Role of nutritional ketosis in the improvement of metabolic parameters following bariatric surgery

BACKGROUNDKetone bodies (KB) might act as potential metabolic modulators besides serving as energy substrates. Bariatric metabolic surgery (BMS) offers a unique opportunity to study nutritional ketosis, as acute postoperative caloric restriction leads to increased lipolysis and circulating free fatty acids.AIMTo characterize the relationship between KB production, weight loss (WL) and metabolic changes following BMS.METHODSFor this retrospective study we enrolled male and female subjects aged 18-65 years who underwent BMS at a single Institution. Data on demographics, anthropometrics, body composition, laboratory values and urinary KB were collected.RESULTSThirty-nine patients had data available for analyses [74.4% women, mean age 46.5 & PLUSMN; 9.0 years, median body mass index 41.0 (38.5; 45.4) kg/m(2), fat mass 45.2% & PLUSMN; 6.2%, 23.1% had diabetes, 43.6% arterial hypertension and 74.4% liver steatosis]. At 46.0 & PLUSMN; 13.6 d post-surgery, subjects had lost 12.0% & PLUSMN; 3.6% of pre-operative weight. Sixty-nine percent developed ketonuria. Those with nutritional ketosis were significantly younger [42.9 (37.6; 50.7) years vs 51.9 (48.3; 59.9) years, P = 0.018], and had significantly lower fasting glucose [89.5 (82.5; 96.3) mg/dL vs 96.0 (91.0; 105.3) mg/dL, P = 0.025] and triglyceride levels [108.0 (84.5; 152.5) mg/dL vs 152.0 (124.0; 186.0) mg/dL, P = 0.045] vs those with ketosis. At 6 mo, percent WL was greater in those with postoperative ketosis (-27.5% & PLUSMN; 5.1% vs 23.8% & PLUSMN; 4.3%, P = 0.035). Urinary KBs correlated with percent WL at 6 and 12 mo. Other metabolic changes were similar.CONCLUSIONOur data support the hypothesis that subjects with worse metabolic status have reduced ketogenic capacity and, thereby, exhibit a lower WL following BMS.

Automated summary

This study found that nutritional ketosis is associated with greater weight loss and better metabolic status in patients undergoing bariatric metabolic surgery. Patients with better metabolic status have a higher capacity for ketogenesis, leading to more significant weight loss.