none6noneAntonio  Paoli;Keith  Grimaldi;Antonino  Bianco;Alessandra  Lodi;Lorenzo  Cenci;Andrea  ParmagnaniPaoli, Antonio; Keith, Grimaldi; Antonino, Bianco; Lodi, Alessandra; Lorenzo, Cenci; Parmagnani, Andre

A Paoli

A Tagliabue

Alessandra Lodi

Andrea Parmagnani

Antonino Bianco

Antonio Paoli

JS Volek

Keith Grimaldi

Lorenzo Cenci

BMC Proceedings

English

PubMed

Springer - Publisher Connector

Medium term effects of a ketogenic diet and a Mediterranean diet on resting energy expenditure and respiratory ratio

POSTER PRESENTATION Open Access
Medium term effects of a ketogenic diet and a
Mediterranean diet on resting energy
expenditure and respiratory ratio
Antonio Paoli1*, Keith Grimaldi2, Antonino Bianco3, Alessandra Lodi4, Lorenzo Cenci5, Andrea Parmagnani1
From Metabolism, diet and disease
Washington, DC, USA. 29-31 May 2012
Background
Very low carbohydrate ketogenic type diets (VLCKD) have
been shown to be more effective for body weight reduc-
tion and fat loss compared to balanced or low-calorie
Mediterranean diets, at least in the short-medium term
[1,2], although the underlying mechanisms of its efficacy
are still not well understood. Despite being a diet in wide-
spread use there are few data available regarding effects on
respiratory ratio (RR) [3,4] and resting energy expenditure
(REE) and, more specifically, there are no reports about
the effects on RR following a return to a non ketogenic
diet. The aim of this study was to compare the effects of a
20 day ketogenic Mediterranean diet with phytoextracts
(KEMEPHY) and a low-calorie Mediterranean diet (MD)
on RR and REE during and 20 days after finishing the
ketogenic phase.
Materials and methods
Forty healthy, overweight subjects were recruited and ran-
domly divided into two groups: MD (age 46.61 ± 14.6,
BMI 26.8±2.6, weight 76.3±9.9 kg ) and KEMEPHY (age
50.63 ±11.6, BMI 28.8±2.8, weight 81.8±11.6 kg). KEME-
PHY group followed a ketogenic diet (<30g/day of carbo-
hydrates) using meals that mimic the aspect and the taste
of carbohydrates but with virtually zero CHO and with
phytoextracts (Tisanoreica®, Lonigo, Italy); after 20 days of
strictly KD subjects followed a low carbohydrate non keto-
genic diet for 20 days. The MD group followed a standard
low-calorie Mediterranean diet (tot Kcal). REE and RR,
together with body weight and body composition, were
measured in the morning after overnight fasting at the
start of the study and after 20 (t20) and 40 days (t40). An
Anova test for repeated measures and unpaired t-test with
Welch’s correction were performed when appropriate.
Results
Compared to starting values RR was significantly
decreased in the KEMEPHY group after 20 days (p<0.05)
and after 40 days (p=0.0002) (0.86±0.06; 0.79±0.05; 0.76
±0.08; respectively) whilst no significant differences were
detected in RR in the MED group. No significant differ-
ences in REE were detected. Both groups showed a signifi-
cant decrease in body weight at t20 and t40 compared to
basal conditions (KEMEPHY basal 81.8±11.6; t20 77.8
±11.4; t40 75±11.2. MED basal 76.3±9.9; t20 75.6±9.9; 71.7
±9.8) with the percentage changes in body weight being
significantly greater for the KEMEPHY group. Both groups
showed a significant decrease in body fat mass at t20 and
t40 compared to basal conditions with the percentage
changes in body fat mass being significantly greater for the
KEMEPHY group (P=0.0135).
Conclusions
These preliminary data showed that whilst both diet pro-
tocols lead to a significant decrease in body weight, the
reduction was significantly greater during KEMEPHY. The
KEMEPHY diet also lead to a lowering of RR and
increased fat oxidation at rest without any effect on REE.
These findings suggest that one of the main weight loss
mechanisms of KD might be attributed to an improve-
ment in resting nutrient oxidation and interestingly this
effect was long lasting, at least for up to 20 days following
cessation of the ketogenic. Data on metabolic effects of
KEMEPHY 3 months the ketogenic period will soon be
available.
1Biomedical Engineering Laboratory, Institute of Communication and
Computer Systems, National Technical University of Athens, Athens, Greece
Full list of author information is available at the end of the article
Paoli et al. BMC Proceedings 2012, 6(Suppl 3):P37
http://www.biomedcentral.com/1753-6561/6/S3/P37
© 2012 Paoli et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
Author details
1Biomedical Engineering Laboratory, Institute of Communication and
Computer Systems, National Technical University of Athens, Athens, Greece.
2. 3Dept. of Sports and Exercise Science (DISMOT), University of Palermo,
Italy. 4Pharmaceutical and Chemistry and Technologies, University of Padova,
Italy. 5Tisanoreica Research Center, Lonigo, Vicenza, Italy.
Published: 1 June 2012
References
1. Volek JS, Sharman MJ: Cardiovascular and hormonal aspects of very-low-
carbohydrate ketogenic diets. Obes Res 2004, 12(Suppl 2):115S-23S.
2. Paoli A, Cenci L, Grimaldi KA: Effect of ketogenic Mediterranean diet with
phytoextracts and low carbohydrates/high-protein meals on weight,
cardiovascular risk factors, body composition and diet compliance in
Italian council employees. Nutr J 2011, 10:112.
3. Paoli A, Cenci L, Fancelli M, Parmagnani A, Fratter A, Cucchi A, Bianco A:
Ketogenic diet and phytoextracts: comparison of the efficacy of
mediterranean, Zone and Tisanoreica diet on some health risk factors.
Agro Food Ind Hi Tec 2010, 21:24-29.
4. Tagliabue A, Bertoli S, Trentani C, Borrelli P, Veggiotti P: Effects of the
ketogenic diet on nutritional status, resting energy expenditure, and
substrate oxidation in patients with medically refractory epilepsy: A 6-
month prospective observational study. Clin Nutr 2012, 31:246-249.
doi:10.1186/1753-6561-6-S3-P37
Cite this article as: Paoli et al.: Medium term effects of a ketogenic diet
and a Mediterranean diet on resting energy expenditure and
respiratory ratio. BMC Proceedings 2012 6(Suppl 3):P37.
Submit your next manuscript to BioMed Central
and take full advantage of: 
• Convenient online submission
• Thorough peer review
• No space constraints or color figure charges
• Immediate publication on acceptance
• Inclusion in PubMed, CAS, Scopus and Google Scholar
• Research which is freely available for redistribution
Submit your manuscript at 
www.biomedcentral.com/submit
Paoli et al. BMC Proceedings 2012, 6(Suppl 3):P37
http://www.biomedcentral.com/1753-6561/6/S3/P37
Page 2 of 2


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PAOLI, ANTONIO

LODI, ALESSANDRA

PARMAGNANI, ANDREA

Archivio istituzionale della ricerca - Università di Padova

POSTER PRESENTATION Open AccessMedium term effects of a ketogenic diet and aMediterranean diet on resting energyexpenditure and respiratory ratioAntonio Paoli1*, Keith Grimaldi2, Antonino Bianco3, Alessandra Lodi4, Lorenzo Cenci5, Andrea Parmagnani1From Metabolism, diet and diseaseWashington, DC, USA. 29-31 May 2012BackgroundVery low carbohydrate ketogenic type diets (VLCKD) havebeen shown to be more effective for body weight reduc-tion and fat loss compared to balanced or low-calorieMediterranean diets, at least in the short-medium term[1,2], although the underlying mechanisms of its efficacyare still not well understood. Despite being a diet in wide-spread use there are few data available regarding effects onrespiratory ratio (RR) [3,4] and resting energy expenditure(REE) and, more specifically, there are no reports aboutthe effects on RR following a return to a non ketogenicdiet. The aim of this study was to compare the effects of a20 day ketogenic Mediterranean diet with phytoextracts(KEMEPHY) and a low-calorie Mediterranean diet (MD)on RR and REE during and 20 days after finishing theketogenic phase.Materials and methodsForty healthy, overweight subjects were recruited and ran-domly divided into two groups: MD (age 46.61 ± 14.6,BMI 26.8±2.6, weight 76.3±9.9 kg ) and KEMEPHY (age50.63 ±11.6, BMI 28.8±2.8, weight 81.8±11.6 kg). KEME-PHY group followed a ketogenic diet (<30g/day of carbo-hydrates) using meals that mimic the aspect and the tasteof carbohydrates but with virtually zero CHO and withphytoextracts (Tisanoreica®, Lonigo, Italy); after 20 days ofstrictly KD subjects followed a low carbohydrate non keto-genic diet for 20 days. The MD group followed a standardlow-calorie Mediterranean diet (tot Kcal). REE and RR,together with body weight and body composition, weremeasured in the morning after overnight fasting at thestart of the study and after 20 (t20) and 40 days (t40). AnAnova test for repeated measures and unpaired t-test withWelch’s correction were performed when appropriate.ResultsCompared to starting values RR was significantlydecreased in the KEMEPHY group after 20 days (p<0.05)and after 40 days (p=0.0002) (0.86±0.06; 0.79±0.05; 0.76±0.08; respectively) whilst no significant differences weredetected in RR in the MED group. No significant differ-ences in REE were detected. Both groups showed a signifi-cant decrease in body weight at t20 and t40 compared tobasal conditions (KEMEPHY basal 81.8±11.6; t20 77.8±11.4; t40 75±11.2. MED basal 76.3±9.9; t20 75.6±9.9; 71.7±9.8) with the percentage changes in body weight beingsignificantly greater for the KEMEPHY group. Both groupsshowed a significant decrease in body fat mass at t20 andt40 compared to basal conditions with the percentagechanges in body fat mass being significantly greater for theKEMEPHY group (P=0.0135).ConclusionsThese preliminary data showed that whilst both diet pro-tocols lead to a significant decrease in body weight, thereduction was significantly greater during KEMEPHY. TheKEMEPHY diet also lead to a lowering of RR andincreased fat oxidation at rest without any effect on REE.These findings suggest that one of the main weight lossmechanisms of KD might be attributed to an improve-ment in resting nutrient oxidation and interestingly thiseffect was long lasting, at least for up to 20 days followingcessation of the ketogenic. Data on metabolic effects ofKEMEPHY 3 months the ketogenic period will soon beavailable.1Biomedical Engineering Laboratory, Institute of Communication andComputer Systems, National Technical University of Athens, Athens, GreeceFull list of author information is available at the end of the articlePaoli et al. BMC Proceedings 2012, 6(Suppl 3):P37http://www.biomedcentral.com/1753-6561/6/S3/P37© 2012 Paoli et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited.Author details1Biomedical Engineering Laboratory, Institute of Communication andComputer Systems, National Technical University of Athens, Athens, Greece.2. 3Dept. of Sports and Exercise Science (DISMOT), University of Palermo,Italy. 4Pharmaceutical and Chemistry and Technologies, University of Padova,Italy. 5Tisanoreica Research Center, Lonigo, Vicenza, Italy.Published: 1 June 2012References1. Volek JS, Sharman MJ: Cardiovascular and hormonal aspects of very-low-carbohydrate ketogenic diets. Obes Res 2004, 12(Suppl 2):115S-23S.2. Paoli A, Cenci L, Grimaldi KA: Effect of ketogenic Mediterranean diet withphytoextracts and low carbohydrates/high-protein meals on weight,cardiovascular risk factors, body composition and diet compliance inItalian council employees. Nutr J 2011, 10:112.3. Paoli A, Cenci L, Fancelli M, Parmagnani A, Fratter A, Cucchi A, Bianco A:Ketogenic diet and phytoextracts: comparison of the efficacy ofmediterranean, Zone and Tisanoreica diet on some health risk factors.Agro Food Ind Hi Tec 2010, 21:24-29.4. Tagliabue A, Bertoli S, Trentani C, Borrelli P, Veggiotti P: Effects of theketogenic diet on nutritional status, resting energy expenditure, andsubstrate oxidation in patients with medically refractory epilepsy: A 6-month prospective observational study. Clin Nutr 2012, 31:246-249.doi:10.1186/1753-6561-6-S3-P37Cite this article as: Paoli et al.: Medium term effects of a ketogenic dietand a Mediterranean diet on resting energy expenditure andrespiratory ratio. BMC Proceedings 2012 6(Suppl 3):P37.Submit your next manuscript to BioMed Centraland take full advantage of: • Convenient online submission• Thorough peer review• No space constraints or color figure charges• Immediate publication on acceptance• Inclusion in PubMed, CAS, Scopus and Google Scholar• Research which is freely available for redistributionSubmit your manuscript at www.biomedcentral.com/submitPaoli et al. BMC Proceedings 2012, 6(Suppl 3):P37http://www.biomedcentral.com/1753-6561/6/S3/P37Page 2 of 2

Paoli, A

Grimaldi, K

BIANCO, Antonino

Lodi, A

Cenci, L

Parmagnani, A.

Archivio istituzionale della ricerca - Università di Palermo

Effect of ketogenic Mediterranean diet with phytoextracts and low carbohydrates/high-protein meals on weight, cardiovascular risk factors, body composition and diet compliance in Italian council employees.

Effects of the ketogenic diet on nutritional status, resting energy expenditure, and substrate oxidation in patients with medically refractory epilepsy: A 6-month prospective observational study. Clin Nutr

MJ: Cardiovascular and hormonal aspects of very-lowcarbohydrate ketogenic diets. Obes Res

Submit your next manuscript to BioMed Central and take full advantage of: • Convenient online submission • Thorough peer review • No space constraints or color ﬁgure charges • Immediate publication on acceptance

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Medium term effects of a ketogenic diet and a Mediterranean diet on resting energy expenditure and respiratory ratio

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