Middle and Long-Term Impact of a Very Low-Carbohydrate Ketogenic Diet on Cardiometabolic Factors: A Multi-Center, Cross-Sectional, Clinical Study

Abstract

IntroductionObesity is a constantly growing illness in developed countries and it is strictly related to cardiovascular (CV) diseases, i.e. the main cause of mortality throughout industralised areas.Aimto test the ability of trained general physician to safely and effectively prescribe a very-low carbohydrate ketogenic (VLCK) diet in clinical practice, with a specific attention to the effect of this approach on overweight related CV risk factors (anthropometric measures) blood pressure, lipid levels, glucose metabolism).MethodsThe study has been carried out on a group of 377 patients scattered across Italy and monitored during 1 year. The proposed VLCK diet is a nutritional regimen characterized by low-fat and low- carbohydrates formulations and a protein content of 1.2/1.5 g/kg of ideal body weight, followed by a period of slow re-insertion and alimentary re-education.ResultsAll the predetermined goals—namely safety, reduction of body weight and CV risk factors levels—have been reached with a significant reduction of body weight (from baseline to 4 weeks (−7 ± 5 kg, p < 0.001), from 4 to 12 weeks (−5 ± 3 kg, p < 0.001), no changes from 12 weeks to 12 months; waistline (from baseline to 4 weeks (−7 ± 4 cm, p < 0.001), from 4 to 12 weeks (−5 ± 7 cm, p < 0.001), no changes from 12 weeks to 12 months; fatty mass (from baseline to 4 weeks (−3.8 ± 3.8 %, p < 0.001), from 4 to 12 weeks (−3.4 ± 3.5 %, p < 0.001), no changes from 12 weeks to 12 months; SBP from baseline to 3 months (−10.5 ± 6.4 mmHg, p < 0.001), no further changes after 1 year of observation).Conclusionthe tested VLCD diet suggested by trained general physicians in the setting of clinical practice seems to be able to significantly improve on the middle-term a number of anthropometric, haemodynamic and laboratory with an overall good tolerability.

Non-Energy-Restricted Low-Carbohydrate Diet Combined with Exercise Intervention Improved Cardiometabolic Health in Overweight Chinese Females

“…Incorporated exercise training has no additional effects on weight loss, but has additional benefits on cardiorespiratory fitness, and HIIT is more time efficient than the traditional MICT (2.5 min vs. 30 min).Nutrients 2019, 11, 3051 2 of 15 (LCs). Emerging evidence mainly derived from western countries has clearly shown that LCs could be effective dietary strategies for weight loss and the management of several common and rare pathological conditions [7][8][9][10][11][12][13]. A meta-analysis has revealed that LCs had greater long-term effects on weight loss when compared to the traditional low-fat diets; furthermore, triglycerides, high-density lipoprotein cholesterol (HDL-C), and blood pressure values were also more favorably altered in LCs [7].…”

“…A meta-analysis has revealed that LCs had greater long-term effects on weight loss when compared to the traditional low-fat diets; furthermore, triglycerides, high-density lipoprotein cholesterol (HDL-C), and blood pressure values were also more favorably altered in LCs [7]. Additionally, LC-induced weight loss is generally accompanied with several positive metabolic changes, including improvements in blood pressure, glycaemic control, insulin sensitivity, and serum concentrations of C-reactive protein and certain lipids [8][9][10][11][12], which may have the potential to alleviate the features of metabolic disorder and reduce the risk factors associated with developing CVD and T2D. However, limited studies have tested whether LCs are also useful and feasible for the large Chinese overweight/obese population [11,13] given that people in China and in Western countries have distinct dietary patterns and preferences [14,15], which may lead to different levels of acceptance toward LCs.…”

Ketogenic diets in weight loss: a systematic review under physiological and biochemical aspects of nutrition

“…Feinman and Fine 25 state that weight loss may be related to the use of protein as an energy source, which is a process with greater energy expenditure in relation to the normal physiological process. Some studies also mention that weight loss can be attributed to reduced appetite due to the increased satiety provided by proteins 16 , to the action of ketone bodies on the direct suppression of appetite 6 , or reduced lipogenesis and increased lipolysis 8 .…”

“…Based on this reasoning, from the 17 studies, eight assessed the ketogenic diet at medium and long-terms (from three months to two years) by associating it with other periods of Mediterranean diet or another type of diet balanced in nutrients 8,9,12,13,18,19,20,21 . In these studies, there was significant weight loss, reduced body fat and BMI.…”

“…In this study, however, weight loss and body fat was equally proportional to the group that followed the ketogenic diet. Another clear limitation is the heterogeneity of participants at the beginning of the research, which was cited as a limitation by Alessandro et al 8 and Cicero et al 9 . In the study by Merra et al 16 although not described as a limitation, in the data presented by the authors, the difference in the initial parameters among groups is clear, which prevents accurate comparisons among diets.…”