Efficacy of a 2-Month Very Low-Calorie Ketogenic Diet (VLCKD) Compared to a Standard Low-Calorie Diet in Reducing Visceral and Liver Fat Accumulation in Patients With Obesity

Guilherme Moura Cunha, German Guzman, Livia Lugarinho Correa De Mello, Barbara Trein, Luciana Spina, Isabela Bussade, Juliana Marques Prata, Ignacio Sajoux, Walmir Countinho, Guilherme Moura Cunha, German Guzman, Livia Lugarinho Correa De Mello, Barbara Trein, Luciana Spina, Isabela Bussade, Juliana Marques Prata, Ignacio Sajoux, Walmir Countinho

Abstract

Background: Currently the treatment of non-alcoholic fatty liver disease (NAFLD) is based on weight loss through lifestyle changes, such as exercise combined with calorie-restricted dieting. Objectives: To assess the effects of a commercially available weight loss program based on a very low-calorie ketogenic diet (VLCKD) on visceral adipose tissue (VAT) and liver fat content compared to a standard low-calorie (LC) diet. As a secondary aim, we evaluated the effect on liver stiffness measurements. Methods: Open, randomized controlled, prospective pilot study. Patients were randomized and treated either with an LC or a VLCKD and received orientation and encouragement to physical activity equally for both groups. VAT, liver fat fraction, and liver stiffness were measured at baseline and after 2 months of treatment using magnetic resonance imaging. Paired t-tests were used for comparison of continuous variables between visits and unpaired test between groups. Categorical variables were compared using the χ2-test. Pearson correlation was used to assess the association between VAT, anthropometric measures, and hepatic fat fraction. A significance level of the results was established at p < 0.05. Results: Thirty-nine patients (20 with VLCKD and 19 with LC) were evaluated at baseline and 2 months of intervention. Relative weight loss at 2 months was -9.59 ± 2.87% in the VLCKD group and -1.87 ± 2.4% in the LC group (p < 0.001). Mean reductions in VAT were -32.0 cm2 for VLCKD group and -12.58 cm2 for LC group (p < 0.05). Reductions in liver fat fraction were significantly more pronounced in the VLCKD group than in the LC group (4.77 vs. 0.79%; p < 0.005). Conclusion: Patients undergoing a VLCKD achieved superior weight loss, with significant VAT and liver fat fraction reductions when compared to the standard LC diet. The weight loss and rapid mobilization of liver fat demonstrated with VLCKD could serve as an effective alternative for the treatment of NAFLD. Clinical Trial Registration: ClinicalTrials.gov, identifier: NCT04322110.

Keywords: NAFLD; Pnk method; ketogenic diet; liver PDFF; very low-calorie ketogenic diet; visceral adipose tissue.

Copyright © 2020 Cunha, Guzman, Correa De Mello, Trein, Spina, Bussade, Marques Prata, Sajoux and Countinho.

Figures

Figure 1
Figure 1
Active phase dietary counseling for patients undergoing the VLCKD method.
Figure 2
Figure 2
Study diagram describing the included population and groups.
Figure 3
Figure 3
Reduction in VAT and liver fat content assessed by PDFF between the two study groups.
Figure 4
Figure 4
Comparison of liver steatosis between VLCKD and LCD groups at baseline and follow-up.

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