Efficacy, feasibility and tolerability of ketogenic diet for the treatment of poor response to bariatric surgery.

PURPOSE: Poor response to bariatric surgery, namely insufficient weight loss (IWL) or weight regain (WR), is a critical issue in the treatment of obesity. The purpose of our study was to assess the efficacy, feasibility, and tolerability of very low-calorie ketogenic diet (VLCKD) for the management of this condition. METHODS: A real-life prospective study was conducted on twenty-two patients who experienced poor response after bariatric surgery and followed a structured VLCKD. Anthropometric parameters, body composition, muscular strength, biochemical analyses, and nutritional behavior questionnaires were evaluated. RESULTS: A significant weight loss (mean 14.1 ± 4.8%), mostly due to fat mass, was observed during VLCKD with the preservation of muscular strength. The weight loss obtained allowed patients with IWL to reach a body weight significantly lower than that obtained at the post-bariatric surgery nadir and to report the body weight of patients with WR at the nadir observed after surgery. The significantly beneficial changes in nutritional behaviors and metabolic profiles were observed without variations in kidney and liver function, vitamins, and iron status. The nutritional regimen was well tolerated, and no significant side effects were detected. CONCLUSION: Our data demonstrate the efficacy, feasibility, and tolerability of VLCKD in patients with poor response after bariatric surgery.

Association of maternal smoking during pregnancy with aerobic fitness of offspring in young adulthood: a prospective cohort study.

OBJECTIVE: We evaluated the association of maternal pre-pregnancy body mass index (BMI), gestational weight gain (GWG), and maternal smoking with aerobic fitness in young men aged 19-20 years. DESIGN: A 19-year prospective cohort study. SETTING: Data from the Northern Finland Birth Cohort 1986 (NFBC 1986) and the Sodankylä Jaeger Brigade, Finland, in 2005-6. POPULATION: Mothers and the 508 offspring in the NFBC 1986 who entered military service at the Sodankylä Jaeger Brigade in 2005. METHODS: Associations of weight, 12-minute running test (Cooper test), and muscle fitness index (MFI) of offspring on entry to military service were evaluated with antenatal factors, including maternal smoking, pre-pregnancy BMI, and GWG. MAIN OUTCOME MEASURES: Aerobic and muscle fitness of the offspring were evaluated by the Cooper test and MFI. RESULTS: Maternal smoking during pregnancy was associated with lower aerobic fitness of male adolescents, measured by the Cooper test (2356 m; 95% confidence interval, 95% CI 2265-2446 m), compared with the offspring of mothers who did not smoke during pregnancy (2537 m, 95% CI 2499-2574 m). This association was independent of the BMIs of both the mother and the offspring, GWG, and the smoking and physical activity of offspring (regression coefficient -140.6 m, 95% CI -273.1 to -8.0 m). High maternal pre-pregnancy BMI and excessive GWG were also associated with lower aerobic fitness of the offspring; however, this association was mediated via the weight of the offspring. CONCLUSIONS: Maternal smoking during pregnancy may have a negative impact on the aerobic fitness of the offspring. TWEETABLE ABSTRACT: Study shows that young men have lower aerobic fitness if their mothers smoked during pregnancy.