title: Preoperative weight loss with a very-low-energy diet: quantitation of changes in liver and abdominal fat by serial imaging.
abstract: BACKGROUND
  A very-low-energy diet (VLED) can result in substantial, rapid weight loss and is increasingly prescribed before obesity surgery to minimize risk and difficulty by reducing liver size and abdominal adiposity. Despite its growing popularity, a VLED in this setting has received little attention.
  
  
  OBJECTIVE
  The aim of this study was to investigate the efficacy and acceptability of a preoperative VLED.
  
  
  METHODS
  In a prospective observational study, 32 subjects (n = 19 men and 13 women) with a mean (+/-SD) age of 47.5 +/- 8.3 y and a body mass index (in kg/m(2)) of 47.3 +/- 5.3 consumed a VLED for 12 wk. Primary outcomes included changes in liver volume (LV) and in visceral and subcutaneous adipose tissue (VAT/SAT). Changes in body weight, anthropometric measures, and biochemical variables were also recorded, and compliance with, acceptability of, and side effects of treatment were assessed. Changes in LV and VAT/SAT area were measured by computed tomography and magnetic resonance imaging at baseline and weeks 2, 4, 8, and 12.
  
  
  RESULTS
  Mean (+/-SD) LV, VAT/SAT, and body weight decreased significantly (P < 0.001 for all). The degree of LV reduction was directly related to the reduction in relative body weight (r = 0.54, P = 0.001) and initial LV (r = 0.43, P = 0.015). Eighty percent of the reduction in LV occurred between weeks 0 and 2 (P < 0.001). Reductions in body weight and VAT were uniform over the 12-wk period. Attrition was 14%. Acceptability was adequate but waned over time, and mild transitory side effects occurred.
  
  
  CONCLUSIONS
  Given the observed early reduction in LV and the progressive reduction in VAT, we suggest that the minimum duration for a preoperative VLED be 2 wk. Ideally, the duration should be 6 wk to achieve maximal LV reduction and significant reductions in VAT and body weight without compromising compliance and acceptability.
authors.affiliation: Centre for Obesity Research and Education, Monash University, Melbourne, Australia. susan.colles@med.monash.edu.au
authors.forename: Susan L
authors.initials: SL
authors.lastname: Colles
authors.forename: John B
authors.initials: JB
authors.lastname: Dixon
authors.forename: Paul
authors.initials: P
authors.lastname: Marks
authors.forename: Boyd J
authors.initials: BJ
authors.lastname: Strauss
authors.forename: Paul E
authors.initials: PE
authors.lastname: O'Brien
mesh_terms: D050153:Abdominal Fat / Q000000981:diagnostic imaging / Q000378:metabolism*; D000328:Adult; D004038:Diet, Reducing; D002149:Energy Intake / Q000502:physiology; D005234:Fatty Liver / Q000150:complications / Q000178:diet therapy; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging / Q000378:metabolism; D008099:Liver / Q000000981:diagnostic imaging / Q000378:metabolism*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000178:diet therapy* / Q000601:surgery; D010349:Patient Compliance; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D050507:Subcutaneous Fat, Abdominal / Q000000981:diagnostic imaging / Q000378:metabolism; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D015431:Weight Loss / Q000502:physiology*