title: Very low-carbohydrate ketogenic diet before bariatric surgery: prospective evaluation of a sequential diet.
abstract: BACKGROUND
  We evaluated the effectiveness of a sequential diet regimen termed the obese preoperative diet (OPOD) in morbidly obese patients with and without type 2 diabetes mellitus (T2DM) scheduled for laparoscopic bariatric surgery.
  
  
  METHODS
  Fifty patients (body mass index 53.5 ± 8.4 kg/m(2)) scheduled for bariatric surgery, including 14 with T2DM, were prospectively enrolled and followed the OPOD regimen: a very low-calorie ketogenic diet for 10 days, followed by a very low-calorie diet for 10 days, and then a low-calorie diet for 10 days. Patients were evaluated at baseline (T0) and after 10 days (T1), 20 days (T2), and 30 days (T3).
  
  
  RESULTS
  Body weight, body mass index, waist circumference, and neck circumference were significantly lower at T1, T2, and T3 than at T0 in the 48 patients who completed the OPOD. Two patients discontinued the OPOD after 4-7 days. In patients with T2DM, fasting plasma glucose levels decreased significantly, enabling reduction of diabetic medications. Plasma and urine ketone levels increased at T1 but were all <1 mmol/L, and hunger decreased during the diet period.
  
  
  CONCLUSIONS
  OPOD, including 10 days of a VLCKD, was safe and effective in morbidly obese patients, and it seems to be promising in morbidly obese patients with and without T2DM scheduled for laparoscopic bariatric surgery.
authors.affiliation: Department of Experimental Medicine, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
authors.forename: Frida
authors.initials: F
authors.lastname: Leonetti
authors.forename: Fabio Cesare
authors.initials: FC
authors.lastname: Campanile
authors.forename: Federica
authors.initials: F
authors.lastname: Coccia
authors.forename: Danila
authors.initials: D
authors.lastname: Capoccia
authors.forename: Laura
authors.initials: L
authors.lastname: Alessandroni
authors.forename: Alessandro
authors.initials: A
authors.lastname: Puzziello
authors.forename: Ilenia
authors.initials: I
authors.lastname: Coluzzi
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Silecchia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000379:methods*; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000178:diet therapy* / Q000601:surgery*; D050528:Diet, Carbohydrate-Restricted; D055423:Diet, Ketogenic; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000178:diet therapy* / Q000601:surgery*; D057234:Preoperative Period; D011446:Prospective Studies; D015431:Weight Loss / Q000502:physiology; D055815:Young Adult
chemical_list: D001786:Blood Glucose