Influence Of Type 2 Diabetes Mellitus On Liver Histology Among Morbidly Obese Individuals. A Cross-sectional Study.

Nonalcoholic fatty liver disease (NAFLD) has become a public health concern. It encompasses a wide spectrum of histological abnormalities and has close relationships with insulin resistance and type 2 diabetes mellitus (T2DM). This study sought to compare the histological alterations observed in morbidly obese individuals with and without T2DM who underwent Roux-en-Y gastric bypass. Cross-sectional study in a tertiary-level public hospital. This was a cross-sectional study on 197 individuals who underwent gastric bypass surgery between 2011 and 2013. NAFLD was assessed through liver biopsies. T2DM was diagnosed through the International Diabetes Federation criteria. Non-diabetics presented significantly more biopsies without any histological abnormalities, regarding steatosis (42.6% versus 25.5%; P = 0.0400), fibrosis (60.6% versus 36.2%; P = 0.0042) and steatohepatitis (27.3% versus 12.8%; P = 0.0495), while diabetics presented significantly higher frequency of moderate forms of steatosis (36.2% versus 20%; P = 0.0307) and fibrosis (23.4% versus 4%; P = 0.0002). T2DM was associated with more advanced forms of NAFLD within the population studied. NAFLD has previously been correlated with severe forms of heart disease. Screening for and early detecting of NAFLD in high-risk populations are important for avoiding further development of severe forms and the need for liver transplantation.13

Influence of type 2 diabetes mellitus on liver histology among morbidly obese individuals. A cross-sectional study

CONTEXT AND OBJECTIVE: Nonalcoholic fatty liver disease (NAFLD) has become a public health concern. It encompasses a wide spectrum of histological abnormalities and has close relationships with insulin resistance and type 2 diabetes mellitus (T2DM). This study sought to compare the histological alterations observed in morbidly obese individuals with and without T2DM who underwent Roux-en-Y gastric bypass. DESIGN AND SETTING: Cross-sectional study in a tertiary-level public hospital. METHODS: This was a cross-sectional study on 197 individuals who underwent gastric bypass surgery between 2011 and 2013. NAFLD was assessed through liver biopsies. T2DM was diagnosed through the International Diabetes Federation criteria. RESULTS: Non-diabetics presented significantly more biopsies without any histological abnormalities, regarding steatosis (42.6% versus 25.5%; P = 0.0400), fibrosis (60.6% versus 36.2%; P = 0.0042) and steatohepatitis (27.3% versus 12.8%; P = 0.0495), while diabetics presented significantly higher frequency of moderate forms of steatosis (36.2% versus 20%; P = 0.0307) and fibrosis (23.4% versus 4%; P = 0.0002). DISCUSSION: T2DM was associated with more advanced forms of NAFLD within the population studied. NAFLD has previously been correlated with severe forms of heart disease. CONCLUSION: Screening for and early detecting of NAFLD in high-risk populations are important for avoiding further development of severe forms and the need for liver transplantation

Renal function 1 year after bariatric surgery : influence of roux-en-y gastric bypass and identification of pre-operative predictors of improvement

While evidence of improved renal function following gastric bypass exists, pre-operative predictors of this improvement are not completely known.To assess the glomerular filtration rate (GFR) 1 year after Roux-en-Y gastric bypass (RYGB) and to identify pre-operative predictors associated with the improvement of renal function.A historical cohort study, which included 109 obese patients before and 12 months after RYGB, was classified into subgroups according to GFR (normofiltration, hypofiltration (GFR  95th percentile)). The 5th and 95th percentiles were 90 and 120 mL/min/1.73 m2, respectively. The primary outcome was the variation of GFR (%GFR) estimated by the Chronic Kidney Disease - Epidemiology Collaboration (CKD-EPI) formula, calculated using serum creatinine, ethnicity, and gender. The mean age was 38.3 ± 10.3 years and 77% were female; 52.3% presented hypertension and 27.5% type 2 diabetes. One year after surgery, the mean BMI decreased from 36.7 ± 3.6 to 28.8 ± 3.3 kg/m2 (p < 0.001). Pre-surgically, 37.6% presented hypofiltration, 47.7% normofiltration, and 14.7% hyperfiltration. The overall GFR increased from 95.5 ± 19 to 104 ± 16.4 mL/min (10.9%) (p < 0.001). The overall post-surgical %GFR was negatively correlated with the pre-surgical GFR (R = − 0.687; p < 0.001). In the hypofiltration and normofiltration subgroups, the post-surgical %GFR was negatively correlated with age (R = − 0.328, p = 0.036; and R = − 0.355, p = 0.004, respectively) and pre-surgical GFR (R = − 0.436, p = 0.04; and R = − 0.528, p < 0.001, respectively).30386086

Weight loss and vomiting 1 year after banded versus non-banded one anastomosis gastric bypass : a prospective randomized trial

The weight loss outcomes after banded one-anastomosis gastric bypass (OAGB) remain to be determined. To compare weight loss and vomiting 1 year after banded versus non-banded OAGB. This is a prospective, open-label, randomized study, which evaluated 33 individuals with morbid obesity, which underwent banded (16 individuals) and non-banded OAGB (17 individuals) and were followed up for 12 months. Weight loss (percentages of total weight loss—%TWL—and excess weight loss—%EWL) and occurrence of vomiting were assessed and compared before surgery and after 6 and 12 months. At baseline, there were no differences between groups in regard to age, gender, and body mass index (BMI). At 6 and 12 months post-op, and the overall mean %TWL regardless of band use was 22.4 ± 7% and 29 ± 6.9%, respectively, and the overall average %EWL regardless of band use was 66.8 ± 22.9% and 86.3 ± 24%, respectively. %TWL did not differ between the banded and non-banded groups at 6 (21.8 ± 6.8% vs. 23.1 ± 7.4%; p = 0.7) and 12 months post-op (27.5 ± 6.6% vs. 30.4 ± 7.1%; p = 0.3), as well as %EWL at 6 (67 ± 22.9% vs. 67.6 ± 23.6%; p = 0.6) and 12 months post-op (83.5 ± 24.4% vs. 89 ± 24.1%; p = 0.4). The occurrence of vomiting did not significantly differ between banded and non-banded OAGB at 6 (12.5% vs. 11.8%; p = 0.9) and 12 months post-op (12.5% vs. 5.9%; p = 0.5). OAGB led to an overall satisfactory weight loss after 1 year, regardless of band use. Banded OAGB did not lead to neither significantly higher weight loss nor more vomiting than non-banded OAGB 1 year after surger

Non-alcoholic fatty liver disease is associated with impairment of ejection fraction among individuals with obesity undergoing bariatric surgery: results of a cross-sectional study

The relationship between non-alcoholic fatty liver disease (NAFLD) and myocardial function seems to be more than just the effect of mutual metabolic risk factors. Objective: To determine whether there is a significant association between NAFLD assessed by means of liver biopsy and left ventricular function expressed by the estimated ejection fraction among individuals with obesity. Methods: This is a cross-sectional study which enrolled individuals who consecutively underwent bariatric surgery. NAFLD was assessed by means of liver biopsies which were systematically collected during the procedures. The estimated ejection fraction was obtained by means of transthoracic echocardiograms. The main outcome evaluated was a possible association between NAFLD features and ejection fraction. The results of liver biopsies and the respective degrees of severity of each NAFLD feature were also correlated with the ejection fraction and main anthropometric, biochemical, and clinical variables. Results: Of 112 individuals, 86.6% were female and the mean age was 38.5 ± 9.3 years. It was observed that the average estimated ejection fraction (EEF) was significantly lower among individuals with liver fibrosis (67.6 ± 5.5% vs. 70.8 ± 4.9%, p = 0.008). After adjustment for confounding variables in a multivariate model, the degree of liver fibrosis was independently associated with the EEF (R = − 0.3, p = 0.02). Conclusion: Among individuals with morbid obesity, the findings of this study are suggestive that liver fibrosis confirmed by histopathological examination is associated with a slight impairment of left ventricular function. Further studies are needed to confirm this association30245646