Obesity Surgery

, Volume 28, Issue 12, pp 3756–3768 | Cite as

Effects of Two Preoperatory Weight Loss Diets on Hepatic Volume, Metabolic Parameters, and Surgical Complications in Morbid Obese Bariatric Surgery Candidates: a Randomized Clinical Trial

  • A. Gils Contreras
  • A. Bonada Sanjaume
  • M. Montero Jaime
  • A. Rabassa Soler
  • F. Sabench Pereferrer
  • A. Molina López
  • N. Becerra Tomás
  • D. Del Castillo DéjardinEmail author
  • J. Salas-SalvadóEmail author
Original Contributions



To assess which type of preoperative dietary strategy is most effective in reducing liver volume and assessing its influence on different biochemical parameters and on surgical complications in individuals undergoing bariatric surgery.


Parallel randomized trial comparing the effect of a very low calorie diet (VLCD) and a low calorie diet (LCD) for a period of 21 days before surgery on hepatic volume, anthropometric and biochemical parameters. Compliance and tolerance to the diets, surgical complications, and hospital stay were also determined.


Eighty-six morbid obese participants undergoing bariatric surgery were randomized. The hepatic volume was significantly reduced in both intervention groups, but no differences in changes between groups were detected. The reduction in the hepatic volume was higher in those patients with a baseline hepatic volume > 3 L compared to those with < 3 L (adjusted P value < 0.001). The percentages of total weight lost were 5.8 and 4.2% (adjusted P value = 0.004) for participants on the VLCD and LCD, respectively. There were no differences between groups for any of the biochemical parameters analyzed, nor in the number of surgical complications nor the length of hospital stay. Adherence to the diet was good; nevertheless, participants in the VLCD intervention showed worse tolerance.


In subjects with morbid obesity undergoing bariatric surgery, compared to a LCD, a preoperative 21-day intervention with VLCD is more effective in terms of reducing total body weight but not in terms of reducing the liver volume. Both types of preoperative diets have similar effects on clinical biochemical parameters, rate of surgical complications, and hospital length stay.


Preoperative diet Bariatric surgery Liver size Weight loss 


Compliance with Ethical Standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of Interest

Author 9 reports receiving a grant from Nestle thorough his Institution. The rest of authors declare that they have no conflict of interest.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    World Health Organization (WHO) –NCD RisC. (NCD RiSk Factor Collaboration). [Internet]. 2017. Available from:
  2. 2.
    Attar BM, Van Thiel DH. Current concepts and management approaches in nonalcoholic fatty liver disease. Sci World J [Internet]. 2013;2013. Available from:
  3. 3.
    Sasaki A, Nitta H, Otsuka K, Umemura A, Baba S, Obuchi T, et al. Bariatric surgery and non-alcoholic fatty liver disease: Current and potential future treatments. Front Endocrinol (Lausanne). 2014;5(OCT):1–6.Google Scholar
  4. 4.
    Sjöström CD, Lissner L, Wedel H, et al. Reduction in incidence of diabetes, hypertension and lipid disturbances after intentional weight loss induced by bariatric surgery: the SOS intervention study. Obes Res. 1999;7:477–84.CrossRefGoogle Scholar
  5. 5.
    Edholm D, Kullberg J, Karlsson FA, et al. Changes in liver volume and body composition during 4 weeks of low calorie diet before laparoscopic gastric bypass. Surg Obes Relat Dis. 2015;11(3):602–6. Available from:. Scholar
  6. 6.
    van Wissen J, Bakker N, Doodeman HJ, et al. Preoperative methods to reduce liver volume in bariatric surgery: a systematic review. Obes Surg. 2016;26(2):251–6.CrossRefGoogle Scholar
  7. 7.
    Van-Nieuwenhove Y. Preoperative Very Low-Calorie Diet and Operative Outcome After Laparoscopic Gastric Bypass. A Randomized Multicenter Study. Arch Surg. 2011;146(11):1300. Available from: CrossRefGoogle Scholar
  8. 8.
    Kim JJ, Rogers AM, Ballem N, et al. ASMBS updated position statement on insurance mandated preoperative weight loss requirements. Surg Obes Relat Dis. 2016;12(5):955–9. Available from:. Scholar
  9. 9.
    Lewis M, Phillips M, Slavotinek J, et al. Change in liver size and fat content after treatment with Optifast ® very low calorie diet. Obes Surg. 2006;16(6):697–701.CrossRefGoogle Scholar
  10. 10.
    Collins J, McCloskey C, Titchner R, et al. Preoperative weight loss in high-risk superobese bariatric patients: a computed tomography-based analysis. Surg Obes Relat Dis. 2011;7(4):480–5. Available from:. Scholar
  11. 11.
    Colles SL, Dixon JB, Marks P, et al. Preoperative weight loss with a very-low-energy diet: quantitation of changes in liver and abdominal fat by serial imaging. Am J Clin Nutr. 2006;84(2):304–11. Available from: CrossRefGoogle Scholar
  12. 12.
    González-Pérez J, Sánchez-Leenheer S, Delgado AR, et al. Clinical impact of a 6-week preoperative very low calorie diet on body weight and liver size in morbidly obese patients. Obes Surg. 2013;23(10):1624–31.CrossRefGoogle Scholar
  13. 13.
    Faria SL, Faria OP, de Cardeal MA, et al. Effects of a very low calorie diet in the preoperative stage of bariatric surgery: a randomized trial. Surg Obes Relat Dis. 2015;11(1):230–7. Available from: CrossRefGoogle Scholar
  14. 14.
    Alabdali F, Rueda-Clausen CF, Robbins S, et al. Efficacy and safety of long-term low-calorie diet in severely obese patients non-eligible for surgery. Clin Obes. 2013;3(3–4):90–4.CrossRefGoogle Scholar
  15. 15.
    Benjaminov O, Beglaibter N, Gindy L, et al. The effect of a low-carbohydrate diet on the nonalcoholic fatty liver in morbidly obese patients before bariatric surgery. Surg Endosc Other Interv Tech. 2007;21(8):1423–7.CrossRefGoogle Scholar
  16. 16.
    Pekkarinen T. Use of very low-calorie diet in preoperative weight loss: efficacy and safety. Obes Res. 1997;5(6):595–602.CrossRefGoogle Scholar
  17. 17.
    Carbajo MA, Castro MJ, Kleinfinger S, et al. Effects of a balanced energy and high protein formula diet (Vegestart complet®) vs. low-calorie regular diet in morbid obese patients prior to bariatric surgery (laparoscopic single anastomosis gastric bypass): a prospective, double-blind randomized study. Nutr Hosp. 2010;25(6):939–48.PubMedGoogle Scholar
  18. 18.
    Schouten R, van der Kaaden I. Van ‘t Hof G, Feskens PGBM. Comparison of preoperative diets before bariatric surgery: a randomized, single-blinded, non-inferiority trial. Obes Surg. 2016;26(8):1743–9.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Nutrition Unit, Department of Internal MedicineUniversity Hospital of Sant JoanReusSpain
  2. 2.Human Nutrition Unit, Faculty of Medicine and Health SciencesUniversitat Rovira i VirgiliReusSpain
  3. 3.Diagnostic Service for the Image, Department of RadiologyUniversity Hospital of Sant JoanReusSpain
  4. 4.Bariatric and Metabolic Surgery Unit, General and Digestive Surgery DepartmentUniversity Hospital of Sant JoanReusSpain
  5. 5.Surgery Service, Sant Joan University Hospital, Faculty of Medicine and Health Sciences, IISPVRovira i Virgili UniversityReusSpain
  6. 6.Consorcio CIBER, M.P., Physiopathology of Obesity and Nutrition (CIBERobn)Instituto de Salud Carlos III (ISCIII)MadridSpain

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