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

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.

Very Low-Carbohydrate Ketogenic Diet for the Treatment of Severe Obesity and Associated Non-Alcoholic Fatty Liver Disease: The Role of Sex Differences

“…Details of the diet are shown in Supplementary Figure S1 . The composition of the nutritional supplements was previously described [ 18 ].…”

“…The null hypothesis was rejected for a probability ( p ) <0.05 under the null hypothesis assumption. Based on our previous experience [ 18 ], we estimated a difference in γGT levels between groups of 12 ± 18 IU/L. For a statistical power of 0.8, a sample size of 35 subjects for each group was requested.…”

“…In our previous work, we observed that VLCKDs are associated with a reduction in the ultrasonographically measured degree of liver steatosis and γ-glutamyl transferase (γGT) levels [ 18 ]. We chose γGT as a non-invasive biomarker of NAFLD because it is a routinely performed, easily accessible, and non-expensive test.…”

تأثیر نظام الکیتوجینیک والصیام المتقطع على مرضى السمنة

“…Waist and hip circumference recorded the highest value 136.5cm and 145.3cm. in the beginning., respectively, but at the end of the Ministrini et al, (2019) who reported that after very low carbohydrate ketogenic diet and intermittent fasting, body weight and BMI were significantly reduced (p<0.001 for both). Similarly, waist, hip circumference and fat mass were significantly reduced as well.…”

Nutritional Approach Targeting Gut Microbiota in NAFLD—To Date

“…In another study, concerned the “Spanish Ketogenic Mediterranean Diet”(SKMD)(unrestricted calorie intake, high omega-3 PUFA), significant improvements in the body mass, BMI, waist circumference (WC), LDL, TG, HDL, ALT, AST, fasting plasma glucose (FPG), and steatosis degree wereobserved [ 91 ]. Interesting results were provided inthe study by Ministrini et al [ 92 ], in which morbidly obese patients (n-52) underwent a 25-day very-low-carbohydrate ketogenic diet (VLCKD). After the intervention, significant reductions in the body mass index, FPG, insulinemia, and lipid profile parameters wereobserved.…”