Long-term health outcomes in adolescents with obesity treated with faecal microbiota transplantation: 4-year follow-up

Brooke C. Wilson, Michele Zuppi, José G. B. Derraik, Benjamin B. Albert, Ry Y. Tweedie-Cullen, Karen S. W. Leong, Kathryn L. Beck, Tommi Vatanen, Justin M. O’Sullivan () and Wayne S. Cutfield ()
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Brooke C. Wilson: University of Auckland
Michele Zuppi: University of Auckland
José G. B. Derraik: University of Auckland
Benjamin B. Albert: University of Auckland
Ry Y. Tweedie-Cullen: University of Auckland
Karen S. W. Leong: University of Auckland
Kathryn L. Beck: Massey University
Tommi Vatanen: University of Helsinki
Justin M. O’Sullivan: University of Auckland
Wayne S. Cutfield: University of Auckland

Nature Communications, 2025, vol. 16, issue 1, 1-11

Abstract: Abstract Faecal microbiota transplantation (FMT) has been explored as a potential treatment for obesity, but its long-term effects on metabolic health remain unclear. Here, we report 4-year follow-up findings from a double-blind, randomised, placebo-controlled trial assessing FMT in adolescents with obesity (ACTRN12615001351505, Australian New Zealand Clinical Trials Registry). This unblinded follow-up study evaluated 63% (55/87) of the original participants (27 FMT, 28 placebo). There was no difference in BMI between the two groups, after adjusting for sex, age, diet, and physical activity (−3.6 kg/m2, p = 0.095). However, FMT recipients showed clinical improvements in body composition and metabolic health compared to the placebo group. Specifically, FMT recipients had smaller waist circumference (−10.0 cm, p = 0.026), total body fat (−4.8%, p = 0.024), metabolic syndrome severity score (−0.58, p = 0.003), and systemic inflammation (−68% hs-CRP, p = 0.002) and higher levels of HDL cholesterol (0.16 mmol/L, p = 0.037). No group differences were observed in glucose markers, or other lipid parameters. Shotgun metagenomic sequencing revealed sustained long-term alterations in gut microbiome richness, composition and functional capacity, with persistence of donor-derived bacterial and bacteriophage strains. These findings highlight the potential relevance of FMT as a microbiome-augmenting intervention for obesity management and metabolic health, warranting further investigation.

Date: 2025
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DOI: 10.1038/s41467-025-62752-4

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