title: Aggressive nutritional strategy in morbid obesity in clinical practice: Safety, feasibility, and effects on metabolic and haemodynamic risk factors.
abstract: In morbid obesity, optimisation of nutritional strategies impacting cardiovascular and metabolic risk profile is a desirable target in clinical practice.
  
  
  
  To assess in morbid obesity the feasibility, safety and efficacy of a nutritional cycle comprising a short-term carbohydrates-free diet delivered by nasogastric tube followed by an almost equivalent oral diet.
  
  
  
  In our clinical practice, adults with body mass index (BMI)≥45kg/m(2), otherwise clinically healthy, signed informed consent for a 14-day stint of continuous and controlled carbohydrates-free nutritional regiment delivered via 8-Fr nasogastric tube (enteral nutrition, EN), followed by a 14-day stint of almost comparable oral nutrition (ON). Body metrics, insulin resistance, blood pressure (BP) and heart rate (HR), as well as parameters for safety were monitored.
  
  
  
  In 112 patients, EN significantly reduced BMI and waist circumference (WC), BP, insulin resistance while it increased urine ketones and uric acid increased (all p<0.01 independent to confounders), but had no clinically significant impact on kidney and renal function, and coagulation parameters as well. With ON, findings were consistent. No major safety concerns were recorded during the nutritional treatment. In a subset of patients sharing clinical characteristics with the whole sample, the nutritional strategy reduced the mesenteric fat assessed by ultrasound.
  
  
  
  In morbid obesity, an aggressive nutritional cycle comprising a short-term ketogenic EN followed by an almost carbohydrates-free ON may be feasible, safe, and highly effective in reducing body weight, WC, BP and insulin resistance.
authors.affiliation: Clinical Nutrition Unit, "San Giuseppe Moscati" National Hospital (AORN), Avellino, Italy. Electronic address: fightingobesity1@gmail.com.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Castaldo
authors.affiliation: Department of Heart and Vessels, Cardiology Unit, "San Giuseppe Moscati" National Hospital (AORN), Avellino, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Palmieri
authors.affiliation: Clinical Nutrition Unit, "San Giuseppe Moscati" National Hospital (AORN), Avellino, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Galdo
authors.affiliation: Clinical Nutrition Unit, "San Giuseppe Moscati" National Hospital (AORN), Avellino, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Castaldo
authors.affiliation: Clinical Nutrition Unit, "San Giuseppe Moscati" National Hospital (AORN), Avellino, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Molettieri
authors.affiliation: Clinical Nutrition Unit, "San Giuseppe Moscati" National Hospital (AORN), Avellino, Italy.
authors.forename: Assunta
authors.initials: A
authors.lastname: Vitale
authors.affiliation: Department of Imaging, Ultrasound Unit, "San Giuseppe Moscati" National Hospital (AORN), Avellino, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Monaco
mesh_terms: D000328:Adult; D001794:Blood Pressure; D015992:Body Mass Index; D050528:Diet, Carbohydrate-Restricted; D055423:Diet, Ketogenic; D004038:Diet, Reducing; D004750:Enteral Nutrition; D005260:Female; D006339:Heart Rate; D006801:Humans; D007333:Insulin Resistance; D050152:Intra-Abdominal Fat / Q000378:metabolism; D007659:Ketones / Q000652:urine; D007668:Kidney; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000178:diet therapy* / Q000628:therapy; D014527:Uric Acid / Q000097:blood; D055105:Waist Circumference; D015431:Weight Loss; D055815:Young Adult
chemical_list: D007659:Ketones; D014527:Uric Acid
keywords: Diet; Efficacy; Metabolism; Obesity; Safety