Background: Obesity is a complex, multifactorial disease with deleterious effects on cardiac function. Currently, the obesity treatment is one of the most difficult challenges. Very low calorie ketogenic diet (VLCKD) has been proposed as an effective intervention for obesity. Furthermore, hyperketonemia induced by VLCKD is associated with beneficial cardiovascular effects. On the other hand, sleeve gastrectomy (SG) has been proven to be the most effective long-term weight management treatment. However, to date, it is still unclear whether the positive effects of SG on cardiovascular disease are mediated only by weight loss.
Aim: To evaluate the changes in anthropometric and metabolic parameters and in cardiac structure and function after treatment with SG or VLCKD. The results obtained in the two groups have been compared to verify if, in the short time, there were differences between these two treatments.
Methods: Twenty obese patients were enrolled. All the patients underwent a complete anthropometrical evaluation, laboratory determinations and echocardiogram evaluation. Ten patients have been treated with SG and 10 with VLCKD. The two group were comparable for weight loss: -26 kg (28%) after 3 months in patients treated with VLCKD and -25 kg (27.5%) after 6 months in patients treated with SG.
Results: An improvement in the anthropometric and metabolic profile was observed in all the patients. There were significant improvements in cardiovascular risk factors, including total cholesterol levels, triglyceridis, fasting glycemia, systolic and diastolic blood pressure, serum uric acid and HOMA-IR values. Similarly, the echocardiogram evaluation showed, in both groups of treatment, a reduction of the end-diastolic left ventricular volume, a reduction of the end-systolic left ventricular volume and a reduction of interventricular septal thickness and posterior wall thickness. Furthermore, an increase in the Ejection Fraction has been observed. No significantly differences between two groups were observed. Interestingly, in patients in treatment with VLCKD, a significant change in the global myocardial work efficiency (GWE) was observed.
Conclusion: Our data showed that VLCKD and SG have the potential to protect cardiometabolic health and myocardial remodeling in obese patients. VLCKD is a promising lifestyle intervention that can be used to prevent or treat cardiovascular disease. However, its effectiveness in the medium to long term must be evaluated.