[Does bariatric surgery cure the metabolic syndrome?]

Abstract

Metabolic syndrome (MS) is a risk condition for the development of systemic atherosclerotic disease. Morbid obesity is a state of insulin resistance (IR) associated with visceral fat accumulation, which is involved in the development of MS. In severe obesity, conservative therapies promote an improvement of MS, but weight regain is frequent, whereas bariatric surgery promotes a more significant and sustained weight loss. Bariatric surgery is recommended for patients with unsatisfactory response to clinical treatment and with IMC > 40 kg/m(2) or > 35 in case of co-morbidities. In those cases, surgical risk must be acceptable and patients submitted to surgery must be informed about complications and postoperative care. Prevention, improvement and reversion of diabetes (DM2) (70 to 90% of cases) are seen in several bariatric surgery modalities. Disabsorptive are more efficient than restrictive procedures in terms of weight reduction and insulin sensitivity improvement, but chronic complications, such as malnutrition, are also more frequent. Vertical gastroplasty with jejunoileal derivation is a mixed surgery in which the restrictive component predominates. In this modality, reversion of DM2 is due to an increase in insulin sensitivity associated with improved beta cell function. Reversion of MS and its manifestations after bariatric surgery are associated with reduction of cardiovascular mortality and, thus, in severe obesity cases, MS can be considered a surgical condition.