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A 4-Week Preoperative Ketogenic Micronutrient-Enriched Diet Is Effective in Reducing Body Weight, Left Hepatic Lobe Volume, and Micronutrient Deficiencies in Patients Undergoing Bariatric Surgery: a Prospective Pilot Study

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Abstract

Background

Before bariatric surgery (BS), moderate weight loss, left hepatic lobe volume reduction, and micronutrient deficiency (MD) identification and correction are desirable.

Objectives

The objective of this study was to assess the safety and the effectiveness of a 4-week preoperative ketogenic micronutrient-enriched diet (KMED) in reducing body weight (BW), left hepatic lobe volume, and correcting MD in patients scheduled for BS.

Materials and Methods

In this prospective pilot study, a cohort of morbidly obese patients (n = 27, 17 females, 10 males) with a mean body mass index (BMI) of 45.2 kg/m2 scheduled for BS underwent a 4-week preoperative KMED. Their BW, BMI, fat mass (FM), fat-free mass (FFM), resting metabolic rate (RMR), left hepatic lobe volume, micronutrient status, and biochemical and metabolic patterns were measured before and after the 4-week KMED. Patient compliance was assessed by validated questionnaires (3-day estimated food records and 72-h recall). Qualitative methods (5-point Likert questionnaire) were used to measure diet acceptability and side effects.

Results

All patients completed the study. We observed highly significant decreases in BW (− 10.3%, p < 0.001, in males; − 8.2%, p < 0.001, in females), left hepatic lobe volume (− 19.8%, p < 0.001), and an amelioration of patient micronutrient status. All patients showed a high frequency of acceptability and compliance in following the diet. No adverse side effect was reported.

Conclusion

This study demonstrates that a 4-week preoperative KMED is safe and effective in reducing BW, left hepatic lobe volume, and correcting MD in obese patients scheduled for BS.

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Author information

Authors and Affiliations

  1. Department of Cardio-Thoracic and Respiratory Science, University of Campania “Luigi Vanvitelli”, Naples, Italy

    Luigi Schiavo & Alfonso Barbarisi

  2. IX Division of General Surgery, Vascular Surgery, and Applied Biotechnology, Naples University Polyclinic, Naples, Italy

    Luigi Schiavo & Alfonso Barbarisi

  3. Department of Medicine, Surgery, and Dentistry, “Scuola Medica Salernitana”, University of Salerno, Salerno, Italy

    Vincenzo Pilone

  4. Bariatric Surgery and Metabolic Disease Unit, “Beato Matteo” Clinic, Vigevano, Pavia, Italy

    Gianluca Rossetti

  5. Department of HPB Surgery and Liver Transplantation, Hôpital Beaujon, AP-HP, Clichy, France

    Manuela Cesaretti

  6. Department of Nanophysics, Italian Institute of Technology, Genoa, Italy

    Manuela Cesaretti

  7. University of Nice Sophia-Antipolis, Nice, France

    Antonio Iannelli

  8. Digestive Unit, Archet 2 Hospital, University Hospital of Nice, Nice, France

    Antonio Iannelli

  9. Inserm, U1065, Team 8 “Hepatic complications of obesity”, Nice, France

    Antonio Iannelli

Authors
  1. Luigi Schiavo
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  6. Antonio Iannelli
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Corresponding author

Correspondence to Luigi Schiavo.

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Conflict of Interest

The Ketocompleat was kindly provided by MVMedical Solutions.

AI and LS received travel grants and consulting fees from MVMedical Solutions.

Informed Consent

Written informed consent was obtained for each individual participant included in the study.

Ethical Approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments.

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Schiavo, L., Pilone, V., Rossetti, G. et al. A 4-Week Preoperative Ketogenic Micronutrient-Enriched Diet Is Effective in Reducing Body Weight, Left Hepatic Lobe Volume, and Micronutrient Deficiencies in Patients Undergoing Bariatric Surgery: a Prospective Pilot Study. OBES SURG 28, 2215–2224 (2018). https://doi.org/10.1007/s11695-018-3145-8

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  • DOI: https://doi.org/10.1007/s11695-018-3145-8

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