Effect of a Very-Low-Calorie Ketogenic Diet on Circulating Myokine Levels Compared with the Effect of Bariatric Surgery or a Low-Calorie Diet in Patients with Obesity

Ignacio Sajoux, Paula M Lorenzo, Diego Gomez-Arbelaez, M Angeles Zulet, Itziar Abete, Ana I Castro, Javier Baltar, María P Portillo, Francisco J Tinahones, J Alfredo Martinez, Ana B Crujeiras, Felipe F Casanueva, Ignacio Sajoux, Paula M Lorenzo, Diego Gomez-Arbelaez, M Angeles Zulet, Itziar Abete, Ana I Castro, Javier Baltar, María P Portillo, Francisco J Tinahones, J Alfredo Martinez, Ana B Crujeiras, Felipe F Casanueva

Abstract

: The preservation of muscle mass and muscle function after weight loss therapy is currently a considerable challenge in the fight against obesity. Muscle mass secretes proteins called myokines that have relevant functions in the regulation of metabolism and health. This study was aimed to evaluate whether a very low-calorie ketogenic (VLCK) diet may modulate myokine levels, in addition to changes in body composition, compared to a standard, balanced low-calorie (LC) diet or bariatric surgery in patients with obesity. Body composition, ketosis, insulin sensitivity and myokines were evaluated in 79 patients with overweight/obesity after a therapy to lose weight with a VLCK diet, a LC diet or bariatric surgery. The follow-up was 6 months. The weight loss therapies induced changes in myokine levels in association with changes in body composition and biochemical parameters. The effects on circulating myokine levels compared to those at baseline were stronger after the VLCK diet than LC diet or bariatric surgery. Differences reached statistical significance for IL-8, MMP2 and irisin. In conclusion, nutritional interventions or bariatric surgery to lose weight induces changes in circulating myokine levels, being this effect potentially most notable after following a VLCK diet.

Keywords: PnK method; bariatric surgery; body composition; fat free mass; ketogenic diet; low-calorie diet; obesity; protein diet; very low-energy diet.

Conflict of interest statement

A.B.C. and F.F.C. received advisory board fees and/or research grants from Pronokal Protein Supplies, Spain. I.S. is the Medical Director of Pronokal, Spain..

Figures

Figure 1
Figure 1
Effect of the weight-loss therapies on body weight and body composition during a follow-up period of 4–6 months. Data show differences compared to baseline for body weight (a), fat mass (b) and fat-free mass (c) after a very-low calorie ketogenic diet (VLCKD), a low-calorie diet (LCD) or bariatric surgery. Data are shown as mean values. ‡ Statistically significant (p < 0.05) changes across time calculated with repeated-measures ANOVA.
Figure 2
Figure 2
Comparison of circulating levels of myokines according to adiposity at baseline. Differences in interleukin (IL)-8, IL-6, matrix metalloproteinase-2 (MMP2) and irisin levels between normal-weight healthy individuals and patients with excess body weight, classified according to the body mass index as overweight (25–29.9), obesity (30–39.9) and morbid obesity (≥40). Data are presented as the mean; error bars represent the standard error. Asterisk (*) denotes statistically significant differences (p < 0.05) in relation to normal-weight individuals evaluated using ANOVA or ANCOVA adjusted for age, as applicable.
Figure 3
Figure 3
Changes in circulating myokine levels during a very-low calorie ketogenic diet (VLCKD), a low-calorie diet (LCD) or bariatric surgery. (a) Changes compared to baseline in interleukin (IL)-8 during the weight loss treatments. (b) Changes compared to baseline in circulating IL-6 levels during the weight loss treatments. (c) Changes compared to baseline in circulating metalloproteinase-2 (MMP2) levels during the weight loss treatments. (d) Changes compared to baseline in circulating irisin levels during the weight loss treatments. Data show differences compared to baseline during the time-course of the intervention. ‡ Statistically significant differences over the duration of the nutritional program (from 0 to 4–6 months) evaluated with repeated-measures ANOVA or ANCOVA adjusted for age, as applicable. * Statistically significant differences in relation to baseline evaluated by Student’s t-test within each weight loss treatment. † Statistically significant differences among the three therapeutic procedures to lose weight evaluated by univariate ANOVA.
Figure 4
Figure 4
Scatterplot representing the association between weight loss treatment-induced differences from baseline (Δ) at endpoint (2–3 months) in fat-free mass (FFM) and differences in circulating levels of interleukine-8 (IL-8) at endpoint and at follow-up (6 months). In the plots each point refers individual changes. The center line represents the linear regression trendline. The lines above and below the center line represent the upper and lower bounds of the 95% confidence interval around the trendline. VLCKD, very-low calorie ketogenic diet, LCD; low-calorie diet; r, correlation coefficient evaluated by the Rho Spearman test; p, p value.

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