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. 2023 Sep;46(9):1807-1814.
doi: 10.1007/s40618-023-02034-2. Epub 2023 Feb 21.

Efficacy, feasibility and tolerability of ketogenic diet for the treatment of poor response to bariatric surgery

F Vinciguerra  1 , S Longhitano  2 , N Carrubba  2 , L Piazza  3 , C Di Stefano  3 , M L Arpi  4 , R Baratta  4 , M Hagnäs  5   6 , L Frittitta  2   4   7
Affiliations

Efficacy, feasibility and tolerability of ketogenic diet for the treatment of poor response to bariatric surgery

F Vinciguerra et al. J Endocrinol Invest. 2023 Sep.

Abstract

Purpose: Poor response to bariatric surgery, namely insufficient weight loss (IWL) or weight regain (WR), is a critical issue in the treatment of obesity. The purpose of our study was to assess the efficacy, feasibility, and tolerability of very low-calorie ketogenic diet (VLCKD) for the management of this condition.

Methods: A real-life prospective study was conducted on twenty-two patients who experienced poor response after bariatric surgery and followed a structured VLCKD. Anthropometric parameters, body composition, muscular strength, biochemical analyses, and nutritional behavior questionnaires were evaluated.

Results: A significant weight loss (mean 14.1 ± 4.8%), mostly due to fat mass, was observed during VLCKD with the preservation of muscular strength. The weight loss obtained allowed patients with IWL to reach a body weight significantly lower than that obtained at the post-bariatric surgery nadir and to report the body weight of patients with WR at the nadir observed after surgery. The significantly beneficial changes in nutritional behaviors and metabolic profiles were observed without variations in kidney and liver function, vitamins, and iron status. The nutritional regimen was well tolerated, and no significant side effects were detected.

Conclusion: Our data demonstrate the efficacy, feasibility, and tolerability of VLCKD in patients with poor response after bariatric surgery.

Keywords: Bariatric surgery; Insufficient weight loss; Poor response; Very-low-calorie ketogenic diet; Weight regain.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose. We declare Lucia Frittitta is associate editor of the Journal of Endocrinology Investigation.

Figures

Fig. 1
Fig. 1
Body weight in the entire cohort (a), in patients with WR (b) and in patients with IWL (c) ^p < 0.005 vs pre-bariatric; §p < 0.005 vs nadir post-bariatric; *p < 0.005 vs pre VLCKD
Fig. 2
Fig. 2
Change in hunger, eating, and food craving-related items from the Control of Eating Questionnaire during the protocol. *p < 0.05 vs basal
See this image and copyright information in PMC

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