O035 - A LOW ENERGY KETOGENIC DIET AMPLIFIES REDUCTION OF HEPATOCELLULAR ADENOMA SIZE

O035

A LOW ENERGY KETOGENIC DIET AMPLIFIES REDUCTION OF HEPATOCELLULAR ADENOMA SIZE

L. Beuk¹, C. Oudmaijer¹, E. van der Louw², E. te Nijenhuis², M. Thomeer³, R. de Wilde¹, N. Vogelaar¹, M. Meijer⁴, R. de Man⁴, T. Terkivatan¹, D. Sprengers⁴, K. Berk^2,*, J. Ijzermans¹

¹Transplant Institute, Department of Surgery., ²Internal Medicine, division of Dietetics, ³Department of Radiology & Nuclear Medicine, ⁴Transplant Institute, Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, Netherlands

Rationale: Management of hepatocellular adenoma (HCA) in women typically involves surveillance and cessation of oral contraceptives (OC). In obese patients, weight loss is recommended as an adjunctive treatment due to its potential to accelerate HCA size regression. A low-energy ketogenic diet (LEKD) leads to down-regulation of hepatic growth hormone receptors and could potentially affect adenoma size more profoundly than an energy-restricted diet alone.  

Methods: In this single-center cohort study with historical matched controls, participants followed a LEKD (1800 kcal, 35 grams of carbohydrates/day, after 3 months option for 60 grams/day). Matched historical controls were selected from a retrospective cohort spanning from January 2000 to October 2017.  

Results: Forty-four patients were included between March 2021 and July 2025, with 36 patients completing the study according to protocol. Participants decreased significant in weight (-9.5 kg, 95%CI [-12.7;-6.2], p=<0.001) and BMI (-3.3 kg/m2, 95%CI [4.4;-2.2, p=<0.001). Matching analysis, based on age, baseline BMI, OC use, and adenoma characteristics indicated a significant difference in adenoma size in the LEKD group at six months (-12.17 mm, 95%CI [-19.6;-4.8], p=0.002). After adjustment for BMI loss during follow-up, the LEKD group still showed a smaller adenoma size (-13.13 mm, 95%CI [-21.4;-4.8], p=0.002). Additional matching on weight loss, estimating the ketogenic effect, confirmed these findings (-15.5 mm, 95%CI [-23.5;-7.5], p=<0.001).  

Conclusion: Our study indicates that a LEKD effectively contributes to weight loss and induces enhanced regression of HCA. Mechanism for this ketogenic effect may be significant hormone receptor changes, but further research is needed to elucidate these effects to optimize HCA management strategies.

Disclosure of Interest: None declared