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Preoperative weight loss with a very-low-energy diet: quantitation of changes in liver and abdominal fat by serial imaging^1,2,3

¹ From the Centre for Obesity Research and Education (CORE), Monash University, Melbourne, Australia (SLC, JBD, and PEO); the Radiology Department, The Avenue Hospital, Windsor, Australia (PM); and the Department of Medicine, Monash University, Clayton, Australia (BJS)

Background: A very-low-energy diet (VLED) can result in substantial, rapid weight loss and is increasingly prescribed before obesity surgery to minimize risk and difficulty by reducing liver size and abdominal adiposity. Despite its growing popularity, a VLED in this setting has received little attention.

Objective: The aim of this study was to investigate the efficacy and acceptability of a preoperative VLED.

Design: In a prospective observational study, 32 subjects (n = 19 men and 13 women) with a mean (±SD) age of 47.5 ± 8.3 y and a body mass index (in kg/m²) of 47.3 ± 5.3 consumed a VLED for 12 wk. Primary outcomes included changes in liver volume (LV) and in visceral and subcutaneous adipose tissue (VAT/SAT). Changes in body weight, anthropometric measures, and biochemical variables were also recorded, and compliance with, acceptability of, and side effects of treatment were assessed. Changes in LV and VAT/SAT area were measured by computed tomography and magnetic resonance imaging at baseline and weeks 2, 4, 8, and 12.

Results: Mean (±SD) LV, VAT/SAT, and body weight decreased significantly (P < 0.001 for all). The degree of LV reduction was directly 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 of the reduction in LV occurred between weeks 0 and 2 (P < 0.001). Reductions in body weight and VAT were uniform over the 12-wk period. Attrition was 14%. Acceptability was adequate but waned over time, and mild transitory side effects occurred.

Conclusions: Given the observed early reduction in LV and the progressive reduction in VAT, we suggest that the minimum duration for a preoperative VLED be 2 wk. Ideally, the duration should be 6 wk to achieve maximal LV reduction and significant reductions in VAT and body weight without compromising compliance and acceptability.

Key Words: Severe obesity • fatty liver • very-low-energy diet • VLED • weight loss • surgery • laparoscopy • body composition

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