Ketogenic enteral nutrition as a treatment for obesity: short term and long term results from 19,000 patients

Abstract

BackgroundOnly protein diet has been used successfully to prevent loss of lean body mass first in post-surgical and then in obese patients. We studied overweight and obese patients receiving short treatments of an exclusively protein-based nutritional solution as 24-hour enteral infusion.Methods19,036 patients (age 44.3 ± 13, M:F = 2:5) with an initial body mass index of 36.5 ± 7.1 underwent 10-day cycles of enteral nutrition through a fine nasogastric tube. The nutritional solution consisted solely of 50–65 g of proteins, plus vitamins and electrolytes. The 24-hour infusion was controlled with a small portable pump. Before and after each 10-day cycle body composition was checked with a Handy 3000 impedance analyzer. At the onset of treatment, average fat mass was 40.9 ± 12.8 kg while body cell mass was 42.7 ± 7.2 kg in males and 27.4 ± 4.6 kg in females.ResultsAfter an average of 2.5 cycles the patients lost 10.2 ± 7.0 kg of body weight, 5.8 ± 5.5 kg of fat mass and 2.2 ± 3.3 kg of body cell mass. No significant adverse effects were recorded except asthenia and constipation which were easily controlled with therapy. Long-term results were obtained from 15,444 patients and after an average of 362 ± 296 days we found a mean weight regain of 15.4%.ConclusionKetogenic Enteral Nutrition treatment of over 19,000 patients induced a rapid 10% weight loss, 57% of which was Fat Mass. No significant adverse effects were found. The treatment is safe, fast, inexpensive and has good one-year results for weight maintenance.

A Retrospective Study on the Safety and Efficacy of a Ketogenic Feeding Tube Diet in the Treatment of Obesity

“…We observed no serious complications due to feeding tube insertion including no epistaxis, sinusitis, nasal septum perforation, laryngospasm or aspiration pneumonia. The published Italian data on over 19,000 patients using a similar diet also confirmed the safety and lack of complications relating to the use of a feeding tube [10].…”

“…However, major limitations of pre-operative LCK diets are compliance and the time (at least six months) to achieve the required weight loss. However, a recent Italian study consisting of a retrospective analysis of over 19,000 patients suggested that ketogenic eternal nutrition cycles with a protein-only solution (KEN or NEC) administered via a nasogastric tube was safe and resulted in a rapid fat mass reduction in obese patients [10].…”

Very Low-Calorie Ketogenic Diet (VLCKD) as Pre-Operative First-Line Dietary Therapy in Patients with Obesity Who Are Candidates for Bariatric Surgery

“…Overall, KD has been shown to be an effective strategy for inducing rapid weight loss, and its use before surgery, especially when available in the short term, is particularly attractive [37]. The aim of this review was to summarize the current evidence on the VLCKD as pre-operative dietary treatment in patients with obesity candidates for BS.…”

The Real-Life Use of a Protein-Sparing Modified Fast Diet by Nasogastric Tube (ProMoFasT) in Adults with Obesity: An Open-Label Randomized Controlled Trial

“…According to Blackburn et al, the PSMF diet exhibits a protein-sparing effect, based on the rationale that the administration of amino acids during fasting without glucose induces a much smaller insulin response compared to the administration in combination with glucose, minimizing the antilipolytic effect of insulin [17]. However, it should be considered that the protein intake is interrupted throughout the night, resulting in protracted overnight fasting with muscle catabolism and a decrease in lipolytic action [18].…”

“…Thus, the continuous enteral nutrition (EN) of a high-protein diet administered through a nasogastric tube (NGT) may be a valid approach for counteracting the catabolism of lean mass [18]. Moreover, Beale et al observed a greater suppression of appetite and increased levels of glucagon-like peptide 1 and peptide YY with a single mixed-meal bolus via NGT compared to the same meal taken orally [19]; additionally, NGT feeding could bypass the limited poor dietary adherence characterizing VLCKDs [20,21].…”