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, Germán Guzmán, Livia Lugarinho Correa De Mello, Barbara Trein, Luciana Diniz Carneiro Spina, Isabela Bussade, Juliana Marques Prata, Ignacio Sajoux, Walmir Countinho
Abstract
BBackground: Currently the treatment of nonalcoholic 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 diet (LC). 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 a 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 (MRI). Paired t-tests were used for comparison of continuous variables between visits and unpaired test between groups. Categorical variables were compared using the Chi-squared test. Pearson’s 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: 39 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 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 standard the low-calorie diet. The weight loss and rapid mobilization of liver fat demonstrated with VLCKD, could serve as an effective alternative for the treatment of NAFLD.