title: Ketogenic enteral nutrition as a treatment for obesity: short term and long term results from 19,000 patients.
abstract: BACKGROUND
  Only protein diet has been used successfully to prevent loss of lean body mass first in post-surgical and then in obese patients. We studied overweight and obese patients receiving short treatments of an exclusively protein-based nutritional solution as 24-hour enteral infusion.
  
  
  METHODS
  19,036 patients (age 44.3 ± 13, M:F = 2:5) with an initial body mass index of 36.5 ± 7.1 underwent 10-day cycles of enteral nutrition through a fine nasogastric tube. The nutritional solution consisted solely of 50-65 g of proteins, plus vitamins and electrolytes. The 24-hour infusion was controlled with a small portable pump. Before and after each 10-day cycle body composition was checked with a Handy 3000 impedance analyzer. At the onset of treatment, average fat mass was 40.9 ± 12.8 kg while body cell mass was 42.7 ± 7.2 kg in males and 27.4 ± 4.6 kg in females.
  
  
  RESULTS
  After an average of 2.5 cycles the patients lost 10.2 ± 7.0 kg of body weight, 5.8 ± 5.5 kg of fat mass and 2.2 ± 3.3 kg of body cell mass. No significant adverse effects were recorded except asthenia and constipation which were easily controlled with therapy. Long-term results were obtained from 15,444 patients and after an average of 362 ± 296 days we found a mean weight regain of 15.4%.
  
  
  CONCLUSIONS
  Ketogenic Enteral Nutrition treatment of over 19,000 patients induced a rapid 10% weight loss, 57% of which was Fat Mass. No significant adverse effects were found. The treatment is safe, fast, inexpensive and has good one-year results for weight maintenance.
authors.affiliation: Clinical Nutrition Service of the Department of Surgery Paride Stefanini, University of Rome La Sapienza, Rome, Italy. cappello.g@in.it.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Cappello
authors.forename: Antonella
authors.initials: A
authors.lastname: Franceschelli
authors.forename: Annalisa
authors.initials: A
authors.lastname: Cappello
authors.forename: Paolo
authors.initials: P
authors.lastname: De Luca