Abstract
Background
We evaluated the effectiveness of a sequential diet regimen termed the obese preoperative diet (OPOD) in morbidly obese patients with and without type 2 diabetes mellitus (T2DM) scheduled for laparoscopic bariatric surgery.
Methods
Fifty patients (body mass index 53.5 ± 8.4 kg/m2) scheduled for bariatric surgery, including 14 with T2DM, were prospectively enrolled and followed the OPOD regimen: a very low-calorie ketogenic diet for 10 days, followed by a very low-calorie diet for 10 days, and then a low-calorie diet for 10 days. Patients were evaluated at baseline (T0) and after 10 days (T1), 20 days (T2), and 30 days (T3).
Results
Body weight, body mass index, waist circumference, and neck circumference were significantly lower at T1, T2, and T3 than at T0 in the 48 patients who completed the OPOD. Two patients discontinued the OPOD after 4–7 days. In patients with T2DM, fasting plasma glucose levels decreased significantly, enabling reduction of diabetic medications. Plasma and urine ketone levels increased at T1 but were all <1 mmol/L, and hunger decreased during the diet period.
Conclusions
OPOD, including 10 days of a VLCKD, was safe and effective in morbidly obese patients, and it seems to be promising in morbidly obese patients with and without T2DM scheduled for laparoscopic bariatric surgery.
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References
Craig BM, Tseng DS. Cost-effectiveness of gastric bypass for severe obesity. Am J Med. 2002;113:491–8.
Buchwald H, Ikramuddin S, Dorman RB, et al. Management of the metabolic/bariatric surgery patient. Am J Med. 2011;124:1099–105.
Sjöström L, Peltonen M, Jacobson P. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307(1):56–65.
DeMaria EJ, Portenier D, Wolfe L. Obesity surgery mortality risk score: proposal for a clinically useful score to predict mortality risk in patients undergoing gastric bypass. Surg Obes Relat Dis. 2007;3(2):134–40.
Thomas H, Agrawal S. Systematic review of obesity surgery mortality risk score—preoperative risk stratification in bariatric surgery. Obes Surg. 2012;22(7):1135–40.
Van Nieuwenhove Y, Dambrauskas Z, Campillo-Soto A, et al. Preoperative very low-calorie diet and operative outcome after laparoscopic gastric bypass: a randomized multicenter study. Arch Surg. 2011;146:13005.
Tarnoff M, Kaplan LM, Shikora S. An evidence based assessment of preoperative weight loss in bariatric surgery. Obes Surg. 2008;18:1059–61.
Livhits M, Mercado C, Yermilov I, et al. Does weight loss immediately before bariatric surgery improve outcomes: a systematic review. Surg Obes Relat Dis. 2009;5:713–21.
Cassie S, Menezes C, Birch DW, et al. Effect of preoperative weight loss in bariatric surgical patients: a systematic review. Surg Obes Relat Dis. 2011;7(6):760–7.
Adrianzén Vargas M, Cassinello Fernández N, Ortega Serrano J. Preoperative weight loss in patients with indication of bariatric surgery: which is the best method? Nutr Hosp. 2011;26(6):1227–30.
Al-Khalifa A, Mathew TC, Al-Zaid NS, et al. Therapeutic role of low-carbohydrate ketogenic diet in diabetes. Nutrition. 2009;25:1177–85.
Dashti HM, Mathew TC, Khadada M, et al. Beneficial effects of ketogenic diet in obese diabetic subjects. Mol Cell Biochem. 2007;302:249–56.
Brehm BJ, Seeley RJ, Daniels SR, et al. A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women. J Clin Endocrinol Metab. 2003;88:1617–23.
Veech RL. The therapeutic implications of ketone bodies: the effects of ketone bodies in pathological conditions: ketosis, ketogenic diet, redox states, insulin resistance, and mitochondrial metabolism. Prostaglandins Leukot Essent Fat Acids. 2004;70:309–19.
Dashti HM, Al-Zaid NS, Mathew TC, et al. Long term effects of ketogenic diet in obese subjects with high cholesterol level. Mol Cell Biochem. 2006;286:1–9.
Bueno NB, de Melo ISV, de Oliveira SL, et al. Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. Br J Nutr. 2013;110:1178–87.
Braga M, Ljungqvist O, Soeters P, et al. ESPEN guidelines on parenteral nutrition: surgery. Clin Nutr. 2009;28:378–86.
Gustafsson UO, Scott MJ, Schwenk W, et al. Guidelines for perioperative care in elective colonic surgery: enhanced recovery after surgery (ERAS®) society recommendations. Clin Nutr. 2012;31:783–800.
American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2011;34 Suppl 1:S11–61.
Busetto L, Segato G, De Luca M, et al. Preoperative weight loss by intragastric balloon in super-obese patients treated with laparoscopic gastric banding: a case-control study. Obes Surg. 2004;14:671–6.
Fris RJ. Preoperative low energy diet diminishes liver size. Obes Surg. 2004;4(9):1165–70.
Owers CE, Abbas Y, Ackroyd R, Barron N, Khan M. Perioperative optimization of patients undergoing bariatric surgery. J Obes 2012; 2012:781546.
Hession M, Rolland C, Kulkarni U, et al. Systematic review of randomized controlled trials of low-carbohydrate vs. low-fat/low-calorie diets in the management of obesity and its comorbidities. Obes Rev. 2009;10:36–50.
Feinman RD, Volek JS. Carbohydrate restriction as the default treatment for type 2 diabetes and metabolic syndrome. Scand Cardiovasc J. 2008;42:256–63.
Lankinen M, Schwab U, Gopalacharyulu PV, et al. Dietary carbohydrate modification alters serum metabolic profiles in individuals with the metabolic syndrome. Nutr Metab Cardiovasc Dis. 2010;20:249–57.
Adam-Perrot A, Clifton P, Brouns F. Low-carbohydrate diets: nutritional and physiological aspects. Obes Rev. 2006;7:49–58.
Sharman MJ, Kraemer WJ, Love DM, et al. A ketogenic diet favorably affects serum biomarkers for cardiovascular disease in normal-weight men. J Nutr. 2002;132:1879–85.
Hussain TA, Mathew TC, Dashti AA, et al. Effect of low-calorie versus low-carbohydrate ketogenic diet in type 2 diabetes. Nutrition. 2012;28:1016–21.
McClernon FJ, Yancy Jr WS, Eberstein JA, et al. The effects of a low-carbohydrate ketogenic diet and a low-fat diet on mood, hunger, and other self-reported symptoms. Obesity (Silver Spring). 2007;15:182–7.
Allen BG, Bhatia SK, Buatti JM, Brandt KE, Lindholm KE, Button AM, et al. Ketogenic diets enhance oxidative stress and radio-chemo-therapy responses in lung cancer xenografts. Clin Cancer Res. 2013;19:3905–13.
Kitabchi AE, McDaniel KA, Wan JY, Tylavsky FA, Jacovino CA, Sands CW, et al. Effects of high-protein versus high-carbohydrate diets on markers of β-cell function, oxidative stress, lipid peroxidation, proinflammatory cytokines, and adipokines in obese, premenopausal women without diabetes: a randomized controlled trial. Diabetes Care. 2013;36:1919–25.
Pösö T, Kesek D, Aroch R, et al. Rapid weight loss is associated with preoperative hypovolemia in morbidly obese patients. Obes Surg. 2013;23:306–13.
Preis SR, Massaro JM, Robins SJ, et al. Abdominal subcutaneous and visceral adipose tissue and insulin resistance in the Framingham heart study. Obesity. 2010;18(11):2191–8.
Stabe C, Vasques AC, Lima MM, et al. Neck circumference as a simple tool for identifying the metabolic syndrome and insulin resistance: results from the Brazilian Metabolic Syndrome Study (BRAMS). Clin Endocrinol (Oxf). 2013;78(6):874–81.
Iyer US, Koh KF, Chia NCH, et al. Perioperative risk factors in obese patients for bariatric surgery: a Singapore experience. Singap Med J. 2011;52(2):94.
Gonzalez H, Minville V, Delanoue K, et al. The importance of increased neck circumference to intubation difficulties in obese patients. Anesth Analg. 2008;106:1132–6.
Kim WH, Ahn HJ, Lee CJ, et al. Neck circumference to thyromental distance ratio: a new predictor of difficult intubation in obese patients. Br J Anaesth. 2011;106:743–8.
Budde AO, Desciak M, Reddy V, et al. The prediction of difficult intubation in obese patients using mirror indirect laryngoscopy: a prospective pilot study. J Anaesthesiol Clin Pharmacol. 2013;29:183–6.
Casé León CK, Hachoue Saliba ZS. Orotracheal intubation difficulty with lighted stylet: correlation of body mass index and neck circumference. Rev Esp Anestesiol Reanim. 2013;60:74–8.
Beymer C, Kowdley KV, Larson A, Edmonson P, Dellinger EP, Flum DR. Prevalence and predictors of asymptomatic liver disease in patients undergoing gastric bypass surgery. Arch Surg 2003;138:1240–1244.
Schwartz ML, Drew RL, Chazin-Caldie M. Laparoscopic Roux-en-Y gastric bypass: preoperative determinants of prolonged operative times, conversion to open gastric bypasses, and postoperative complications. Obes Surg. 2003;13:734–8.
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;84:304–11.
Lewis MC, Phillips ML, Slavotinek JP, et al. Change in liver size and fat content after treatment with Optifast very low calorie diet. Obes Surg. 2006;16:697–701.
Brody F, Vaziri K, Garey C, et al. Preoperative liver reduction utilizing a novel nutritional supplement. J Laparoendosc Adv Surg Tech A. 2011;21:491–5.
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;7:480–5.
Westman EC, Yancy Jr WS, Mavropoulos JC, et al. The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutr Metab (Lond). 2008;5:36.
Paoli A, Cenci L, Grimaldi KA. Effect of ketogenic Mediterranean diet with phytoextracts and low carbohydrates/high-protein meals on weight, cardiovascular risk factors, body composition and diet compliance in Italian council employees. Nutr J. 2011;10:112.
Paoli A, Canato M, Toniolo L, et al. The ketogenic diet: an underappreciated therapeutic option? Clin Ter. 2011;162:e145–53.
Conflict of Interest
The study received support by Nutri & Biotech which provided products and funded the editing of the manuscript. Frida Leonetti, Fabio Cesare Campanile, Federica Coccia, Danila Capoccia, Laura Alessandroni, Alessandro Puzziello, Ilenia Coluzzi, and Gianfranco Silecchia have no conflicts of interest or other financial ties to disclose.
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Leonetti, F., Campanile, F.C., Coccia, F. et al. Very Low-Carbohydrate Ketogenic Diet Before Bariatric Surgery: Prospective Evaluation of a Sequential Diet. OBES SURG 25, 64–71 (2015). https://doi.org/10.1007/s11695-014-1348-1
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DOI: https://doi.org/10.1007/s11695-014-1348-1