Abstract

Background. Short-term interventions based on very low-calorie ketogenic diets (VLCKDs) and meal replacements may be prescribed to selected metabolic syndrome patients and/or to those with an altered microbiota composition. In this view, protein source choise is still debated. In fact, few and inconsistent data, are available on protein intake from various sources on body weight, composition of gut microbiota and metabolic outcomes in these patients. Clinical case. A 52-year-old man affected by first degree obesity, hypertension, hyperuricemia, hyperinsulinism, hypercholesterolemia, hypertriglyceridemia and an altered gut microbiota with an increased Firmicutes/Bacteroidetes ratio, was admitted to our facility. Therefore, a diet therapy treatment with VLCKD (≤800 kcal/day) was set for a 45 days period based on meal replacements containing vegetal proteins. Anthropometric indexes, blood and urine chemistry, body composition, muscle strength and taxonomic composition of gut microbiota were assessed at the beginning and after 45 days. A significant reduction of body weight (109 vs 93,4 Kg), BMI (33 vs 27 Kg/m2), blood pressure (150/100 vs 120/70 mmHg), waist circumference (114 vs 101 cm), HOMA index (9,1 vs 2,3), triglycerides (612 vs 129 mg/dl) , total cholesterol (318 vs 151 mg/dl) and HDL cholesterol (32 vs 48mg/dl) and visceral adipose tissue (793 vs 599 g) was observed at 0-45 days respectively. Moreover, a decrease in relative abundance of Firmicutes, an increase of Bacteroidetes and an increase of Verrucomicrobiae were also observed. Conclusions. These preliminary results suggest that vegan VLCKD administrated to our patient led to a significant weight loss, a striking improvement of the metabolic parameters and a restoring eubiosis in gut microbiota. VLCKD with vegetal protein could be a good treatment for obesity leading to an improvement of metabolic syndrome also assisted by the rebalancing of gut microbiota.

Highlights

  • Proceedings 2020, 57, x; doi: FOR PEER REVIEW www.mdpi.com/journal/proceedingsProceedings 2020, 57, x FOR PEER REVIEWMetabolic Syndrome (MetS) was described for the first time by Gerald Reaven in 1988 [1] and was defined as the association between insulin resistance (IR), hypertension, dyslipidemia, Nonalcoholic fatty liver disease (NAFLD), impaired glucose tolerance and other metabolic abnormalities related to increased cardiovascular risk [2]. MetS is linked to increase mortality for coronary heart disease (CHD), diabetes and cancer [3,4]. the pathophysiological mechanism is still under study, a key factor in the pathogenesis of MetS is represented by IR, a phenomenon prevalent in the obese population and characterized by the resistance of peripheral tissues to insulin action

  • In particular it is known that in obese subjects there is a dysbiosis of gut microbiota [10,11]: obesity is characterized by an altered intestinal Bacteroides/Firmicutes ratio, with greater relative abundance of Firmicutes [12]

  • Baseline medication therapy was carvedilol 6.25 mg, irbesartan 300 mg, hydrochlorothiazide 12.5 mg and allopurinol 300 mg. This patient was screened from March 2019 to June 2019 and was prescribed very low-calorie ketogenic diets (VLCKDs) with meal replacements based on vegetal protein [780 kcal/day, with the following composition in macronutrients, percentage of caloric intake and g/kg of ideal Body weight (BW) of proteins: carbohydrates g (13.5%), olive oil 20 g plus 15 g of lipids from other sources (40.4%), proteins 90 g (46.1%, 1.4 g/Kg)] for 45 days

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Summary

Introduction

Metabolic Syndrome (MetS) was described for the first time by Gerald Reaven in 1988 [1] and was defined as the association between insulin resistance (IR), hypertension, dyslipidemia, Nonalcoholic fatty liver disease (NAFLD), impaired glucose tolerance and other metabolic abnormalities related to increased cardiovascular risk [2]. In particular it is known that in obese subjects there is a dysbiosis of gut microbiota [10,11]: obesity is characterized by an altered intestinal Bacteroides/Firmicutes ratio, with greater relative abundance of Firmicutes [12]. This modification in gut microbiota composition is associated with greater energy breakdown and absorption from food, higher efficiency in storing fat in adipose tissue, as well as stimulation of metabolic endotoxemia and low-grade inflammation [9,13].

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