Effects of Omega‐3 supplementation in sarcopenia after bariatric surgery: a triple‐blind randomized controlled clinical trial

Background
Bariatric surgery is an effective treatment for obesity but induces substantial muscle loss, potentially leading to sarcopenia. Omega‐3 fatty acids have been associated with improved muscle metabolism, but their effect in the postoperative period of bariatric surgery remains unclear.

Methods
A triple‐blind randomized clinical trial following CONSORT guidelines. Patients undergoing bariatric surgery were randomly assigned to receive omega‐3 supplementation (2000 mg/day of EPA + DHA) or placebo (sunflower oil) for 90 days, including 15 days preoperatively and 75 days postoperatively. Assessments were performed at baseline, 45 days and 105 days after the start of supplementation. Outcomes included skeletal muscle mass (bioelectrical impedance [BIA]), handgrip strength (HGS) and functional performance (timed up and go [TUG] test).

Results
Fifty‐eight patients were randomized (81% women; mean age 38.2 ± 9.9 years; mean body mass index [BMI]: 41.1 ± 4.6 kg/m 2 ). At baseline, intervention and control groups were comparable in weight (112.7 ± 19.1 vs. 113.0 ± 17.9 kg; p = 0.946), muscle mass (33.5 ± 7.5 vs. 32.5 ± 7.3 kg; p = 0.603), HGS (33.3 ± 9.6 vs. 35.4 ± 10.2 kgf; p = 0.428) and TUG (8.7 ± 3.0 vs. 8.7 ± 1.8 s; p = 0.912). Between baseline and 105 days, muscle mass decreased significantly in both groups (−3.1 ± 0.3 kg; −2.2 ± 0.5 kg; both p < 0.001), without interaction between groups ( p = 0.300). HGS remained stable (Δ −0.8 to +2.3 kgf; all p ≥ 0.364), and TUG performance did not change significantly (Δ 0.0–1.1 s; all p ≥ 0.106). Weight loss was marked in both groups (−19.3 ± 1.9 vs. −17.7 ± 2.1 kg; both p < 0.001). The incidence of gastrointestinal symptoms ≥ 3 times/week was similar (34.5% vs. 13.6% at 45 days; p = 0.114). No serious adverse events occurred.

Conclusions
Omega‐3 supplementation (2000 mg/day) during the perioperative period of bariatric surgery did not prevent muscle mass loss nor improve muscle strength or functional performance within 105 days of follow‐up. Although the supplementation was safe and well tolerated, it did not demonstrate efficacy in mitigating early sarcopenia‐related outcomes in this population.