Very-Low-Calorie Ketogenic Diets With Whey, Vegetable, or Animal Protein in Patients With Obesity: A Randomized Pilot Study

Abstract

Context We compared the efficacy, safety, and effect of 45-day isocaloric very-low-calorie ketogenic diets (VLCKDs) incorporating whey, vegetable, or animal protein on the microbiota in patients with obesity and insulin resistance to test the hypothesis that protein source may modulate the response to VLCKD interventions. Subjects and Methods Forty-eight patients with obesity (19 males and 29 females, homeostatic model assessment (HOMA) index ≥ 2.5, aged 56.2 ± 6.1 years, body mass index [BMI] 35.9 ± 4.1 kg/m2) were randomly assigned to three 45-day isocaloric VLCKD regimens (≤800 kcal/day) containing whey, plant, or animal protein. Anthropometric indexes; blood and urine chemistry, including parameters of kidney, liver, glucose, and lipid metabolism; body composition; muscle strength; and taxonomic composition of the gut microbiome were assessed. Adverse events were also recorded. Results Body weight, BMI, blood pressure, waist circumference, HOMA index, insulin, and total and low-density lipoprotein cholesterol decreased in all patients. Patients who consumed whey protein had a more pronounced improvement in muscle strength. The markers of renal function worsened slightly in the animal protein group. A decrease in the relative abundance of Firmicutes and an increase in Bacteroidetes were observed after the consumption of VLCKDs. This pattern was less pronounced in patients consuming animal protein. Conclusions VLCKDs led to significant weight loss and a striking improvement in metabolic parameters over a 45-day period. VLCKDs based on whey or vegetable protein have a safer profile and result in a healthier microbiota composition than those containing animal proteins. VLCKDs incorporating whey protein are more effective in maintaining muscle performance.

The psychological impact of COVID-19 pandemic on patients included in a bariatric surgery program

“…The strong connection between mental status and food behavior warrants first of all an accurately targeted psychological support in order to favor compliance to dietary treatments. However, some dietary manipulations including certain foods [34,35], food supplements [36,37], and dietary patterns [38][39][40][41][42][43] together with pharmacological treatment [44,45] have been shown to impact appetite and mood and/ or proved particularly beneficial in subjects with severe obesity and in post-bariatric patients. Such measures should be therefore taken into consideration in the next months in order to favor dietary adherence and metabolic improvement, leveraging a multidisciplinary approach to treat those severely obese seeking bariatric surgery and those who have lost weight but need lifelong follow-up after bariatric surgery [46].…”

Baseline HOMA IR and Circulating FGF21 Levels Predict NAFLD Improvement in Patients Undergoing a Low Carbohydrate Dietary Intervention for Weight Loss: A Prospective Observational Pilot Study

“…Beside accurate diagnosis and grading from simple hepatic steatosis to steatohepatitis and fibrosis, at present no specific treatment for NAFLD is available, and currently proposed treatments focus on weight loss and insulin resistance improvement [ 9 , 22 , 23 , 24 ], with increasing attention being paid in identifying additional safe and effective means of treatment. Among them, ketogenic diets (KD) represent a safe and effective strategy shown to induce beneficial effects on NALFD [ 25 ] through a significant and rapid decrease in insulin-resistance and total body and abdominal fat [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ], but its impact may also be independent of weight change [ 34 ]. Moreover, very low-calorie ketogenic diets (VLCKDs) proved effective in reversing T2D through a reduction in triglycerides content and insulin resistance in the liver [ 33 ].…”

Blood SIRT1 Shows a Coherent Association with Leptin and Adiponectin in Relation to the Degree and Distribution of Adiposity: A Study in Obesity, Normal Weight and Anorexia Nervosa

“…The prevalence of obesity is rising [22,23], and with this, many of its complications are increasing, some of which are well acknowledged, such as type 2 diabetes, obstructive sleep apnea syndrome, non-alcoholic fatty liver disease and cardiovascular disease [24][25][26][27], and others are emerging and currently being investigated [28,29]. Several strategies have been proposed for the treatment of weight excess and its detrimental consequences, ranging from dietary regimens [30][31][32] to pharmacological treatments [33], physical exercise [34] and psychological approaches [35]. Although all lead to improvement in many cases, none are always effective.…”