MITSUNORI MATSUDA
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Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
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conferenceObject ANALYSIS OF LIVER FUNCTION IN THE OBESE PATIENT AND ITS CORRELATION WITH METABOLIC COMORBIDITIES NASH and bariatric surgery(2019) SILVA, M. B. D. B. E.; MESQUITA, G. H. A. D.; MOTA, F. C.; KAWAMOTO, F. M.; DANTAS, A. C. B.; MARSON, A. G.; MATSUDA, M.; ANDRAUS, W.; SANTO, M. A.conferenceObject Assessment of Body Composition in Morbid Obesity: a Comparative Study Between Body Impedance and Adiposity index Methods(2012) SANTO, M. A.; RICCIOPPO, D.; PAJECKI, D.; KAWAMOTO, F.; MATSUDA, M.; CECCONELLO, IIntroduction Obesity has become an epidemic public health problem. A reliable method to assess body composition and monitor the effectiveness of treatments for the morbid obesity is mandatory. However, there is still controversy as to which method to use for this purpose. Two Methods are validated in the literature, bioelectrical impedance analysis (BIA) and body adiposity index (BAI). The present study compared these methodologies. Materials & Methods We evaluated 167 patients undergoing bariatric surgery, women prevailed (82.59 %), averaging 44 years-old and mean BMI of 49.48 kg/m2. Weight, height and hip circumference were measured. Body fat (BF) was calculated by BIA and BAI. The following formulas were used: BIA: BF in kg=023.25+(0.09x resistance in ohms)+(1.00x weight in kg)-(0.08xheight in cm)+(0.13x age in years). BAI: BF% of the total weight 0 (hip circumference in centimeters/height in meters x height in meters)-18. Results The patients had an average of 53.35 % (± 5.37) of BF according to BIA, and BAI showed 50.51 % (± 13.59) of BF. There is no difference between the two Methods (p<0,05), even when stratified by BMI (BMI<45, 4550). Essa diferença variou quando o IMC foi dividido em três faixas, abaixo de 45 kg/m2 a diferença foi de 3,1 %, entre 45,1 a 49,99 kg/m2 a diferença foi de 3,78 %, acima de 50 kg/m2 a diferença foi de 1,86%. Discussion The BAI is a simple method of implementation, low cost and effective, when compared to other Methods validated for morbidly obese patients. Conclusion BAI is an effective method to assess BF, comparable to BIA, and also proved to be effective in super obese patients.conferenceObject Preoperative Weight Loss in Super Obesity: Influence on Perioperative Morbidity and Mortality in Patients undergoing Gastric Bypass(2012) SANTO, M. A.; RICCIOPPO, D.; PAJECKI, D.; KAWAMOTO, F.; MATSUDA, M.; CECCONELLO, IIntroduction Super obesity (SO) is increasing in greater proportions, and now represents 30 % of morbidly obese patients. In SO morbidity and mortality rates are greater. The preoperative weight loss in SO decreases operative time, and apparently diminishes morbidity. Based on these data, we initiated a program of preoperative weight loss for the SO. The treatment is based on hospitalization, low-calorie diet, biometrics control and physical activities, aiming to analyze weight loss and influence of weight loss in the perioperative outcome. Materials & Methods Thirty patients underwent our SO preop weight loss program, from 2006 to 2011. The mean age was 46 years, and mean BMI of 66 kg/m2 and the majority was female. All patients underwent gastric bypass after the weight loss. The average caloric intake was 5 cal/Kg/day. Results The mean weight loss was 1.9 kg/week, and after 14 weeks the mean weight loss was15.2 % of initial weight. The mean hospital stay was 21.3 weeks, and the mean weight loss was 19.7 %. All had satisfactory recovery from surgery. The mortality was null. In the last five years, from the total of 592 surgeries, 193 was performed in SO. The SO and general morbidity was 11.14 % and 20.2 %, respectively, and mortality 0.84 % and 2.07 %. Discussion In SO a preoperative weight loss is an important tool to reduce surgical risks. Hospitalization, with low-calorie diet and multidisciplinary follow-up is a safe and effective way to achieve weight loss preoperatively. Conclusion After a mean of 19,7 % of initial body weight loss, the studied group showed an important decreasing in morbimortality when compared with our previous experience. Preoperative weight loss should be encouraged in SO, and a specific program can significantly diminish surgical risks in this complex group of obeses.conferenceObject Influence of the Axcess Weight Loss on Control of Type II Diabetes After Gastric Bypass(2012) SANTO, M. A.; KAWAMOTO, F.; RICCIOPPO, D.; PAJECKI, D.; GARMS, A.; MATSUDA, M.; PINTO JR., P. E.; CLEVA, R.; CECCONELLO, IIntroduction The gastric bypass has influence on the improvement of type II diabetes. The weight loss is related to amelioration of diabetes, but it is not clear the relationship between the amount of weight loss and diabetes control. Objective Analyze the influence of EWL on improving diabetes after one year of gastric bypass. Materials and methods 29 patients type II diabetes, 24 women and 5 men, meanage of 56.9 years, mean BMI: 48.2kg/m2, mean HbA1c: 8.1, underwent standard gastric bypass retrospectively analysed one year after operation with EWL>40 % (mean 57 %). Concerning diabetes control, the patients were divided into two groups: Group A, patients who achieve HbA1c <6.5 (n=21) and in group B those maintained HbA1c>6.5 (n=08). Results In all patients the decrease of mean A1c was significant (8.1 to 6.1, p<0.05). In both groups the decrease was also significant and similar (8 to 5.9 in group A, and 9.2 to 7.6 in group B). The %EWL in group A was 59 % and in group B 57 % (p>0.05) with no difference in the Mann Whitney test. Discussion With at least 40 % of EWL there was improvement on diabetes. In the patients who did not achieve the control target (A1c<6.5) the weight loss was similar that the patients who achieve it. Conclusion Weight loss after gastric bypass is an important factor for the improvement of type 2 diabetes. Despite of amelioration of diabetes in all patients studied, similar EWL in some patients did not result in control of the disease (A1c<6.5).conferenceObject Evaluation of Noninvasive Methods for Preoperative Diagnosis of Advanced Liver Fibrosis or Hepatic Cirrhosis in Morbid Obesity(2012) SANTO, M. A.; RICCIOPPO, D.; PAJECKI, D.; KAWAMOTO, F.; MATSUDA, M.; CECCONELLO, IIntroduction Currently obesity is an epidemic in Western society, with significant increase in prevalence. There are several comorbidities such as systemic hypertension, insulin resistance, dyslipidemia and NAFLD/NASH (Nonalcoholic Fatty Liver Diasease/Non alcoholic steatohepatitis). The liver biopsy is the gold standard for diagnosis of this condition. Due to several difficulties with this method, we compare some non-invasive markers for identification of severe/advanced fibrosis and cirrhosis. Materials & Methods We studied 638 patients undergoing bariatric surgery. Among them, 83 patients underwent liver biopsy. The laboratory data were obtained from medical records, and calculated the following markers: AAR, AP index, APRI, CDS and HALT-C. Using biopsies, performed in part of the serie (n=084), as a control group, statistical analysis was performed to identify the best method and cutoff values. Results The more accurate method was APRI, with a cutoff value of 0.6 (sensitivity and specificity, CI, PPV and NPV were calculated). In the group of patients who underwent biopsy, 5 had advanced fibrosis or cirrhosis (6.02 %) and 25 some degree of fibrosis (30.12 %). Discussion In the population studied, the percentages of fibrosis/cirrhosis, and some degree of NAFLD are compatible with literature data. The APRI index would be useful as a predictor in all cases of advanced fibrosis/cirrhosis in this serie. Conclusion Regarding the markers studied, the APRI was the best method to predict advanced liver disease. Thus, it can apparently be used as a screening method for performing liver biopsies.