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
Before bariatric surgery (BS), moderate weight loss, left hepatic lobe volume reduction, and micronutrient deficiency (MD) identification and correction are desirable.
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.
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.
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.
KeywordsObesity Weight loss Ketogenic diet Liver volume Steatosis Micronutrient deficiencies Bariatric surgery
Compliance with Ethical Standards
Conflict of Interest
The Ketocompleat was kindly provided by MVMedical Solutions.
AI and LS received travel grants and consulting fees from MVMedical Solutions.
Written informed consent was obtained for each individual participant included in the study.
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.
- 14.Schiavo L, Scalera G, Pilone V, De Sena G, Capuozzo V, Barbarisi A. Micronutrient deficiencies in patients candidate for bariatric surgery: a prospective, preoperative trial of screening, diagnosis, and treatment. Int J Vitam Nutr Res. 2016;1–8. https://doi.org/10.1024/0300-9831/a000282.
- 17.Smith Jr JC, Butrimovitz GP, Purdy WC. Direct measurement of zinc in plasma by atomic adsorption spectroscopy. Clin Chem. 1979;25(8):1487–91.Google Scholar
- 26.Schiavo L, Favrè G, Pilone V, Rossetti G, de Sena G, Iannelli A, Barbarisi A Low-purine diet is more effective than normal-purine diet in reducing the risk of gouty attacks after sleeve gastrectomy in patients suffering of gout before surgery: a retrospective study. Obes Surg. 2017. https://doi.org/10.1007/s11695-017-2984-z
- 37.Kimmons JE, Blanck HM, Tohil BC, et al. Association between body mass index and the prevalence of low micronutrient levels among US adults. Med Gen Med. 2006;19:8–59.Google Scholar