Endocrine Abstracts

JOINT2788

The global prevalence of obesity and type 2 diabetes (T2D) has risen dramatically, affecting over 890 million adults. Sedentary lifestyle and increased consumption of Western Diet contribute not only to obesity but also to the development of steatotic liver disease associated with metabolic dysfunction (MASLD). Ketogenic Diet (KD), which induces ketosis, has gained clinical interest due to its therapeutic effects in reducing body weight, improving insulin sensitivity, and ameliorating dyslipidemia. The very-low-calorie ketogenic diet (VLCKD) protocol is one of the most used in clinical practice, characterized by low carbohydrate (<40g/day), adequate protein for ideal body weight, and normal fat intake, with a total daily caloric intake of 500-800 Kcal. Despite promising evidence on VLCKD antiseizure effects, its impact on T2D associated with MASLD remains controversial. This 12-week pilot study investigates the VLCKD effects on metabolic parameters and MASLD in patients with T2D and obesity. 10 out of 15 enrolled patients ended the study protocol. All participants (mean age: 44.43 years) had T2D with a mean disease duration of 2.7 years (HbA1c: 6.6% ± 0.76), obesity (BMI: 39.42 kg/m²), and MASLD (CAP: 273.56 ± 48.82 dB/min, LS: 5.89 ± 1.7 kPa), diagnosed via liver ultrasound and vibration-controlled transient elastography (VCTE, FibroScan Echosens). At the end of the 12 weeks, we observed significant improvements, including reductions in body weight, BMI, hip and waist circumferences, and fat mass percentage (40.07 ± 4.13 vs. 34.5 ± 12%), while fat-free mass increased (59.9 ± 4.1% vs. 64.0 ± 20.8%). Blood pressure improved, along with fasting insulin, HbA1c (6.5 ± 0.2% vs. 5.6 ± 0.2%), and triglycerides. Liver parameters of MASLD at VCTE improved, as shown by reductions in CAP (283.1 ± 51 vs. 241.6 ± 71 dB/m) and LS (5.8 ± 1.93 vs. 4.67 ± 1.27 kPA). At the beginning of the study, 3 patients stopped SGLT2 inhibitors and insulin treatments, without needing to add them at the end of the study. Nobody added new drugs. These preliminary findings suggest that VLCKD seems to have potential benefits in improving the short-term T2D parameters coupled with amelioration of MASLD, likely due to a reduction in de novo lipogenesis and an increase in hepatic lipolysis.