The aim was to investigate the prevalence of non-alcoholic steatohepatitis (NASH) and risk factors for hepatic fibrosis in morbidly obese patients submitted to bariatric surgery. This retrospective study recruited all patients submitted to bariatric surgery from January 2007 to December 2012 at a reference attendance center of Southern Brazil. Clinical and biochemical data were studied as a function of the histological findings of liver biopsies done during the surgery. Steatosis was present in 226 (90.4%) and NASH in 176 (70.4%) cases. The diagnosis of cirrhosis was established in four cases (1.6%) and fibrosis in 108 (43.2%). Risk factors associated with NASH at multivariate analysis were alanine aminotransferase (ALT) >1.5 times the upper limit of normal (ULN); glucose ≥ 126 mg/dL and triglycerides ≥ 150 mg/dL. All patients with ALT ≥1.5 times the ULN had NASH. When the presence of fibrosis was analyzed, ALT > 1.5 times the ULN and triglycerides ≥ 150 mg/dL were risk factors, furthermore, there was an increase of 1% in the prevalence of fibrosis for each year of age increase. Not only steatosis, but NASH is a frequent finding in MO patients. In the present study, ALT ≥ 1.5 times the ULN identifies all patients with NASH, this finding needs to be further validated in other studies. Moreover, the presence of fibrosis was associated with ALT, triglycerides and age, identifying a subset of patients with more severe disease.

Introduction: Male obesity has a negative correlation with plasma testosterone (T) levels and sexual function (SF).Aim: To evaluate the effect of weight loss through bariatric surgery (BS) on SF, low T symptoms, and hormonal profiles in obese men. Methods: Thirty-three men who underwent BS participated in this cohort study. Before surgery, all participants underwent clinical examinations, including anthropometric, lipid, glycemic, and hormonal evaluations. SF was evaluated using the International Index of Erectile Function (IIEF) questionnaire; low T symptoms were evaluated using the Aging Males' Symptoms (AMS) and Androgen Deficiency in the Aging Male (ADAM) questionnaires. The participants were reevaluated 6 months post-surgery. Main outcome measures: Sex hormone profile, SF, and low T symptoms Results: After BS, a significant increase in mean total T (201 § 111−548 § 190 ng/dL, P < .001), free T (5.8 § 2.8−9.3 § 3.4 ng/dL, P < .001), bioavailable T (110.3 § 57.8−198.6 § 74.3 ng/dL, P < .001), and sexual hormone-binding globulin (19.8 § 13.7−54.6 § 23.2 nmol/L, P < .001) levels. There was a significant decrease in estradiol (64.6 § 27.4−29.2 § 20.0 [pg/mL], P < .001). SF significantly improved. The total IIEF score increased 5.2 points (62.3 § 7.4−67.5 § 7.4, P = .004), erectile function subdomain increased 2.4 points (25.7 § 4.1−28.1 § 3.9, P = .011), desire subdomain increased 1.0 points (8.3 § 1.5−9.3 § 1.6, P = .006), and intercourse satisfaction subdomain increased 1.2 points (11.4 § 1.9−12.6 § 1.8, P = .012). Post-surgery, a 44% reduction (P = .001) was observed in the positive ADAM questionnaire, and improvements in all domains of the AMS questionnaire were found (P < .001). Conclusion: Significant weight loss through BS improves erectile function, hormonal profile, and symptoms of T deficiency.

Background: Strongly associated with obesity, non-alcoholic fatty liver disease is considered the hepatic manifestation of the metabolic syndrome. It presents as simple steatosis and steatohepatitis, which can progress to cirrhosis and its complications. Among the therapeutic alternatives is bariatric surgery. Aim: To compare the effect of the two most frequent bariatric procedures (sleeve and bypass) on liver disease regarding to epidemiological, demographic, clinical and laboratory parameters. Methods: The results of intraoperative and 12 months after surgery liver biopsies were used. The NAFLD activity score (NAS) was used to assess and compare the stages of liver disease. Results: Sixteen (66.7%) patients underwent Bypass procedure and eight (33.3%) Sleeve. It was observed that the variation in the NAFLD activity score was significantly greater in the Bypass group than in Sleeve (p=0.028) and there was a trend regarding the variation in fibrosis (p=0.054). Conclusion: Both surgical techniques were effective in improving the hepatic histology of most operated patients. When comparing sleeve and bypass groups, bypass showed better results, according to the NAS score.

Metabolic syndroMe resolution by roux-en-y gastric bypass in a real world: a case control study rev assoC med bras 2015; 61 (2) Conflict of interest: noneObjectives: the aim of this study was to evaluate the efficacy of Roux-en-Y Gastric Bypass (RYGB), compared with nonsurgical treatment (NS group), as an instrument for inducing remission of co-morbidities related to Metabolic Syndrome (MetS) in patients with Obesity, grades 2 and 3 (Ob2,3). Methods: two hundred and fifty eight Ob2,3 patients were selected in a retrospective analysis and included in a case control study. MetS was defined as described by the International Diabetes Federation. One hundred and twenty-nine of these patients underwent RYGB (S group), and 129 were assessed as an NS group. Results: at baseline, S and NS groups did not differ in BMI, age, female sex and prevalence of MetS (p>0.05). For the S group the outcomes were a reduction in BMI of 38.1% (p<0.001), waist circumference of 28.6% (p<0.001), fasting plasma glucose of 10.5% (p<0.001), serum LDL-cholesterol of 21.9% (p<0.001) and of 85% in the number of patients with MetS (p<0.001). For the NS group, only a decrease of 4.12%(p=0.047) in triglyceride levels and of 5.9%(p=0.031) in Diastolic Blood Pressure was observed. In the NS group, 98.6% of the patients continued to have MetS. The number needed to treat (NNT) with surgery to resolve one case of MetS was 1.2 (CI 95%: 1.1 -1.4). Conclusion: in the real world, in the South of Brazil, compared with NS treatment and after 1 year of observation, RYGB is highly effective for decreasing the prevalence of MetS.

Type 2 diabetes mellitus plays an important role in the progression of non-alcoholic fatty liver disease as an independent risk factor for severe fibrosis.