Evaluating the impact of a moderately low-calorie ketogenic diet on mafld in patients with obesity: the role of magnetic resonance imaging

Massari Maria Chiara; Davide Masi; Elena Colonnello; Filippo Biagi; Marta Zerunian; Benedetta Masci; Flaminia Ferri; Monica Mischitelli; Carla Lubrano; Stefania Mariani; Andrea Laghi; Corradini Stefano Ginanni; Lucio Gnessi; Damiano Caruso; Mikiko Watanabe

doi:10.1530/endoabs.99.EP59

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Endocrine Abstracts (2024) 99 EP59 | DOI: 10.1530/endoabs.99.EP59

ECE2024 Eposter Presentations Diabetes, Obesity, Metabolism and Nutrition (383 abstracts)

Evaluating the impact of a moderately low-calorie ketogenic diet on mafld in patients with obesity: the role of magnetic resonance imaging

Maria Chiara Massari ¹ , Davide Masi ¹ , Elena Colonnello ¹ , Filippo Biagi ¹ , Marta Zerunian ² , Benedetta Masci ² , Flaminia Ferri ³ , Monica Mischitelli ³ , Carla Lubrano ¹ , Stefania Mariani ¹ , Andrea Laghi ² , Stefano Ginanni Corradini ³ , Lucio Gnessi ¹ , Damiano Caruso ² & Mikiko Watanabe ¹

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¹Sapienza University of Rome, Department of Experimental Medicine and Endocrinology, Sapienza University of Rome, Rome 00161, Italy; ²Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant’Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy; ³Division of Gastroenterology, Department of Clinical Medicine, Sapienza University of Rome, Rome 00161, Italy

Introduction: Metabolically associated fatty liver disease (MAFLD), prevalent in the Western world and a leading cause of liver transplantation among U.S. women, ranges from intra-hepatocyte lipid accumulation to cirrhosis. Fibrosis severity is crucial for prognosis, correlating with risks of advanced cirrhosis, portal hypertension, and hepatocellular carcinoma. 5-10% weight loss is associated with improvement of liver steatosis, but achieving >10% weight loss is usually necessary to improve NASH. Ketogenic diets, regardless of calorie intake, seem effective in treating steatosis, but there is very little evidence on their impact on liver fibrosis. The objective of this study is to evaluate the effect of a moderately low calorie, high-fat ketogenic diet (HFKD) on liver health in patients with MAFLD.

Methods: This prospective, pilot study involved patients with a confirmed MAFLD diagnosis through Magnetic Resonance Imaging (MRE) and Proton Density Fat Fraction (PDFF). Inclusion criteria included age over 18, and BMI ≥ 30 kg/m², while exclusion criteria included decompensated liver failure, pregnancy/lactation, type 1 diabetes mellitus, chronic renal disease, alcoholism, hepatotropic viral infection. The primary outcome was reduction of liver steatosis, while secondary outcomes focused on safety, improvements in liver fibrosis, metabolic profile, and body composition. The patients underwent a moderately hypocaloric HFKD for 90 days and Magnetic Resonance Imaging (MRE) was employed to evaluate steatosis (PDFF %) and stiffness (kPa). Baseline and post-intervention assessments included anthropometric measurements, biochemical analysis, and body composition evaluation (DEXA).

Results: Seven patients with MAFLD (mean age 61.3±8.14 years and mean BMI 38.84±6.62 kg/m²) were included. Following the dietary intervention, weight loss (-8.14 kg, P=0.03) and a decrease in mean BMI (-2.92 kg/m², P=0.02) and fat mass percentage (-3.57%, P=0.02) were reported. As expected given the small calorie deficit, none had >10% weight loss, allowing for better evaluation of the impact of macronutrient composition beyond calorie deficit/weight loss per se. MRE revealed a significant reduction in steatosis (PDFF -6.16%, P=0.03). Although no statistical reduction in liver fibrosis was observed overall likely due to the small sample size, three out of seven patients exhibited clinically relevant stiffness decrease. Notably, two patients achieved complete resolution of NASH, while another, despite remaining cirrhotic, demonstrated significant improvement. Safety parameters were unchanged.

Conclusion: Despite modest weight loss, preliminary data indicate a role for HFKD in managing MAFLD, not only in mitigating steatosis but potentially in more advanced stages characterized by liver fibrosis. MRE emerges as a sensitive tool for assessing MAFLD changes over time.