Obesity Surgery

, Volume 28, Issue 8, pp 2215–2224 | Cite as

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

  • Luigi Schiavo
  • Vincenzo Pilone
  • Gianluca Rossetti
  • Alfonso Barbarisi
  • Manuela Cesaretti
  • Antonio Iannelli
Original Contributions



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.


Obesity 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.

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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Copyright information

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

Authors and Affiliations

  1. 1.Department of Cardio-Thoracic and Respiratory ScienceUniversity of Campania “Luigi Vanvitelli”NaplesItaly
  2. 2.IX Division of General Surgery, Vascular Surgery, and Applied BiotechnologyNaples University PolyclinicNaplesItaly
  3. 3.Department of Medicine, Surgery, and Dentistry, “Scuola Medica Salernitana”University of SalernoSalernoItaly
  4. 4.Bariatric Surgery and Metabolic Disease Unit, “Beato Matteo” ClinicVigevanoItaly
  5. 5.Department of HPB Surgery and Liver Transplantation, Hôpital Beaujon, AP-HPClichyFrance
  6. 6.Department of NanophysicsItalian Institute of TechnologyGenoaItaly
  7. 7.University of Nice Sophia-AntipolisNiceFrance
  8. 8.Digestive Unit, Archet 2 HospitalUniversity Hospital of NiceNiceFrance
  9. 9.Inserm, U1065, Team 8 “Hepatic complications of obesity”NiceFrance

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