title: Weight loss and body composition changes following three sequential cycles of ketogenic enteral nutrition.
abstract: BACKGROUND
  Ketogenic enteral nutrition (KEN) is a modification of the protein sparing modified fast in which a protein solution is introduced with a continuous infusion through a nasogastric tube over 10-days cycles. The aim of the study was to perform a retrospective analysis of the safety, compliance, weight loss and body composition changes after 3 sequential 10-days cycles of KEN therapy.
  
  
  METHODS
  From a large number of patients who underwent KEN therapy in our department over a 5-year period, we selected 188 patients who participated in 3 KEN cycles with 10-13 days of break between them. Before and after the treatment cycles, body composition was analyzed by bioelectric impedance; a final assessment was made 10 days after the end of last cycle. During each rest period all the patients were on a low-carbohydrate, normal caloric diet.
  
  
  RESULTS
  Most patients (97%) successfully tolerated the nasogastric treatment and lost an average of 14.4 kg of body weight, 10.6 kg of fat mass and 3.4 kg of body cell mass. Adverse effects were recorded as mild gastric hypersecretion (2%) and constipation (5%). Patients continued to lose fat during the 10-day follow up period after the end of each KEN Cycle. This effect may be explained by abnormality of water distribution during the rapid weight loss inducing the observed change in fat mass.
  
  
  CONCLUSIONS
  Ten-days KEN treatment cycles can induce rapid weight loss and reduction of fat mass in obese patients. Furthermore, preservation of lean mass can be achieved by infusing 1.9 g of protein/kg of BCM.
authors.affiliation: Department of Surgery, University of Rome La Sapienza, Rome, Italy.
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
keywords: Body composition; enteral nutrition; obesity; protein