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Lipids and cardiovascular/metabolic health

Ketosis and appetite-mediating nutrients and hormones after weight loss

Abstract

Background/Objectives:

Diet-induced weight loss is accompanied by compensatory changes, which increase appetite and encourage weight regain. There is some evidence that ketogenic diets suppress appetite. The objective is to examine the effect of ketosis on a number of circulating factors involved in appetite regulation, following diet-induced weight loss.

Subjects/Methods:

Of 50 non-diabetic overweight or obese subjects who began the study, 39 completed an 8-week ketogenic very-low-energy diet (VLED), followed by 2 weeks of reintroduction of foods. Following weight loss, circulating concentrations of glucose, insulin, non-esterified fatty acids (NEFA), β-hydroxybutyrate (BHB), leptin, gastrointestinal hormones and subjective ratings of appetite were compared when subjects were ketotic, and after refeeding.

Results:

During the ketogenic VLED, subjects lost 13% of initial weight and fasting BHB increased from (mean±s.e.m.) 0.07±0.00 to 0.48±0.07 mmol/l (P<0.001). BHB fell to 0.19±0.03 mmol/l after 2 weeks of refeeding (P<0.001 compared with week 8). When participants were ketotic, the weight loss induced increase in ghrelin was suppressed. Glucose and NEFA were higher, and amylin, leptin and subjective ratings of appetite were lower at week 8 than after refeeding.

Conclusions:

The circulating concentrations of several hormones and nutrients which influence appetite were altered after weight loss induced by a ketogenic diet, compared with after refeeding. The increase in circulating ghrelin and subjective appetite which accompany dietary weight reduction were mitigated when weight-reduced participants were ketotic.

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Acknowledgements

This work was supported by NHMRC project grant (508920), Endocrine Society of Australia scholarship (PS), Royal Australasian College of Physicians Shields Research Entry scholarship (PS), and Sir Edward Dunlop Medical Research Foundation (JP). We thank Celestine Bouniu, John Cardinal, Sherrell Cardinal, Christian Rantzau, Rebecca Sgambellone, Sherley Visinoni and Mildred Yim for technical assistance.

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Correspondence to J Proietto.

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JP was chairman of the Optifast medical advisory board at the time the study was conducted. The other authors have no conflict of interest.

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Supplementary Information accompanies this paper on European Journal of Clinical Nutrition website

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Sumithran, P., Prendergast, L., Delbridge, E. et al. Ketosis and appetite-mediating nutrients and hormones after weight loss. Eur J Clin Nutr 67, 759–764 (2013). https://doi.org/10.1038/ejcn.2013.90

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  • DOI: https://doi.org/10.1038/ejcn.2013.90

Keywords

  • appetite
  • ketosis
  • very-low-energy diet
  • weight loss

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