Effects of a Very-Low-Calories Ketogenic Diet on Visceral Adipose and Muscular Tissues in Comparison with a Mediterranean Dietary Intervention

Introduction and Objective: Compared to a low caloric Mediterranean diet (LC-med), Very Low Calories Ketogenic Diet (VLCKD) obtains weight loss with a greater caloric deficit and an almost complete carbohydrates restriction that markedly reduces insulin secretion. We compared the impact of VLCKD and LC-med on visceral fat (VAT) and muscle loss. Methods: We studied prospectively 116 subjects who underwent LC-med, and 53 who underwent VLCKD. VAT was measured by ultrasound, Arm Muscle Area (AMA) by anthropometry. HOMA index was derived from fasting insulin and glucose concentrations. LC-med and VLCKD groups were, respectively, 70% vs 72% females, median (IQR) age 55 (44-65) vs 51 (46, 57) yrs, BMI 32 (28.8-35.2) vs 35 (31.5-39.2) kg/m², waist circumference 104 cm (98-113) vs 112 cm (101-122) cm, VAT 5.4 (3.38-6.88) vs 5.64 (3.53-7.32) cm and AMA 56 (47,68) vs 62 (51-76) cm². Results: The duration of intervention was similar but VLCKD reached more rapidly the -5% and the -10% weight loss targets. Nonetheless, at - 5% and -10% wt loss, VLCKD and LC-med lost similar amounts of VAT (-28% vs -41% and -69 vs - 64%) and of AMA (-3% vs -8% and -11% and -7%) from basal. VLCKD showed greater reductions in insulin at -5% wt loss (-23% vs -0%, p<0,001), in glucose concentration at -10% wt loss (-16 vs -3% p=0,045) and in HOMA at -10% wt loss (p=0.025). Conclusion: VLCKD is associated with a more rapid body weight reduction and to lower insulin concentrations compared to LC-med. Nonetheless, both treatments are equally effective in reducing visceral adipose tissue and in preserving muscle mass. Disclosure G. Pozzi: None. A. Foppiani: None. F. Sileo: None. S. Bertoli: None. A. Battezzati: None. Funding National Recovery and Resilience Plan (NRRP), Mission 4 Component 2 Investment 1.3 - Call for proposals No. 341 of 15 March 2022 of Italian Ministry of University and Research funded by the European Union NextGenerationEU; Award Number: Project code PE00000003, Concession Decree No. 1550 of 11 October 2022 adopted by the Italian Ministry of University and Research, CUP D93C22000890001, Project title ON Foods - Research and innovation network on food and nutrition Sustainability, Safety and Security Working ON Foods.