Luigi Schiavo1,2, Vincenzo Pilone3, Gianluca Rossetti4, Alfonso Barbarisi5,6, Manuela Cesaretti7,8, Antonio Iannelli9,10,11. 1. Department of Cardio-Thoracic and Respiratory Science, University of Campania "Luigi Vanvitelli", Naples, Italy. luigi.schiavo@unicampania.it. 2. IX Division of General Surgery, Vascular Surgery, and Applied Biotechnology, Naples University Polyclinic, Naples, Italy. luigi.schiavo@unicampania.it. 3. Department of Medicine, Surgery, and Dentistry, "Scuola Medica Salernitana", University of Salerno, Salerno, Italy. 4. Bariatric Surgery and Metabolic Disease Unit, "Beato Matteo" Clinic, Vigevano, Pavia, Italy. 5. Department of Cardio-Thoracic and Respiratory Science, University of Campania "Luigi Vanvitelli", Naples, Italy. 6. IX Division of General Surgery, Vascular Surgery, and Applied Biotechnology, Naples University Polyclinic, Naples, Italy. 7. Department of HPB Surgery and Liver Transplantation, Hôpital Beaujon, AP-HP, Clichy, France. 8. Department of Nanophysics, Italian Institute of Technology, Genoa, Italy. 9. University of Nice Sophia-Antipolis, Nice, France. 10. Digestive Unit, Archet 2 Hospital, University Hospital of Nice, Nice, France. 11. Inserm, U1065, Team 8 "Hepatic complications of obesity", Nice, France.
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.
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 obesepatients (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 obesepatients scheduled for BS.
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Authors: Luigi Schiavo; Giovanni De Stefano; Francesco Persico; Stefano Gargiulo; Federica Di Spirito; Giulia Griguolo; Niccolò Petrucciani; Eric Fontas; Antonio Iannelli; Vincenzo Pilone Journal: Obes Surg Date: 2020-11-20 Impact factor: 4.129