Preoperative weight loss with a very-low-energy diet: quantitation of changes in liver and abdominal fat by serial imaging
Date
2006
Authors
Colles, S.L.
Dixon, J.B.
Marks, P.
Strauss, B.J.
O'Brien, P.
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American Journal of Clinical Nutrition, 2006
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Background: A very-low-energy diet (VLED) can result in substantial,rapid weight loss and is increasingly prescribed before obesitysurgery to minimize risk and difficulty by reducing liver size andabdominal adiposity. Despite its growing popularity, a VLED in thissetting has received little attention.Objective: The aim of this study was to investigate the efficacy andacceptability of a preoperative VLED.Design: In a prospective observational study, 32 subjects (n  19men and 13 women) with a mean (SD) age of 47.5  8.3 y and abody mass index (in kg/m2) of 47.35.3 consumed a VLED for 12wk. Primary outcomes included changes in liver volume (LV) and invisceral and subcutaneous adipose tissue (VAT/SAT). Changes inbody weight, anthropometric measures, and biochemical variableswere also recorded, and compliance with, acceptability of, and sideeffects of treatment were assessed. Changes in LV and VAT/SATarea were measured by computed tomography and magnetic resonanceimaging at baseline and weeks 2, 4, 8, and 12.Results: Mean (SD) LV, VAT/SAT, and body weight decreasedsignificantly (P  0.001 for all). The degree of LV reduction wasdirectly related to the reduction in relative body weight (r  0.54,P  0.001) and initial LV (r  0.43, P  0.015). Eighty percent ofthe reduction in LV occurred between weeks 0 and 2 (P  0.001).Reductions in body weight and VAT were uniform over the 12-wkperiod. Attrition was 14%. Acceptability was adequate but wanedover time, and mild transitory side effects occurred.Conclusions: Given the observed early reduction in LV and theprogressive reduction in VAT, we suggest that the minimum durationfor a preoperative VLED be 2 wk. Ideally, the duration shouldbe 6 wk to achieve maximal LV reduction and significant reductionsin VAT and body weight without compromising compliance andacceptability.
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Copyright 2006 American Society for Nutrition