Resting metabolic rate of obese patients under very low calorie ketogenic diet - PubMed (original) (raw)

Resting metabolic rate of obese patients under very low calorie ketogenic diet

Diego Gomez-Arbelaez et al. Nutr Metab (Lond). 2018.

Abstract

Background: The resting metabolic rate (RMR) decrease, observed after an obesity reduction therapy is a determinant of a short-time weight regain. Thus, the objective of this study was to evaluate changes in RMR, and the associated hormonal alterations in obese patients with a very low-calorie ketogenic (VLCK)-diet induced severe body weight (BW) loss.

Method: From 20 obese patients who lost 20.2 kg of BW after a 4-months VLCK-diet, blood samples and body composition analysis, determined by DXA and MF-Bioimpedance, and RMR by indirect calorimetry, were obtained on four subsequent visits: visit C-1, basal, initial fat mass (FM) and free fat mass (FFM); visit C-2, - 7.2 kg in FM, - 4.3 kg in FFM, maximal ketosis; visit C-3, - 14.4 kg FM, - 4.5 kg FFM, low ketosis; visit C-4, - 16.5 kg FM, - 3.8 kg FFM, no ketosis. Each subject acted as his own control.

Results: Despite the large BW reduction, measured RMR varied from basal visit C-1 to visit C-2, - 1.0%; visit C-3, - 2.4% and visit C-4, - 8.0%, without statistical significance. No metabolic adaptation was observed. The absent reduction in RMR was not due to increased sympathetic tone, as thyroid hormones, catecholamines, and leptin were reduced at any visit from baseline. Under regression analysis FFM, adjusted by levels of ketonic bodies, was the only predictor of the RMR changes (R2 = 0.36; p < 0.001).

Conclusion: The rapid and sustained weight and FM loss induced by VLCK-diet in obese subjects did not induce the expected reduction in RMR, probably due to the preservation of lean mass.

Trial registration: This is a follow up study on a published clinical trial.

Keywords: DXA; Energy expenditure; Indirect calorimetry; Ketogenic diet; Metabolic adaptation; Multifrequency BIA; Obesity; Pronokal method; Protein diet; Very low-energy diet.

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Conflict of interest statement

The study protocol was in accordance with the Declaration of Helsinki and was approved by the Ethics Committee for Clinical Research of Galicia, Santiago de Compostela, Spain (registry 2010/119). Participants gave informed consent before any intervention related to the study. Participants received no monetary incentive.Not applicableDB, ABC and FFC received advisory board fees and or research grants from Pronokal Protein Supplies Spain. IS is Medical Director of Pronokal Spain SLSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1

Fig. 1

Ketone bodies (a) and body composition (b) during the study. The broken line represents the level at which the existence of ketosis is defined.a_P_ < 0.05 compared with Visit C-1; b_P_ < 0.05 compared with Visit C-2; c_P_ < 0.05 compared with Visit C-3 (Repeated measures ANOVA with Tukey’s adjustment for multiple comparisons). β-OHB: β-hydroxy-butyrate

Fig. 2

Fig. 2

Resting metabolic rate (RMR) changes during the study. RMR-expected refers to the change in energy expenditure explained by changes in free fat mass (FFM) or muscle mass. Statistical analysis was performed by repeated measures ANOVA with Tukey’s adjustment for multiple comparisons)

Fig. 3

Fig. 3

Thyroid hormones (a), Catecholamines (b) and Leptin (c) levels during the study. a Changes in Thyroid Hormones; b. Changes in Catecholamines; and c. Changes in Leptin. FT3: free triiodothyronine; FT4: tyroxine. a_P_ < 0.05 compared with Visit C-1; b_P_ < 0.05 compared with Visit C-2; c_P_ < 0.05 compared with Visit C-3 (Repeated measures ANOVA with Tukey’s adjustment for multiple comparisons)

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