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D’Abbondanza M, Ministrini S, Pucci G, Nulli Migliola E, Martorelli EE, Gandolfo V, Siepi D, Lupattelli G, Vaudo G. Very Low-Carbohydrate Ketogenic Diet for the Treatment of Severe Obesity and Associated Non-Alcoholic Fatty Liver Disease: The Role of Sex Differences. Nutrients 2020; 12:nu12092748. [PMID: 32916989 PMCID: PMC7551320 DOI: 10.3390/nu12092748] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/07/2020] [Accepted: 09/07/2020] [Indexed: 12/12/2022] Open
Abstract
Very low-carbohydrate ketogenic diets (VLCKDs) are an emerging nutritional treatment for severe obesity and are associated with a significant improvement in non-alcoholic fatty liver disease (NAFLD). Little is known about the effect of sex differences on weight loss induced by following a VLCKD. The aim of this study was to investigate the effects of sex differences on weight loss and NAFLD improvement in patients with severe obesity undergoing a VLCKD. Forty-two females and 28 males with severe obesity underwent a 25-day VLCKD. Anthropometric parameters, bioimpedentiometry, degree of liver steatosis measured by ultrasonography, liver function tests, and glucose homeostasis were measured before and after the VLCKD. Males experienced a significantly larger excess body weight loss (EBWL) and a greater reduction in γ-glutamyl transferase (γGT) than females. Dividing the female group by menopausal status, a significant difference between males and pre-menopausal females was found for both EBWL and γGT. No significant difference between groups was observed for improvement in the Edmonton stage or in the degree of steatosis. We conclude that the efficacy of following a VLCKD in severe obesity is affected by sex differences and, for females, by menopausal status. Males seem to experience larger benefits than females in terms of EBWL and NAFLD improvement. These differences are attenuated after menopause, probably because of changes in hormonal profile and body composition.
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Affiliation(s)
- Marco D’Abbondanza
- Internal Medicine, Department of Medicine, Università degli Studi di Perugia, 06129 Perugia, Italy; (M.D.); (G.P.); (E.N.M.); (E.-E.M.); (V.G.); (D.S.); (G.L.); (G.V.)
- Internal Medicine, “Santa Maria” University Hospital, Azienda Ospedaliera di Terni, 05100 Terni, Italy
| | - Stefano Ministrini
- Internal Medicine, Department of Medicine, Università degli Studi di Perugia, 06129 Perugia, Italy; (M.D.); (G.P.); (E.N.M.); (E.-E.M.); (V.G.); (D.S.); (G.L.); (G.V.)
- Correspondence: ; Tel.: +39-075-578-4020
| | - Giacomo Pucci
- Internal Medicine, Department of Medicine, Università degli Studi di Perugia, 06129 Perugia, Italy; (M.D.); (G.P.); (E.N.M.); (E.-E.M.); (V.G.); (D.S.); (G.L.); (G.V.)
- Internal Medicine, “Santa Maria” University Hospital, Azienda Ospedaliera di Terni, 05100 Terni, Italy
| | - Elisa Nulli Migliola
- Internal Medicine, Department of Medicine, Università degli Studi di Perugia, 06129 Perugia, Italy; (M.D.); (G.P.); (E.N.M.); (E.-E.M.); (V.G.); (D.S.); (G.L.); (G.V.)
| | - Eva-Edvige Martorelli
- Internal Medicine, Department of Medicine, Università degli Studi di Perugia, 06129 Perugia, Italy; (M.D.); (G.P.); (E.N.M.); (E.-E.M.); (V.G.); (D.S.); (G.L.); (G.V.)
| | - Vito Gandolfo
- Internal Medicine, Department of Medicine, Università degli Studi di Perugia, 06129 Perugia, Italy; (M.D.); (G.P.); (E.N.M.); (E.-E.M.); (V.G.); (D.S.); (G.L.); (G.V.)
- Internal Medicine, “Santa Maria” University Hospital, Azienda Ospedaliera di Terni, 05100 Terni, Italy
| | - Donatella Siepi
- Internal Medicine, Department of Medicine, Università degli Studi di Perugia, 06129 Perugia, Italy; (M.D.); (G.P.); (E.N.M.); (E.-E.M.); (V.G.); (D.S.); (G.L.); (G.V.)
| | - Graziana Lupattelli
- Internal Medicine, Department of Medicine, Università degli Studi di Perugia, 06129 Perugia, Italy; (M.D.); (G.P.); (E.N.M.); (E.-E.M.); (V.G.); (D.S.); (G.L.); (G.V.)
| | - Gaetano Vaudo
- Internal Medicine, Department of Medicine, Università degli Studi di Perugia, 06129 Perugia, Italy; (M.D.); (G.P.); (E.N.M.); (E.-E.M.); (V.G.); (D.S.); (G.L.); (G.V.)
- Internal Medicine, “Santa Maria” University Hospital, Azienda Ospedaliera di Terni, 05100 Terni, Italy
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Ministrini S, Calzini L, Nulli Migliola E, Ricci MA, Roscini AR, Siepi D, Tozzi G, Daviddi G, Martorelli EE, Paganelli MT, Lupattelli G. Lysosomal Acid Lipase as a Molecular Target of the Very Low Carbohydrate Ketogenic Diet in Morbidly Obese Patients: The Potential Effects on Liver Steatosis and Cardiovascular Risk Factors. J Clin Med 2019; 8:jcm8050621. [PMID: 31067824 PMCID: PMC6571559 DOI: 10.3390/jcm8050621] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 05/01/2019] [Accepted: 05/03/2019] [Indexed: 02/08/2023] Open
Abstract
A very low carbohydrate ketogenic diet (VLCKD) is an emerging technique to induce a significant, well-tolerated, and rapid loss of body weight in morbidly obese patients. The low activity of lysosomal acid lipase (LAL) could be involved in the pathogenesis of non-alcoholic fatty liver disease (NAFLD), which is a common feature in morbidly obese patients. Fifty-two obese patients suitable for a bariatric surgery intervention underwent a 25-day-long VLCKD. The biochemical markers of glucose and lipid metabolism, and flow-mediated dilation (FMD) of the brachial artery were measured before and after VLCKD. LAL activity was measured using the dried blood spot technique in 20 obese patients and in a control group of 20 healthy, normal-weight subjects. After VLCKD, we observed a significant reduction in body mass index, fasting glucose, insulinemia, and lipid profile parameters. No significant variation in FMD was observed. The number of patients with severe liver steatosis significantly decreased. LAL activity significantly increased, although the levels were not significantly different as compared to the control group. In conclusion, VLCKD induces the activity of LAL in morbidly obese subjects and reduces the secretion of all circulating lipoproteins. These effects could be attributed to the peculiar composition of the diet, which is particularly poor in carbohydrates and relatively rich in proteins.
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Affiliation(s)
- Stefano Ministrini
- Internal Medicine, Department of Medicine, Università degli Studi di Perugia, 06129 Perugia, Italy.
| | - Lucia Calzini
- Internal Medicine, Department of Medicine, Università degli Studi di Perugia, 06129 Perugia, Italy.
| | - Elisa Nulli Migliola
- Internal Medicine, Department of Medicine, Università degli Studi di Perugia, 06129 Perugia, Italy.
| | - Maria Anastasia Ricci
- Internal Medicine, Department of Medicine, Università degli Studi di Perugia, 06129 Perugia, Italy.
| | - Anna Rita Roscini
- Internal Medicine, Department of Medicine, Università degli Studi di Perugia, 06129 Perugia, Italy.
| | - Donatella Siepi
- Internal Medicine, Department of Medicine, Università degli Studi di Perugia, 06129 Perugia, Italy.
| | - Giulia Tozzi
- Hepatology, Gastroenterology and Nutrition Unit, IRCCS "Bambino Gesù" Children's Hospital, 00165 Rome, Italy.
| | - Giulia Daviddi
- Internal Medicine, Department of Medicine, Università degli Studi di Perugia, 06129 Perugia, Italy.
| | - Eva-Edvige Martorelli
- Internal Medicine, Department of Medicine, Università degli Studi di Perugia, 06129 Perugia, Italy.
| | | | - Graziana Lupattelli
- Internal Medicine, Department of Medicine, Università degli Studi di Perugia, 06129 Perugia, Italy.
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