or ultrasound were excluded from the study. \u003cstrong\u003eFig. 1\u003c/strong\u003e provides a detailed flowchart. A\u0026nbsp;total of 38 participants who completed the postoperative review were finally included (72 participants completed bariatric surgery, 20 participants missed some laboratory tests and 34 participants missed MRI reexaminations. A total of 38 participants completed the all reexamination 6 months after bariatric surgery).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical and Laboratory Indicator Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor all participants, the following demographic, preoperative, and postoperative data were recorded: sex, age, blood pressure, BW, height, and BMI. Body composition analysis includes body fat mass, body fat percentage, visceral fat area, waist-hip ratio, which were assessed by human body composition analyzer using bioelectrical impedance technology (InBody Co., Ltd. South Korea) . Resting-state functional connectivity (rs-FC) of the whole brain were assessed by MRI examination. Laboratory indicators included aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea, creatinine, uric acid (UA), triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL), and high-density lipoprotein (HDL), Glycosylated hemoglobin A1c (HbA1c), fasting blood glucose (FBG), fasting insulin (FI). As an alternative method for evaluating insulin resistance, homeostatic model assessment for insulin resistance (HOMA-IR) is calculated by the formula: HOMA-IR = FBG (mmol/L)\u0026nbsp;×\u0026nbsp;fasting insulin (μU/mL) / 22.5 [16]. Liver fat was quantified by ultrasound. We adopted a unified measurement method and standard for all indicators before and after the surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMRI Data Acquisition\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 3.0 T magnetic resonance scanner (Ingenia, Philips, Holland) was used. Data were obtained during an 9-min scan using rs-fMRI with a gradient echo planar imaging (EPI) sequence (repetition time (TR) = 2000 ms; echo time (TE) = 30 ms; slices = 62; slice thickness = 2 mm; field of view (FOV) = 224×224 mm\u003csup\u003e2\u003c/sup\u003e; flip angle = 90\u003csup\u003e◦\u003c/sup\u003e; matrix = 112\u0026nbsp;×\u0026nbsp;112; voxel size = 2×2×2 mm\u003csup\u003e3\u003c/sup\u003e. Each section contained 150 volumes. 3D-T1WI images of whole brain were acquired for coregistration purposes (TR = 2530 ms; TE =, 2.98 ms; FOV = 256×256 mm\u003csup\u003e2\u003c/sup\u003e; flip angle, 7\u003csup\u003e◦\u003c/sup\u003e; slices = 160; slice oversampling = 33.3%; voxel size = 1×1×1 mm\u003csup\u003e3\u003c/sup\u003e. All participants were instructed to close their eyes, and not to think of anything. Foam pads and earplugs were used to minimize head movement and noise.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMRI Data Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe available data for rs-fMRI working on MATLAB R2018b platform (MathWorks, Inc., Natick, MA, USA) was used to preprocess neuroimaging data. Preprocessing was conducted as follows: the first 5 brain volumes of the rs-fMRI were discarded to minimize the instability of initial scanning. The remaining 145 volumes were slice timing-corrected, realigned, and co-registered to 3D-T1WI. Spatial normalization of images was performed in a standard EPI template of the Montreal Neurological Institute, and then the images were resampled to a resolution voxel size of 2×2×2 mm\u003csup\u003e3\u003c/sup\u003e. All functional images were smoothed using a Gaussian kernel of 6 mm full width at half-maximum. A temporal filter (0.01–0.08 Hz) was applied to reduce the effect of low frequency drift and high frequency noise. Finally each rs-fMRI dataset was selected for further analysis of the rs-FC\u0026nbsp;between 6 obese-related networks and 400 brain regions\u0026nbsp;(\u003cstrong\u003eFig. 2, 3\u003c/strong\u003e).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll statistical analyses were performed using SPSS (version 25; IBM Corp), R software (version 4.2.2; R Foundation for Statistical Computing), and GraphPad (version 8.0.2; GraphPad Software, Inc).\u0026nbsp;A normal analysis of the data was performed using the Shapiro–Wilk test.\u0026nbsp;Normally distributed\u0026nbsp;variables are expressed as\u0026nbsp;mean (SD). For variables with nonnormal distributions, data\u0026nbsp;are\u0026nbsp;expressed as\u0026nbsp;the\u0026nbsp;median and\u0026nbsp;interquartile\u0026nbsp;range.\u0026nbsp;Categorical\u0026nbsp;data\u0026nbsp;are\u0026nbsp;presented as the number and percentage of cases in each category. Student’s\u0026nbsp;\u003cem\u003et\u003c/em\u003e-test was used for normally distributed\u0026nbsp;variables,\u0026nbsp;and a paired \u003cem\u003et\u003c/em\u003e-test was used to analyze the differences in both clinical and MRI results among all participants before and after surgery.\u0026nbsp;The\u0026nbsp;Mann‒Whitney U test was used for\u0026nbsp;nonnormally distributed\u0026nbsp;variables. The chi-square test was used for categorical\u0026nbsp;variables.\u0026nbsp;\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05 (double-tailed) was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\n\u003ch3\u003eBaseline characteristics\u003c/h3\u003e\n\u003cp\u003eA total of 38 participants (16 males and 22 females) were included in this study, with an average age of 31.49 (SD 9.50) years. The average preoperative BW was 137.30 (SD 26.30) kg and the average body mass index (BMI) was 45.97 (SD 7.01) kg/m\u003csup\u003e2\u003c/sup\u003e. The weight loss was very fast in the 6 month after bariatric surgery. The average weight loss at M6 was 39.51 kg. The BMI displays a significant reduction compared with the presurgery levels (32.73, SD 5.50 kg/m\u003csup\u003e2\u003c/sup\u003e vs. 45.97, SD 7.01 kg/m\u003csup\u003e2\u003c/sup\u003e, \u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e). The systolic blood pressure decreased significantly at 6 months after the surgery (\u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e), but the diastolic blood pressure had no significant change. BF and VFA decreased significantly at 6 months after surgery (\u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e), but the WHR had no significant change(Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). TC, TG, LDL, FBG, GHb, FI, HOMA-IR, and AST, ALT, Urea, UA decreased significantly at 6 months after surgery (\u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/em\u003e), CREA showed a decreasing trend at 6 months after surgery. There were statistical differences in the increase of HDL at 6 months after surgery (\u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/em\u003e) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Liver ultrasound showed that all 38 patients were moderate to severe fatty liver, of which severe fatty liver accounted for 68.4%, they turned to mild to moderate fatty liver 6 months after bariatric surgery, and only two cases remained moderate to severe fatty liver.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of clinical variables before and after bariatric surgery\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM0(N\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM6 (N\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBW (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e137.30\u0026thinsp;\u0026plusmn;\u0026thinsp;26.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e97.79\u0026thinsp;\u0026plusmn;\u0026thinsp;20.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e45.97\u0026thinsp;\u0026plusmn;\u0026thinsp;7.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e32.73\u0026thinsp;\u0026plusmn;\u0026thinsp;5.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSBP(mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e131\u0026thinsp;\u0026plusmn;\u0026thinsp;7.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e123\u0026thinsp;\u0026plusmn;\u0026thinsp;6.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDBP( mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e77.1\u0026thinsp;\u0026plusmn;\u0026thinsp;8.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e75.8\u0026thinsp;\u0026plusmn;\u0026thinsp;7.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0598\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBFM(kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e66.62\u0026thinsp;\u0026plusmn;\u0026thinsp;15.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e41.58\u0026thinsp;\u0026plusmn;\u0026thinsp;10.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBF (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e48.35\u0026thinsp;\u0026plusmn;\u0026thinsp;4.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e42.56\u0026thinsp;\u0026plusmn;\u0026thinsp;5.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWHR( %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.112\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVFA (cm\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e257.49\u0026thinsp;\u0026plusmn;\u0026thinsp;26.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e182.97\u0026thinsp;\u0026plusmn;\u0026thinsp;38.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eValues are shown as \u0026plusmn;\u0026thinsp;standard deviation or the median (quartile). M0: pre-operation, M6: 6 months of post-operation.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eBW body weight, BMI body mass index, SBP systolic blood pressure, DBP diastolic blood pressure, BFM body fat mass, BF body fat, WHR waist-to-hip ratio, VFA abdominal visceral fat area.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of laboratory variables before and after bariatric surgery\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM0(N\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM6 (N\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTC (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTG (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.94\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHDL mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLDL (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFBG (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e7.17\u0026thinsp;\u0026plusmn;\u0026thinsp;3.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGHb (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e6.72\u0026thinsp;\u0026plusmn;\u0026thinsp;1.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFI (pmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e306.41\u0026thinsp;\u0026plusmn;\u0026thinsp;220.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e151.79\u0026thinsp;\u0026plusmn;\u0026thinsp;73.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHOMA-IR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e14.75\u0026thinsp;\u0026plusmn;\u0026thinsp;17.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.97\u0026thinsp;\u0026plusmn;\u0026thinsp;2.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAST (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e34.63\u0026thinsp;\u0026plusmn;\u0026thinsp;29.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e23.84\u0026thinsp;\u0026plusmn;\u0026thinsp;5.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALT (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e53.76\u0026thinsp;\u0026plusmn;\u0026thinsp;39.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e23.61\u0026thinsp;\u0026plusmn;\u0026thinsp;8.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrea (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e5.50\u0026thinsp;\u0026plusmn;\u0026thinsp;4.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCREA (\u0026micro;mol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e64.41\u0026thinsp;\u0026plusmn;\u0026thinsp;16.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e58.87\u0026thinsp;\u0026plusmn;\u0026thinsp;9.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.081\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUA (\u0026micro;mol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e488.95\u0026thinsp;\u0026plusmn;\u0026thinsp;108.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e384.06\u0026thinsp;\u0026plusmn;\u0026thinsp;85.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eValues are shown as \u0026plusmn;\u0026thinsp;standard deviation or the median (quartile). M0: pre-operation, M6: 6 months of post-operation.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eHDL high-density lipoprotein, LDL low-density lipoprotein, TC Total cholesterol, TG triglycerides, AST aspartate aminotransferase, ALT alanine aminotransferase, FBG Fasting blood glucose, GHb Glycosylated Hemoglobin, FI Fasting Insulin, HOMA-IR Homeostatic Model Assessment of Insulin Resistance, CREA Creatinine, UA Uric Acid.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eMRI Indicators\u003c/h3\u003e\n\u003cp\u003eThe average rs-FC did not change significantly between 6 major networks and 400 brain regions before and after bariatric surgery. The RN was from 0.32 (SD 0.20) to 0.36 (SD 0.19), the DMN was from 0.38 (SD 0.17) to 0.36 (SD 0.19), the CEN was from 0.39 (SD 0.14) to 0.40 (SD 0.17), the LIM was from 0.28 (SD 0.16) to 0.31 (SD 0.19), the SMN was from 0.52 (SD 0.18) to 0.45 (SD 0.21), the SN was from 0.49 (SD 0.19) to 0.42 (SD 0.22), all \u003cem\u003eP\u003c/em\u003e\u0026gt;\u003cem\u003e0.05\u003c/em\u003e. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe average rs-FC between 6 major networks and 400 brain regions before and after bariatric surgery\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNC(N\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM0(N\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eM6 (N\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.32\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.362\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDMN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.701\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCEN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.637\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.435\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSMN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.179\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.051\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eValues are shown as \u0026plusmn;\u0026thinsp;standard deviation or the median (quartile). M0: pre-operation, M6: 6 months of post-operation.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eRN reward network, DMN default mode network, CEN central execution network, LN limbic network, SMN sensory movement network, SN salience network.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe average rs-FC did not change significantly between 6 major networks before and after bariatric surgery. The RN-DMN was from 0.25 (SD 0.18) to 0.26 (SD 0.18), the RN-CEN was from 0.23 (SD 0.18) to 0.29 (SD 0.19), the RN-LIM was from 0.29 (SD 0.18) to 0.32 (SD 0.17), the RN-SMN was from 0.30 (SD 0.23) to 0.33 (SD 0.23), the RN-SN was from 0.41 (SD 0.19) to 0.40 (SD 0.17), the DMN-CEN was from 0.75 (SD 0.13) to 0.74 (SD 0.12), the DMN-LIM was from 0.21 (SD 0.16) to 0.25 (SD 0.16), the DMN-SMN was from 0.24 (SD 0.20) to 0.27 (SD 0.18), the DMN-SN was from 0.34 (SD 0.21) to 0.32 (SD 0.19), the CEN-LIM was from 0.25 (SD 0.19) to 0.31 (SD 0.12), the CEN-SMN was from 0.23 (SD 0.19) to 0.27 (SD 0.20), the CEN-SN was from 0.24 (SD 0.17) to 0.25 (SD 0.17), the LIM-SMN was from 0.21 (SD 0.16) to 0.24 (SD 0.15), the LIM-SN was from 0.23 (SD 0.17) to 0.21 (SD 0.14), the SMN-SN was from 0.51 (SD 0.22) to 0.48 (SD 0.24), all \u003cem\u003eP\u003c/em\u003e\u0026gt;\u003cem\u003e0.05\u003c/em\u003e. (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe average rs-FC between 6 major networks before and after bariatric surgery\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNC(N\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM0(N\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eM6 (N\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRN-DMN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.771\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRN-CEN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.226\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRN-LN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.32\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.391\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRN-SMN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.573\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRN-SN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.963\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDMN-CEN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.696\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDMN-LN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.356\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDMN-SMN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.504\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDMN-SN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.32\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.700\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCEN-LN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.168\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCEN-SMN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.413\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCEN-SN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.783\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLN-SMN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.350\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLN-SN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.725\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSMN-SN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.517\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eValues are shown as \u0026plusmn;\u0026thinsp;standard deviation or the median (quartile). M0: pre-operation, M6: 6 months of post-operation.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eRN reward network, DMN default mode network, CEN central execution network, LN limbic network, SMN sensory movement network, SN salience network.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, all morbid obese participants lost body weight and fat rapidly after bariatric surgery. As BW changes, the fat liver and VFA significantly decreased 6 months after bariatric surgery. BG, TG, liver and kidney function indicators were significantly improved 6 months after surgery. This may be because of the improvement in fat metabolism caused by the recovery of liver function after surgery [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. MAFLD is a metabolic liver disorder characterized by a range of liver dysfunctions [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Studies have shown that the accumulation of TGs in the liver or an increase in fatty acid oxidation damages liver function [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], and the recovery of liver enzymes to a normal level may reflect a decrease in liver fat content [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. As components of human adipose tissue storage, Visceral adipose tissue can function as endocrine organs to secrete adipokines that play a key role in regulating energy metabolism and maintaining systemic homeostasis [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Exploring the changes in visceral adipose tissue before and after bariatric surgery is crucial to identify the role of surgery in reducing adipose tissue reserve [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. As the portal drainage of visceral fat provides direct hepatic access to free fatty acids secreted by visceral adipocytes, early body fat mobilization is mainly caused by more active visceral adipose tissue [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. These show that bariatric surgery has a significant therapeutic effect on morbid obese patients with metabolic syndrome.\u003c/p\u003e \u003cp\u003eOn the microscopic scale, human brain networks can analyze the connections between brain regions within or between networks. However, on the macroscopic scale of neuroimaging data, there is some statistical measure of the relationship between networks or between networks and the whole brain. In order to define brain regions, automatic anatomical markers are used to divide the whole brain into 400 cortical regions of interest.[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Previous studies have shown that there is a connection between obesity and changes in brain function. Cognitive function has improved after bariatric surgery. At rest-state fMRI also shows the changes of brain functional connections at the micro level in different brain regions. Including several areas involved in inhibition and executive control, especially in regard to areas where reward mechanisms are located. Specific research results are mentioned in the latest review[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], decreased functional connectivity in the dorsolateral prefrontal cortex[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], increased functional connectivity between dorsolateral prefrontal cortex to anterior cingulate gyrus[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], reduced rs-FC within frontoparietal networks[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], increased functional connectivity between the hippocampus and insula[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In summary, the results of previous studies are different. From a macroscopic point of view, we analyzed the brain functional connection of the related brain regions studied in the past, and found that there was no significant difference in the average rs-FC between 6 obesity related networks and 400 brain regions in the whole brain 6 months after bariatric surgery.\u003c/p\u003e \u003cp\u003eGaps remain in our understanding of the impact of weight loss on neurologic changes following bariatric surgery. The existing literature also lacks proof that the observed changes are due to weight loss itself or the result of surgical operation. Studies directly comparing matched cohorts of individuals who have lost the same amount of weight through different means are needed. Additionally, current studies examining the neurologic benefits of bariatric surgery are limited in the heterogeneity of the samples that are mixed regarding sex, and a combination of Roux-en-Y Gastic Bypass (RYGB) and SG surgeries. In addition to the surgeries we highlight here, there is also a general lack of information on ethnicity and thorough postsurgery MRI paired with measurements of metabolic changes and how they may be perceived through health evaluations. Lastly, to our knowledge there are no data on endoscopic procedures such as the SG and its role in inducing changes in the brain.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study has some limitations. This study only pays attention to the overall functional connection strength of 6 major brain functional networks after significant changes in clinical and laboratory indicators in morbid obese patients 6 months after bariatric surgery. Because of the small sample size, there is no further detailed grouping analysis according to variables such as gender, age and obesity complications, because the brain function is complex and varies from person to person, and the changes are affected by many factors, so the next step of detailed grouping analysis is our research focus. The data in this study were from a single institution, which may also have a certain impact on the results.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe clinical and laboratory indicators of morbid obese patients have improved significantly after bariatric surgery, and the restoration of MAFLD is accompanied by a recovery of the liver function and a rapid decrease in the liver fat, followed by a decrease in visceral fat. However the overall rs-FC has not changed significantly, which shows that the overall rs-FC will remain stable and coordinated.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBMI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Body mass index\u003c/p\u003e\n\u003cp\u003eBW \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Body weight\u003c/p\u003e\n\u003cp\u003eCEN \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Central execution network\u003c/p\u003e\n\u003cp\u003eDMN \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp;Default mode network\u003c/p\u003e\n\u003cp\u003eLN \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Limbic network\u003c/p\u003e\n\u003cp\u003eMAFLD \u0026nbsp; Metabolic fatty liver disease\u003c/p\u003e\n\u003cp\u003eMRI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Magnetic resonance imaging\u003c/p\u003e\n\u003cp\u003eRN \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Reward network\u003c/p\u003e\n\u003cp\u003eRYGB \u0026nbsp; Roux-en-Y Gastic Bypass\u003c/p\u003e\n\u003cp\u003eSG \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Sleeve gastrectomy\u003c/p\u003e\n\u003cp\u003eSMN \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Sensory movement network\u003c/p\u003e\n\u003cp\u003eSN \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Salience network\u003c/p\u003e\n\u003cp\u003eVAT \u0026nbsp; \u0026nbsp; Visceral adipose tissue\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eTZ, JB designed the study. CG, CQ, KY were responsible for the recruitment of subjects and acquisition of data. MH, XW, YB performed the experiments and analyzed the data. JB, MH contributed to drafting the manuscript, CG contributed to the setting of MRI scanning scheme, MZ contributed to statistical analysis, XW, XZ, CL contributed to the collection and follow-up of subjects. TZ made the final correction of the manuscript. All authors reviewed the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eZhang, D., Shen, C., Chen, N. et al. Long-term obesity impacts brain morphology, functional connectivity and cognition in adults. Nat. Mental Health. 2025 3, 466\u0026ndash;478.\u003c/li\u003e\n\u003cli\u003eWang J, Li G, Hu Y, et al. Habenular and mediodorsal thalamic connectivity predict persistent weight loss after laparoscopic sleeve gastrectomy. Obesity (Silver Spring). 2022;30(1):172-182.\u003c/li\u003e\n\u003cli\u003eLi G, Ji G, Hu Y, et al. 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Bariatric Surgery and Non-Alcoholic Fatty Liver Disease: a Systematic Review of Liver Biochemistry and Histology.Obes Surg. 2015 Dec;25(12):2280-9.\u003c/li\u003e\n\u003cli\u003eSatish C Kalhan, Lining Guo, John Edmison, Srinivasan Dasarathy,et al. Plasma metabolomic profile in nonalcoholic fatty liver disease.Metabolism.2011 Mar;60(3):404-13.\u003c/li\u003e\n\u003cli\u003eGeraldine J Ooi , Paul R Burton , Lisa Doyle ,et al.Effects of Bariatric Surgery on Liver Function Tests in Patients with Nonalcoholic Fatty Liver Disease.Obes Surg.2017 Jun;27(6):1533-1542.\u003c/li\u003e\n\u003cli\u003eAhn JH, Yu JS, Park KS, et al. Effect of hepatic steatosis on native T1 mapping of 3T magnetic resonance imaging in the assessment of T1 values for patients with non-alcoholic fatty liver disease. Magn Reson Imaging. 2021;80:1-8.\u003c/li\u003e\n\u003cli\u003eSchaefer A, Kong R, Gordon EM, et al. Local-Global Parcellation of the Human Cerebral Cortex from Intrinsic Functional Connectivity MRI. Cereb Cortex. 2018;28(9):3095-3114.\u003c/li\u003e\n\u003cli\u003eSandoval H, Clapp B, O\u0026apos;Dell LE, Clegg DJ. A review of brain structural and functional changes using MRI technology in patients who received bariatric surgery. Surg Obes Relat Dis. 2025;21(1):85-92.\u003c/li\u003e\n\u003cli\u003eHu Y , Ji G, Li G, et al. Laparoscopic sleeve gastrectomy improves brain connectivity in obese patients. J Neurol 2020;267:1931\u0026ndash;40.\u003c/li\u003e\n\u003cli\u003eMallio CA, Spagnolo G, Piervincenzi C, et al. Brain functional connectivity differences between responders and non-responders to sleeve gastrectomy. Neuroradiology 2023;65:131\u0026ndash;43.\u003c/li\u003e\n\u003cli\u003eZhang Y , Ji G, Li G, et al. Ghrelin reductions following bariatric surgery were associated with decreased resting state activity in the hippocampus. Int J Obes 2019;43:842\u0026ndash;51.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"obesity, bariatric surgery, fMRI, resting-state functional connectivity","lastPublishedDoi":"10.21203/rs.3.rs-8318590/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8318590/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eIt is reported that the micro-functional connections of obese patients are abnormal and vary greatly after bariatric surgery. However the effect and change of the overall brain functional connection remain uncertain.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMaterials and Methods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis study included 38 participants who had undergone sleeve gastrectomy (SG). The study aimed to analyze changes of body weight (BW), laboratory tests, and resting-state functional connectivity (rs-FC) of the whole brain conducted before surgery and 6 months after bariatric surgery.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eFollowing a rapid weight loss within 6 months of surgery, there was a concurrent decrease in BW, adipose tissue, some clinical and laboratory indicators. The recovery of metabolic fatty liver disease (MAFLD) is accompanied by a recovery in liver function and a rapid decrease in liver fat, followed by a decrease in visceral fat. But the average rs-FC between 6 major networks and 400 brain regions has not changed 6 months after bariatric surgery.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe clinical and laboratory indicators of morbid obese patients have improved significantly after bariatric surgery, but the overall rs-FC has not changed significantly, which shows that the overall rs-FC will remain stable and coordinated.\u003c/p\u003e","manuscriptTitle":"The overall brain functional connection of morbid obese participants did not change significantly when the rapid decline of body weight after bariatric surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-16 06:23:04","doi":"10.21203/rs.3.rs-8318590/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8623a513-63b5-40a5-b902-6b0d4266d083","owner":[],"postedDate":"January 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-14T23:53:42+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-16 06:23:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8318590","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8318590","identity":"rs-8318590","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}