Metabolic Bariatric Surgery (MBS) exerts its effect in the long term, but it is not clear if benefits remains on metabolic parameters and delays the onset of comorbidities linked to obesity, such as diabetes, cardiovascular diseases and cancer. 10 years follow-up preliminary results from FLORINASH cohort identify 3 patients groups: 23 subjects underwent lifestyle changes, 21 MBS (14 patients with 10 years as time since surgery and 7 with 5 years). After 10 years the incidence of type 2 diabetes was 34% (n=15), cardiovascular events was 11,4% (n=5), cancer was 22,7% (n=10) and it was equally distributed in the 3 groups. We used Total Weight Loss (TWL) and Excess Weight Loss (EWL) to evaluate MBS or diet efficacy. TWL and EWL were significantly higher in 10 years BSM group than in other sets (p=0,004; p=0,018). These two efficacy parameters were significantly correlated with time to surgery (TWL R=-0,518, p<0,001, EWL R=-0,448, p<0,001). During the 10 years follow-up visits patients underwent to body composition evaluation (BIA and DEXA), OGTT (in absence of diabetes), liver ultrasound, carotid intima-media thickness measurements and hand grip. We performed a Multiple t test analysis and among all metabolic parameters we found significantly decreased adipose tissue measured by BIA in the 10 ys MBS group and lower insulin and ALT blood levels in the 3 groups. We also identified increased levels of c reactive protein in the diet group, but no differences in IMT or liver steatosis among the 3 sets. In the next year we will complete the 10 ys follow-up and we will be able to identify new biomarkers linked to comorbidities such as diabetes in patients underwent to MBS or changes in lifestyle.