Effect of a Very-Low-Calorie Ketogenic Diet on Circulating Myokine Levels Compared with the Effect of Bariatric Surgery or a Low-Calorie Diet in Patients with Obesity

The preservation of muscle mass and muscle function after weight loss therapy is currently a considerable challenge in the fight against obesity. Muscle mass secretes proteins called myokines that have relevant functions in the regulation of metabolism and health. This study was aimed to evaluate whether a very low-calorie ketogenic (VLCK) diet may modulate myokine levels, in addition to changes in body composition, compared to a standard, balanced low-calorie (LC) diet or bariatric surgery in patients with obesity. Body composition, ketosis, insulin sensitivity and myokines were evaluated in 79 patients with overweight/obesity after a therapy to lose weight with a VLCK diet, a LC diet or bariatric surgery. The follow-up was 6 months. The weight loss therapies induced changes in myokine levels in association with changes in body composition and biochemical parameters. The effects on circulating myokine levels compared to those at baseline were stronger after the VLCK diet than LC diet or bariatric surgery. Differences reached statistical significance for IL-8, MMP2 and irisin. In conclusion, nutritional interventions or bariatric surgery to lose weight induces changes in circulating myokine levels, being this effect potentially most notable after following a VLCK diet

Effect of a Very-Low-Calorie Ketogenic Diet on Circulating Myokine Levels Compared with the Effect of Bariatric Surgery or a Low-Calorie Diet in Patients with Obesity

: The preservation of muscle mass and muscle function after weight loss therapy is currently a considerable challenge in the fight against obesity. Muscle mass secretes proteins called myokines that have relevant functions in the regulation of metabolism and health. This study was aimed to evaluate whether a very low-calorie ketogenic (VLCK) diet may modulate myokine levels, in addition to changes in body composition, compared to a standard, balanced low-calorie (LC) diet or bariatric surgery in patients with obesity. Body composition, ketosis, insulin sensitivity and myokines were evaluated in 79 patients with overweight/obesity after a therapy to lose weight with a VLCK diet, a LC diet or bariatric surgery. The follow-up was 6 months. The weight loss therapies induced changes in myokine levels in association with changes in body composition and biochemical parameters. The effects on circulating myokine levels compared to those at baseline were stronger after the VLCK diet than LC diet or bariatric surgery. Differences reached statistical significance for IL-8, MMP2 and irisin. In conclusion, nutritional interventions or bariatric surgery to lose weight induces changes in circulating myokine levels, being this effect potentially most notable after following a VLCK diet

Effect of a Very-Low-Calorie Ketogenic Diet on Circulating Myokine Levels Compared with the Effect of Bariatric Surgery or a Low-Calorie Diet in Patients with Obesity

The preservation of muscle mass and muscle function after weight loss therapy is currently a considerable challenge in the fight against obesity. Muscle mass secretes proteins called myokines that have relevant functions in the regulation of metabolism and health. This study was aimed to evaluate whether a very low-calorie ketogenic (VLCK) diet may modulate myokine levels, in addition to changes in body composition, compared to a standard, balanced low-calorie (LC) diet or bariatric surgery in patients with obesity. Body composition, ketosis, insulin sensitivity and myokines were evaluated in 79 patients with overweight/obesity after a therapy to lose weight with a VLCK diet, a LC diet or bariatric surgery. The follow-up was 6 months. The weight loss therapies induced changes in myokine levels in association with changes in body composition and biochemical parameters. The effects on circulating myokine levels compared to those at baseline were stronger after the VLCK diet than LC diet or bariatric surgery. Differences reached statistical significance for IL-8, MMP2 and irisin. In conclusion, nutritional interventions or bariatric surgery to lose weight induces changes in circulating myokine levels, being this effect potentially most notable after following a VLCK dietThis work was supported by the PronoKal Group® and grants from the Fondo de Investigacion Sanitaria, PI17/01287 research projects and CIBERobn (CB06/03/0003, CB12/03/30007, CB12/03/30002, CB06/03/0018) from the Instituto de Salud Carlos III (ISCIII)-Subdireccion General de Evaluacion y Fomento de la Investigación; Fondo Europeo de Desarrollo Regional (FEDER) and the Health Department of the Government of Navarra (48/2009), Spain and Linea Especial “Nutrition, Obesity and Health” (University of Navarra LE/97). Ana B Crujeiras is funded by a research contract “Miguel Servet” (CP17/00088) from the ISCIII, co-financed by the European Regional Development Fund (FEDER)S

Epigenetic Landscape in Blood Leukocytes Following Ketosis and Weight Loss Induced by a Very Low Calorie Ketogenic Diet (VLCKD) in Patients With Obesity

[Abstract] Background:The molecular mechanisms underlying the potential health benefits of a ketogenic diet areunknown and could be mediated by epigenetic mechanisms.Objective:To identify the changes in the obesity-related methylome that are mediated by the inducedweight loss or are dependent on ketosis in subjects with obesity underwent a very-low calorie ketogenicdiet (VLCKD).Methods:Twenty-one patients with obesity (n¼12 women, 47.9±1.02 yr, 33.0±0.2 kg/m2) after 6months on a VLCKD and 12 normal weight volunteers (n¼6 women, 50.3±6.2 yrs, 22.7±1.5 kg/m2)were studied. Data from the Infinium MethylationEPIC BeadChip methylomes of blood leukocytes wereobtained at time points of ketotic phases (basal, maximum ketosis, and out of ketosis) during VLCKD(n¼10) and at baseline in volunteers (n¼12). Results were further validated by pyrosequencing inrepresentative cohort of patients on a VLCKD (n¼18) and correlated with gene expression.Results:After weight reduction by VLCKD, differences were found at 988 CpG sites (786 unique genes).The VLCKD altered methylation levels in patients with obesity had high resemblance with those fromnormal weight volunteers and was concomitant with a downregulation of DNA methyltransferases(DNMT)1, 3a and 3b. Most of the encoded genes were involved in metabolic processes, protein meta-bolism, and muscle, organ, and skeletal system development. Novel genes representing the top scoringassociated events were identified, includingZNF331,FGFRL1(VLCKD-induced weight loss) andCBFA2T3,C3orf38,JSRP1, andLRFN4(VLCKD-induced ketosis). Interestingly,ZNF331andFGFRL1were validated inan independent cohort and inversely correlated with gene expression.Conclusions:The beneficial effects of VLCKD therapy on obesity involve a methylome more suggestive ofnormal weight that could be mainly mediated by the VLCKD-induced ketosis rather than weight loss.This work was supported by the PronoKal Group® and grants from the Fondo de Investigacion Sanitaria as well as PI17/01287, PI20/00628 and PI20/00650 research projects and CIBERobn from the Instituto de Salud Carlos III (ISCIII)-Subdireccion General de Evaluacion y Fomento de la Investigación; Fondo Europeo de Desarrollo Regional (FEDER) Ana B Crujeiras is funded by a research contract “Miguel Servet” (CP17/00088) from the ISCIII, co-financed by the European Regional Development Fund (FEDER) and Xunta de Galicia-GAIN (IN607B2020)Xunta de Galicia; IN607B202

Epigenetic Landscape in Blood Leukocytes Following Ketosis and Weight Loss Induced by a Very Low Calorie Ketogenic Diet (VLCKD) in Patients with Obesity

Background: The molecular mechanisms underlying the potential health benefits of a ketogenic diet are unknown and could be mediated by epigenetic mechanisms. Objective: To identify the changes in the obesity-related methylome that are mediated by the induced weight loss or are dependent on ketosis in subjects with obesity underwent a very-low calorie ketogenic diet (VLCKD). Methods: Twenty-one patients with obesity (n ¼ 12 women, 47.9 ± 1.02 yr, 33.0 ± 0.2 kg/m2 ) after 6 months on a VLCKD and 12 normal weight volunteers (n ¼ 6 women, 50.3 ± 6.2 yrs, 22.7 ± 1.5 kg/m2 ) were studied. Data from the Infinium MethylationEPIC BeadChip methylomes of blood leukocytes were obtained at time points of ketotic phases (basal, maximum ketosis, and out of ketosis) during VLCKD (n ¼ 10) and at baseline in volunteers (n ¼ 12). Results were further validated by pyrosequencing in representative cohort of patients on a VLCKD (n ¼ 18) and correlated with gene expression. Results: After weight reduction by VLCKD, differences were found at 988 CpG sites (786 unique genes). The VLCKD altered methylation levels in patients with obesity had high resemblance with those from normal weight volunteers and was concomitant with a downregulation of DNA methyltransferases (DNMT)1, 3a and 3b. Most of the encoded genes were involved in metabolic processes, protein metabolism, and muscle, organ, and skeletal system development. Novel genes representing the top scoring associated events were identified, including ZNF331, FGFRL1 (VLCKD-induced weight loss) and CBFA2T3, C3orf38, JSRP1, and LRFN4 (VLCKD-induced ketosis). Interestingly, ZNF331 and FGFRL1 were validated in an independent cohort and inversely correlated with gene expression. Conclusions: The beneficial effects of VLCKD therapy on obesity involve a methylome more suggestive of normal weight that could be mainly mediated by the VLCKD-induced ketosis rather than weight loss.This work was supported by the PronoKal Group® and grants from the Fondo de Investigacion Sanitaria as well as PI17/01287, PI20/00628 and PI20/00650 research projects and CIBERobn from the Instituto de Salud Carlos III (ISCIII)-Subdireccion General de Evaluacion y Fomento de la Investigación; Fondo Europeo de Desarrollo Regional (FEDER) Ana B Crujeiras is funded by a research contract “Miguel Servet” (CP17/00088) from the ISCIII, co-financed by the European Regional Development Fund (FEDER) and Xunta de Galicia-GAIN (IN607B2020). The funding source had no involvement in the study design or interpretation of the result

Very-Low-Calorie Ketogenic Diets with Whey, Vegetable or Animal Protein in Patients with Obesity: A Randomized Pilot Study

Context We compared the efficacy, safety and effect of 45-day isocaloric very-low-calorie ketogenic diets (VLCKDs) incorporating whey, vegetable or animal protein on the microbiota in patients with obesity and insulin resistance to test the hypothesis that protein source may modulate the response to VLCKD interventions. Subjects and Methods Forty-eight patients with obesity [19 males and 29 females, HOMA index ≥ 2.5, age 56.2±6.1 years, body mass index (BMI) 35.9±4.1 kg/m2] were randomly assigned to three 45-day isocaloric VLCKD regimens (≤800 kcal/day) containing whey, plant or animal protein. Anthropometric indexes; blood and urine chemistry, including parameters of kidney, liver, glucose and lipid metabolism; body composition; muscle strength; and taxonomic composition of the gut microbiome were assessed. Adverse events were also recorded. Results Body weight, BMI, blood pressure, waist circumference, HOMA index, insulin, and total and LDL cholesterol decreased in all patients. Patients who consumed whey protein had a more pronounced improvement in muscle strength. The markers of renal function worsened slightly in the animal protein group. A decrease in the relative abundance of Firmicutes and an increase in Bacteroidetes were observed after the consumption of VLCKDs. This pattern was less pronounced in patients consuming animal protein. Conclusions VLCKDs led to significant weight loss and a striking improvement in metabolic parameters over a 45-day period. VLCKDs based on whey or vegetable protein have a safer profile and result in a healthier microbiota composition than those containing animal proteins. VLCKDs incorporating whey protein are more effective in maintaining muscle performance

Efeito de uma dieta cetogênica de baixa caloria na composição corporal em adultos com sobrepeso e obesos: uma revisão sistemática e meta-análise

Low-calorie ketogenic diet is known for its effect on reducing body weight. Healthy weight loss should reduce the body fat and maintain the muscle mass, but previous meta-analyses have not evaluated these changes. The objective of this meta-analysis was to quantify the effect of ketogenic diet compared to a hypocaloric diet, on changes in body composition in overweight adults.La dieta cetogénica baja en calorías (DC) se conoce por su efecto para reducir el peso corporal. La pérdida de peso saludable debe reducir la grasa corporal y mantener la masa muscular, pero los metaanálisis previos no han evaluado estos cambios. El objetivo de este metaanálisis fue cuantificar el efecto de la dieta cetogénica comparada con una dieta hipocalórica (DH), sobre los cambios de composición corporal en adultos con exceso de peso.A dieta cetogênica baixa em calorías é conhecida por seu efeito na redução no peso corporal. A perda de peso saudável deve reduzir a gordura corporal e manter a massa muscular, porém em meta-análises anteriores essas variáveis não foram avaliadas. O objetivo desta meta-análise foi avaliar o efeito da dieta cetogênica em comparação com uma dieta hipocalórica, nas mudanças da composição corporal em adultos com excesso de peso

Molecular regulation of nutrient sensing and immunometabolism by calorie restriction

“‘You'll live longer and you'll be healthier too,’ he answered. ‘Because as we were saying today, there's nothing in the world like eating moderately to live a long life.’ ‘If that's the way things are,’ I thought to myself, ‘I never will die.’ Because I've always been forced to keep that rule, and with my luck I'll probably keep it all my life.”—Anonymous, The Life of Lazarillo de Tormes and of His Fortunes and Adversities 1554. Adaptive mechanisms in response to calorie restriction are evolutionarily conserved and necessary to promote longevity and increase health span. Caloric restriction (CR) without malnutrition, constitutes an effective strategy for weight reduction and ameliorates the chronic inflammatory burden of many chronic metabolic diseases. CR is known to impact nutrient sensing and immuno-metabolic processes in immune cells, but not much is known about skeletal muscle, the largest tissue in the body. We first delve into the literature that describes the interaction of CR and epigenetic mechanisms: DNA methylation, histone modifications, and microRNAs. We explore the impact of CR on nutrient sensing and immuno-metabolic processes and provide a comprehensive view of the adaptive and epigenetic machinery coordinated by CR. In our first study, we aimed to uncover the long-term effect of CR following early-life high fat-diet exposure. We analyzed physiological, biochemical, and transcriptional changes in muscle following chronic CR. Our results indicate that CR activates nutrient sensing pathways, promotes protein recycling, and stimulates myogenesis, possibly due to inhibition of cachexia-inducing inflammatory pathways. Then, our second experiment was designed to titrate the effects of CR by using a novel approach with clinical translatability. We used alternate-day CR (ADCR) in 1-3 days a week and 25-75 % energy restriction to delineate the physiological, biochemical, and transcriptional changes in muscle following chronic ADCR. Effective strategies with high translatable potential, such as 50% CR more than 2 days a week or 75% CR more than 1 day a week, produced similar effects to the gold standard of 25% chronic CR. Finally, on our third experiment we dissected the series of adaptive, epigenetic mechanisms employed by CR to decrease muscle inflammation. Chronic CR activates a series of inhibitors of inflammatory factor NF-kB, while increasing promoter DNA methylation and decreasing transcription factor binding of cytokine Tnf, as well as fine-tuning miRNA expression to prevent inflammation. Here we describe that CR orchestrates a series of adaptive nutrient sensing and anti-inflammatory checkpoints to inhibit inflammation and promote skeletal muscle maintenance

Obesity-induced chronic inflammation in C57Bl6J mice, a novel risk factor in the progression of renal AA amyloidosis?

Background: Compelling evidence links obesity induced systemic inflammation to the development of chronic kidney disease (CKD). This systemic inflammation may result from exacerbated adipose inflammation. Besides the known detrimental effects of typical pro-inflammatory factors secreted by the adipose tissue (TNF-α, MCP-1 and IL-6) on the kidney, we hypothesize the enhanced obesity-induced secretion of serum amyloid A (SAA), an acute inflammatory protein, to play a key role in aggravating obesity-induced CKD. Methods: Groups of male C57Bl/6J mice (n = 99 in total) were fed a low (10% lard) or high (45% lard) fat diet for a maximum of 52 weeks. Mice were sacrificed after 24, 40 and 52 weeks. Whole blood samples, kidneys and adipose tissues were collected. The development of adipose and renal tissue inflammation was assessed on gene expression and protein level. Adipocytokine levels were measured in plasma samples. Results: A distinct inflammatory phenotype was observed in the adipose tissue of HFD mice prior to renal inflammation, which was associated with an early systemic elevation of TNF-α, leptin and SAA (1A-C). With aging, sclerotic lesions appeared in the kidney, the extent of which was severely aggravated by HFD feeding. Lesions exhibited typical amyloid characteristics (2A) and pathological severity positively correlated with bodyweight (2B). Interestingly, more SAA protein was detected in lesions of HFD mice. Conclusion: Our data suggest a causal link between obesity induced chronic inflammation and AA amyloidosis in C57Bl/6J mice. Though future studies are necessary to prove this causal link and to determine its relevance for the human situation, obesity may hence be considered a risk factor for the development and progression of renal AA amyloidosis in the course of CKD. (Figure Presented)