PD649 - A SEQUENTIAL LOW CALORIC KETOGENIC NUTRITIONAL PROTOCOL IMPROVES WEIGHT AND BODY COMPOSITION IN OBESE PATIENTS NON-RESPONDERS TO A LOW-CALORIC MEDITERRANEAN DIET

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PD649

A SEQUENTIAL LOW CALORIC KETOGENIC NUTRITIONAL PROTOCOL IMPROVES WEIGHT AND BODY COMPOSITION IN OBESE PATIENTS NON-RESPONDERS TO A LOW-CALORIC MEDITERRANEAN DIET

M. Romano1, P. Raoul1, M. Cintoni1, F. Scialanga1, S. Galli2, E. Capristo3, A. Gasbarrini4, M. C. Mele1, E. Rinninella1,*

1Catholic University of the Sacred Heart, Clinical Nutrition Unit, Fondazione Policlinico A. Gemelli IRCCS, 2Catholic University of the Sacred Heart, School of specialization in Food Science and Nutrition , 3Catholic University of the Sacred Heart, Obesity Medicine Unit, Fondazione Policlinico A. Gemelli IRCCS, 4Catholic University of the Sacred Heart, CEMAD, Digestive Disease Center, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy

 

Rationale: A proportion of patients affected by obesity and metabolic syndrome exhibit a suboptimal response to a hypocaloric Mediterranean diet. This study aimed to evaluate a supervised sequential ketogenic nutritional protocol as a second-line strategy in dietary non-responders.

Methods: In this retrospective longitudinal intra-subject study, 25 adults with overweight/obesity and metabolic complications underwent a hypocaloric Mediterranean diet followed by a 4-week food-based ketogenic diet (~1200 kcal/day, <20 g carbohydrates, protein 1.5 g/kg) and a 4-week low-carbohydrate reintroduction phase (~1300 kcal/day, up to 100 g carbohydrates). Anthropometric and bioimpedance (BIVA) parameters, including body cell mass (BCM) and phase angle (PhA), were assessed at four time points (T0–T3). Paired statistical analyses were performed.

Results: Participants (48.3±11.6 years; BMI 34.4±5.2 kg/m²) exhibited a limited response to the Mediterranean diet (weight Δ -1.68 kg, p=0.033; fat mass Δ -2.7 kg, p=0.0425). The ketogenic phase induced significant reductions in weight (Δ -6.1 kg, p<0.0001), BMI (Δ -2.08, p<0.0001), fat mass (Δ -4.8 kg, p<0.0001), waist circumference (Δ -5.62 cm, p<0.0001) and hip circumference (Δ -4.44 cm, p<0.0001), with a smaller reduction in fat-free mass (Δ -1.4 kg, p=0.0051). BCM (p=0.328) and PhA (p=0.414) remained stable. The combined protocol (T1–T3) resulted in weight Δ -7.79 kg (p<0.0001) and fat mass Δ -6.29 kg (p<0.0001), with further reductions in waist (Δ -6.4 cm) and hip circumference (Δ -6.57 cm), while BCM (p=0.192) and PhA (p=0.839) remained preserved.

Conclusion: A supervised sequential ketogenic nutritional protocol represents an effective second-line strategy for obese non-responders, promoting clinically relevant fat mass reduction and improvement in central adiposity while preserving metabolically active tissue.

Disclosure of Interest: None declared