Major clinical outcomes of dietary therapy in patients with lipedema in the preoperative period of plastic surgery: a systematic review

Abstract

Introduction: The first clinical study on dietary therapy in lipedema showed improvement in general body composition and in specifically affected areas (upper and lower limbs) with the consumption of a low-carbohydrate diet and foods high in antioxidants inspired by the Mediterranean diet. Objective: It was to explore the main directions of dietary therapy in patients with lipedema as a pre-operative management tool for plastic surgery. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from August to September 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 127 articles were found, and 33 articles were evaluated in full, and 23 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 15 studies with a high risk of bias and 29 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X2=71.5%>50%. It was concluded that in the pre-operative phase of plastic surgery for lipedema, the ketogenic diet effectively induced weight loss and fat mass, including in the limbs, areas considered unresponsive to dietary therapy in patients with lipedema. The best results were obtained with the combination of the ketogenic diet and carboxytherapy, which showed both an improvement in body composition and a reduction in pain, as well as an improvement in sleep quality. Healthy eating patterns for lipedema can be whole foods, enzyme-rich, plant-based, or ketogenic. Research favors plant-based low-carb diets, which correlate with decreased all-cause mortality relative to animal-based diets. Furthermore, vitamin D levels must be monitored and normalized in people with lipedema. A low-calorie diet based on foods rich in anti-inflammatory and antioxidant nutrients could contribute to the well-being of patients with lipedema, improving quality of life, and reducing asthenia, pain, and anxiety. Selenium can reduce oxidative stress, which plays an important role in lipedema. MicroRNAs produced by the stromal vascular fraction of lipedema represent important therapeutic targets for the treatment of lipedema. Precision nutrition is an emerging branch of nutrition science that aims to use omics technologies (metabolomics) to better target the nutritional treatment of lipedema