Background: A low-calorie diet (LCD) reduces fat mass excess, improves insulin sensitivity, and alters adipose tissue (AT) gene expression, yet the relation with clinical outcomes remains unclear. Objective: We evaluated AT transcriptome alterations during an LCD and the association with weight and glycemic outcomes both at LCD termination and 6 mo after the LCD. Design: Using RNA sequencing (RNAseq), we analyzed transcriptome changes in AT from 191 obese, nondiabetic patients within a multicenter, controlled dietary intervention. Expression changes were associated with outcomes after an 8-wk LCD (800-1000 kcal/d) and 6 mo after the LCD. Results were validated by using quantitative reverse transcriptase-polymerase chain reaction in 350 subjects from the same cohort. Statistical models were constructed to classify weight maintainers or glycemic improvers. Results: With RNAseq analyses, we identified 1173 genes that were differentially expressed after the LCD, of which 350 and 33 were associated with changes in body mass index (BMI; in kg/m 2 ) and Matsuda index values, respectively, whereas 29 genes were associated with both endpoints. Pathway analyses highlighted enrichment in lipid and glucose metabolism. Classification models were constructed to identify weight maintainers. A model based on clinical baseline variables could not achieve any classification , and Nestlé Institute of Health Sciences. This is a free access article, distributed under terms (http://www.nutrition.org/publications/ guidelines-and-policies/license/) that permit unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Supplemental Figures 1 and 2 and Supplemental Tables 1-11 are available from the "Online Supporting Material" link in the online posting of the article and from the same link in the online table of contents at http://ajcn. nutrition.org.CA and AV contributed equally to this work. Address correspondence to AV (e-mail: armand.valsesia@rd.nestle.com). Abbreviations used: AT, adipose tissue; CAV2, caveolin 2; C7, complement component 7; ELOVL5, ELOVL fatty acid elongase 5; ENSG, Ensembl gene identifier; eQTL, expression quantitative trait loci; FDR, false discovery rate; GSDMB, gasdermin B; LCD, low-calorie diet; LEP, leptin; LOX, lysyl oxidase; ME1, malic enzyme 1; MTCH2, mitochondrial carrier 2; NPY1R, neuropeptide Y receptor Y1; PCK2, phosphoenolpyruvate carboxykinase 2; PPAP2A, phosphatidic acid phosphatase type 2A; RNAseq, RNA sequencing; ROC, receiver operating characteristic; RSD, relative SD; RT-qPCR, reverse transcription quantitative polymerase chain reaction; SNP, single nucleotide polymorphism; SPARC, secreted protein acidic and cysteine rich; SVF, stromal vascular fraction; T2D, type 2 diabetes.