Project
MONUCO
MOnitoring NUtritional COnsequences of Obesity Treatment on women’s health and transgenerational effects for healthier future generations. A multicentre prospective observational cohort study.
Obesity treatments, including metabolic surgery and pharmacological interventions, are effective at reducing body weight and associated comorbidities. However, these treatments can also negatively impact nutritional status, muscle mass, and bone health, especially in women. With the MONUCO study, we aim to explore the long-term consequences of these treatments on women’s health and their children’s development.
Each year, approximately 12,000 patients in the Netherlands undergo obesity treatment through either metabolic surgery or medication, with 80% of these patients being women. While effective in reducing weight and obesity-related complications, these treatments often impair nutritional status, potentially leading to muscle loss, reduced bone mineral density, and other health concerns. Additionally, nutrient deficiencies following obesity treatment could negatively affect fetal growth and child development, particularly in the 50% of women who become pregnant after undergoing treatment.
Prospective Cohort
The MONUCO study is a 10-year multicenter prospective cohort designed to monitor the long-term health outcomes of women aged 18-55 receiving obesity treatment, focusing on musculoskeletal, reproductive, and endocrine health. For this observational cohort study, we will recruit 1,150 women undergoing surgical or pharmacological obesity treatment from several obesity centers across the Netherlands. Measurements will be taken before surgery, at multiple intervals post-surgery, and during any subsequent pregnancies. Women who become pregnant after obesity treatment will be included in the integrated birth cohort, with follow-up on child development up to four years post-partum.
Musculoskeletal Health
We will investigate the long-term impact of obesity treatment on women's musculoskeletal health, focusing on changes in muscle mass, strength, and bone mineral density. These parameters are critical, as obesity treatment, especially bariatric surgery, can result in nutrient deficiencies that may lead to muscle loss and reduced bone density. This is particularly concerning for postmenopausal women, who already face a natural decline in bone mineral density. A subgroup of participants will undergo DEXA and MRI scans to further analyze muscle fat infiltration and bone marrow adiposity, helping to clarify the extent of musculoskeletal changes following obesity treatment.
Reproductive and Endocrine Health
Beyond the musculoskeletal system, we will evaluate how obesity treatment impacts lifestyle factors like physical activity, sleep patterns, and overall endocrine and reproductive health. This includes monitoring menstrual cycles, menopausal symptoms, and hormonal changes, particularly in relation to nutrient deficiencies. Additionally, we will assess immune and gastrointestinal health to provide a comprehensive understanding of how obesity treatment affects women’s broader health outcomes over the long term.
Pregnancy and Child Development
We also aim to explore the transgenerational consequences of obesity treatment, particularly during pregnancy. Nutrient deficiencies resulting from treatments such as bariatric surgery may influence fetal growth and child development, potentially leading to complications like intrauterine growth restriction or low birth weight. The study will follow a birth cohort, assessing maternal nutrient status during pregnancy and tracking child development up to four years of age, providing valuable insights into how maternal health and nutrient intake post-obesity treatment affect the next generation.
Clinical Relevance
Obesity treatment often causes long-term nutritional deficiencies that affect muscle and bone health. These deficiencies may also affect maternal and fetal health during pregnancy. With the MONUCO study, we will provide critical insights to improve guidelines for managing women post-obesity treatment, with the ultimate goal of enhancing the health of these women and their children.
