Sofiya Gancheva, Meriem Ouni, Tomas Jelenik, Chrysi Koliaki, Julia Szendroedi, Frederico G. S. Toledo, Daniel Frank Markgraf, Dominik H. Pesta, Lucia Mastrototaro, Elisabetta De Filippo, Christian Herder, Markus Jähnert, Jürgen Weiss, Klaus Strassburger, Matthias Schlensak, Annette Schürmann, Michael Roden

• The mechanisms underlying improved insulin sensitivity after surgically-induced weight loss are still unclear. We monitored skeletal muscle metabolism in obese individuals before and over 52 weeks after metabolic surgery. Initial weight loss occurs in parallel with a decrease in muscle oxidative capacity and respiratory control ratio. Persistent elevation of intramyocellular lipid intermediates, likely resulting from unrestrained adipose tissue lipolysis, accompanies the lack of rapid changes in insulin sensitivity. Simultaneously, alterations in skeletal muscle expression of genes involved in calcium/lipid metabolism and mitochondrial function associate with subsequent distinct DNA methylation patterns at 52 weeks after surgery. Thus, initial unfavorable metabolic changes including insulin resistance of adipose tissue and skeletal muscle precede epigenetic modifications of genes involved in muscle energy metabolism and the long-term improvement of insulin sensitivity.