Metabolic effects, safety, and acceptability of very low-calorie ketogenic dietetic scheme on candidates for bariatric surgery

Pilone, Vincenzo; Tramontano, Salvatore; Renzulli, Michele; Romano, Mafalda; Cobellis, Luigi; Berselli, Tiziano; Schiavo, Luigi

doi:10.1016/j.soard.2018.03.018

Cited by 47 publications

(26 citation statements)

References 21 publications

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“…A similar 30-day sequential preoperative regimen was used in another uncontrolled study showing a significant reduction in weight, waist circumference and visceral fat, and an improvement in several clinical parameters, including glycemic and lipid profiles. Moreover, a mean 30% reduction in liver volume was also observed [38]. Finally, in a third non randomized study, patients were treated with either VLCKD or VLCD for 3 weeks prior to BS.…”

Section: Vlcd and Vlckd Before Bs May Reduce Surgical Riskmentioning

confidence: 96%

Diet approach before and after bariatric surgery

Bettini

Belligoli

Fabris

2020

Rev Endocr Metab Disord

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Bariatric surgery (BS) is today the most effective therapy for inducing long-term weight loss and for reducing comorbidity burden and mortality in patients with severe obesity. On the other hand, BS may be associated to new clinical problems, complications and side effects, in particular in the nutritional domain. Therefore, the nutritional management of the bariatric patients requires specific nutritional skills. In this paper, a brief overview of the nutritional management of the bariatric patients will be provided from pre-operative to post-operative phase. Patients with severe obesity often display micronutrient deficiencies when compared to normal weight controls. Therefore, nutritional status should be checked in every patient and correction of deficiencies attempted before surgery. At present, evidences from randomized and retrospective studies do not support the hypothesis that pre-operative weight loss could improve weight loss after BS surgery, and the insurance-mandated policy of a preoperative weight loss as a pre-requisite for admission to surgery is not supported by medical evidence. On the contrary, some studies suggest that a modest weight loss of 5–10% in the immediate preoperative period could facilitate surgery and reduce the risk of complications. Very low calories diet (VLCD) and very low calories ketogenic diets (VLCKD) are the most frequently used methods for the induction of a pre-operative weight loss today. After surgery, nutritional counselling is recommended in order to facilitate the adaptation of the eating habits to the new gastro-intestinal physiology. Nutritional deficits may arise according to the type of bariatric procedure and they should be prevented, diagnosed and eventually treated. Finally, specific nutritional problems, like dumping syndrome and reactive hypoglycaemia, can occur and should be managed largely by nutritional manipulation. In conclusion, the nutritional management of the bariatric patients requires specific nutritional skills and the intervention of experienced nutritionists and dieticians.

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Section: Vlcd and Vlckd Before Bs May Reduce Surgical Riskmentioning

confidence: 96%

Diet approach before and after bariatric surgery

Bettini

Belligoli

Fabris

2020

Rev Endocr Metab Disord

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“…For this reason, it has been successfully used in subjects with severe obesity, suitable for bariatric surgery, in order to achieve a fast pre-operative weight loss, which has been demonstrated to reduce the risk of pre- and post-operative complications. In particular, it has been hypothesized that the efficacy of following a pre-operative VLCKD is, at least in part, attributable to the reduction in liver volume and degree of steatosis [ 15 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Very Low-Carbohydrate Ketogenic Diet for the Treatment of Severe Obesity and Associated Non-Alcoholic Fatty Liver Disease: The Role of Sex Differences

et al. 2020

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Very low-carbohydrate ketogenic diets (VLCKDs) are an emerging nutritional treatment for severe obesity and are associated with a significant improvement in non-alcoholic fatty liver disease (NAFLD). Little is known about the effect of sex differences on weight loss induced by following a VLCKD. The aim of this study was to investigate the effects of sex differences on weight loss and NAFLD improvement in patients with severe obesity undergoing a VLCKD. Forty-two females and 28 males with severe obesity underwent a 25-day VLCKD. Anthropometric parameters, bioimpedentiometry, degree of liver steatosis measured by ultrasonography, liver function tests, and glucose homeostasis were measured before and after the VLCKD. Males experienced a significantly larger excess body weight loss (EBWL) and a greater reduction in γ-glutamyl transferase (γGT) than females. Dividing the female group by menopausal status, a significant difference between males and pre-menopausal females was found for both EBWL and γGT. No significant difference between groups was observed for improvement in the Edmonton stage or in the degree of steatosis. We conclude that the efficacy of following a VLCKD in severe obesity is affected by sex differences and, for females, by menopausal status. Males seem to experience larger benefits than females in terms of EBWL and NAFLD improvement. These differences are attenuated after menopause, probably because of changes in hormonal profile and body composition.

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“…Moreover, the degree of operative risk reduction seems to be related to the amount of weight loss [11]. Since the amount of weight loss obtained with VLCKD is related to the improvement in liver volume and steatosis [12], it has been hypothesized that the efficacy of pre-operative VLCKD is, at least in part, attributable to its effect on liver steatosis [13].…”

Section: Introductionmentioning

confidence: 99%

Lysosomal Acid Lipase as a Molecular Target of the Very Low Carbohydrate Ketogenic Diet in Morbidly Obese Patients: The Potential Effects on Liver Steatosis and Cardiovascular Risk Factors

Ministrini

Calzini

Migliola

et al. 2019

JCM

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A very low carbohydrate ketogenic diet (VLCKD) is an emerging technique to induce a significant, well-tolerated, and rapid loss of body weight in morbidly obese patients. The low activity of lysosomal acid lipase (LAL) could be involved in the pathogenesis of non-alcoholic fatty liver disease (NAFLD), which is a common feature in morbidly obese patients. Fifty-two obese patients suitable for a bariatric surgery intervention underwent a 25-day-long VLCKD. The biochemical markers of glucose and lipid metabolism, and flow-mediated dilation (FMD) of the brachial artery were measured before and after VLCKD. LAL activity was measured using the dried blood spot technique in 20 obese patients and in a control group of 20 healthy, normal-weight subjects. After VLCKD, we observed a significant reduction in body mass index, fasting glucose, insulinemia, and lipid profile parameters. No significant variation in FMD was observed. The number of patients with severe liver steatosis significantly decreased. LAL activity significantly increased, although the levels were not significantly different as compared to the control group. In conclusion, VLCKD induces the activity of LAL in morbidly obese subjects and reduces the secretion of all circulating lipoproteins. These effects could be attributed to the peculiar composition of the diet, which is particularly poor in carbohydrates and relatively rich in proteins.

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Metabolic effects, safety, and acceptability of very low-calorie ketogenic dietetic scheme on candidates for bariatric surgery

Cited by 47 publications

References 21 publications

Diet approach before and after bariatric surgery

Diet approach before and after bariatric surgery

Very Low-Carbohydrate Ketogenic Diet for the Treatment of Severe Obesity and Associated Non-Alcoholic Fatty Liver Disease: The Role of Sex Differences

Lysosomal Acid Lipase as a Molecular Target of the Very Low Carbohydrate Ketogenic Diet in Morbidly Obese Patients: The Potential Effects on Liver Steatosis and Cardiovascular Risk Factors

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