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Vinciguerra F, Longhitano S, Carrubba N, Piazza L, Di Stefano C, Arpi ML, Baratta R, Hagnäs M, Frittitta L. Efficacy, feasibility and tolerability of ketogenic diet for the treatment of poor response to bariatric surgery. J Endocrinol Invest 2023:10.1007/s40618-023-02034-2. [PMID: 36809658 PMCID: PMC10371952 DOI: 10.1007/s40618-023-02034-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/05/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE Poor response to bariatric surgery, namely insufficient weight loss (IWL) or weight regain (WR), is a critical issue in the treatment of obesity. The purpose of our study was to assess the efficacy, feasibility, and tolerability of very low-calorie ketogenic diet (VLCKD) for the management of this condition. METHODS A real-life prospective study was conducted on twenty-two patients who experienced poor response after bariatric surgery and followed a structured VLCKD. Anthropometric parameters, body composition, muscular strength, biochemical analyses, and nutritional behavior questionnaires were evaluated. RESULTS A significant weight loss (mean 14.1 ± 4.8%), mostly due to fat mass, was observed during VLCKD with the preservation of muscular strength. The weight loss obtained allowed patients with IWL to reach a body weight significantly lower than that obtained at the post-bariatric surgery nadir and to report the body weight of patients with WR at the nadir observed after surgery. The significantly beneficial changes in nutritional behaviors and metabolic profiles were observed without variations in kidney and liver function, vitamins, and iron status. The nutritional regimen was well tolerated, and no significant side effects were detected. CONCLUSION Our data demonstrate the efficacy, feasibility, and tolerability of VLCKD in patients with poor response after bariatric surgery.
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Affiliation(s)
- F Vinciguerra
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
| | - S Longhitano
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - N Carrubba
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - L Piazza
- General and Emergency Surgery Department, Garibaldi Hospital, Catania, Italy
| | - C Di Stefano
- General and Emergency Surgery Department, Garibaldi Hospital, Catania, Italy
| | - M L Arpi
- Endocrinology Unit: Garibaldi Hospital, Catania, Italy
| | - R Baratta
- Endocrinology Unit: Garibaldi Hospital, Catania, Italy
| | - M Hagnäs
- Rovaniemi Health Center, Rovaniemi and Primary Health Care Unit, Lapland Central Hospital, Rovaniemi, Finland
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - L Frittitta
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Endocrinology Unit: Garibaldi Hospital, Catania, Italy
- Diabetes, Obesity and Dietetic Center, Garibaldi Hospital, Catania, Italy
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Casanueva FF, Castellana M, Bellido D, Trimboli P, Castro AI, Sajoux I, Rodriguez-Carnero G, Gomez-Arbelaez D, Crujeiras AB, Martinez-Olmos MA. Ketogenic diets as treatment of obesity and type 2 diabetes mellitus. Rev Endocr Metab Disord 2020; 21:381-397. [PMID: 32803691 DOI: 10.1007/s11154-020-09580-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
During the last decades, several interventions for the management of overweight and obesity have been proposed. Among diets, the first studies focused on the effect of water only and total fasting diets with or without proteins. Unfortunately, they were found to be associated with adverse events which lead to the abandon of these strategies. Interestingly, despite the radical approach, total fasting was effective and generally well tolerated. A strict connection between protein-calorie malnutrition and increased in morbidity and mortality in hospitalized patients was found at that time. Then, the seminal works of Blackburn and his collaborators lead to the introduction of the protein-sparing modified fast. Encouraged by the early results using this intervention, diets evolved to the current very-low-calorie ketogenic diets (VLCKD). In the present review, results of studies on the VLCKDs are presented and discussed, with a particular reference to the protocolled VLCKD. Also, a recent proposal on the nomenclature on the ketogenic diets is reported. Available evidence suggests VLCKDs to be effective in achieving a rapid and significant weight loss by means of an easily reversible intervention which could be repeated, if needed. Muscle mass and strength are preserved, resting metabolic rate is not impaired, hunger, appetite and mood are not worsened. Symptoms and abnormal laboratory findings can be there, but they have generally been reported as of mild intensity and transient. Preliminary studies suggest VLCKDs to be a potential game-changer in the management of type 2 diabetes too. Therefore, VLCKDs should be considered as an excellent initial step in properly selected and motivated patients with obesity or type 2 diabetes, to be delivered as a part of a multicomponent strategy and under strict medical supervision.
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Affiliation(s)
- Felipe F Casanueva
- Division of Endocrinology, Department of Medicine, Santiago de Compostela University (USC), Complejo Hospitalario Universitario de Santiago, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago, Spain.
- CIBEROBN de Fisiopatologia de Obesidad y Nutricion, Santiago de Compostela, Santiago, Spain.
| | - Marco Castellana
- National Institute of Gastroenterology "S. De Bellis", Bari, Castellana Grotte, Italy
| | - Diego Bellido
- Division of Endocrinology, Complejo Hospitalario Universitario de Ferrol and Coruña University, Ferrol, Spain
| | - Pierpaolo Trimboli
- Clinic of Endocrinology and Diabetology, Lugano and Mendrisio Regional Hospital, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Ana I Castro
- Division of Endocrinology, Department of Medicine, Santiago de Compostela University (USC), Complejo Hospitalario Universitario de Santiago, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago, Spain
- CIBEROBN de Fisiopatologia de Obesidad y Nutricion, Santiago de Compostela, Santiago, Spain
| | - Ignacio Sajoux
- Medical Department Pronokal, Pronokal Group, Barcelona, Spain
| | - Gemma Rodriguez-Carnero
- Division of Endocrinology, Department of Medicine, Santiago de Compostela University (USC), Complejo Hospitalario Universitario de Santiago, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago, Spain
| | - Diego Gomez-Arbelaez
- Faculty of Health Sciences, University of Santander (UDES), Bucaramanga, 680003, Colombia
| | - Ana B Crujeiras
- Division of Endocrinology, Department of Medicine, Santiago de Compostela University (USC), Complejo Hospitalario Universitario de Santiago, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago, Spain
- CIBEROBN de Fisiopatologia de Obesidad y Nutricion, Santiago de Compostela, Santiago, Spain
- Epigenomics in Endocrinology Nutrition Group, Santiago, Spain
| | - Miguel A Martinez-Olmos
- Division of Endocrinology, Department of Medicine, Santiago de Compostela University (USC), Complejo Hospitalario Universitario de Santiago, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago, Spain
- CIBEROBN de Fisiopatologia de Obesidad y Nutricion, Santiago de Compostela, Santiago, Spain
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