D2 | Abstract 16

Annual NUTRIM Symposium 18 November 2020

APPLIED SCIENCE

Effectiveness of a low calorie diet for liver volume reduction prior to bariatric surgery: a systematic review

M.M. Romeijn1, A.M. Kolen1, D.D.B. Holthuijsen1, L. Janssen1, G. Schep2, W.K.G. Leclercq1, J.W.M. Greve3, F.M.H. van Dielen1

1 Department of Surgery, Máxima Medical Center, Eindhoven-Veldhoven, The Netherlands
2 Department of Sport Medicine, Máxima Medical Center, Eindhoven-Veldhoven, The Netherlands
3 Research School NUTRIM, Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
Objective:
 An energy-restricted diet is often prescribed before bariatric surgery to reduce liver volume. Very low calorie diets (VLCD, 450-800 kcal/day) have shown to be effective in liver volume reduction (5%-20%, mean 14%), but bring along certain risks (e.g. lean body mass loss and side-effects). The objective of this systematic review was to assess the effectiveness of an LCD on liver volume reduction in patients awaiting bariatric surgery.

Methods:
 An electronic search of PubMed, EMBASE and the Cochrane Library was conducted. Studies were included if an LCD of 800 up to 1500 kcal/day was prescribed in patients selected for bariatric surgery, and liver volume was assessed. The primary outcome was reduction in liver volume and secondary outcomes were differences in weight and body composition, tolerance and acceptability of the diet, surgical complexity, complications and biochemical- and clinical parameters.

Results:
 Eight studies (n=251) were included describing nine different diets (800-1200 kcal/day, 2-8 weeks). All studies demonstrated that an LCD was effective in liver volume reduction (12-27%) and weight loss (4-17%). The largest decrease in liver volume was observed when the diet lasted for two to four weeks. From the overall weight loss, the lean body mass accounted for 23%-60%. An LCD showed a high compliance rate (80-89%) and seemed well tolerated by patients.

Conclusions:
 This study shows that an LCD is effective in liver volume reduction, particularly during the first weeks. We think that an LCD should be the preferred diet instead of a VLCD because unnecessary excessive dietary restriction and subsequent downsides may be countered.Further research should focus on the impact of an LCD on body composition, as well as explore the option of personalizing preoperative diets.
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