MON-638 Impact of Very Low Energy Ketogenic Therapy on Metabolic Syndrome: Effects on Weight, Cardiometabolic Health, and Sustainability

Abstract Disclosure: E. Camajani: None. S. Gorini: None. A. Persichetti: None. A. Feraco: None. A. Armani: None. M. Lombardo: None. S. Basciani: None. M. Caprio: None. Metabolic Syndrome (MetS) is characterized by the association of insulin resistance (IR), hypertension, dyslipidemia, metabolic-associated steatotic liver disease, impaired glucose tolerance, and is strictly related to increased cardiovascular risk. Recent scientific evidence confirms that very low energy ketogenic therapy (VLEKT) is a valuable treatment for patients with IR and visceral obesity. The aim of this study was to evaluate the efficacy and durability of a VLEKT protocol on cardiometabolic parameters related to the MetS. This study was a prospective, interventional trial conducted to evaluate the efficacy of a VLEKT protocol on cardiometabolic parameters in patients with MetS, as well as to assess the persistence of these effects after transitioning to a low-calorie diet (LCD). A total of 47 patients were enrolled in the study, including 29 patients with MetS and 18 patients without MetS. All patients followed a VLEKT for 45 days (≤800 kcal/day). After the VLEKT phase (45 days), they followed a LCD (1100-1200Kcal) with a low carbohydrate content (60-80g/day) for 45 days. Anthropometric indexes, blood and urine chemistry, including renal, liver, glucose and lipid metabolism parameters, and body composition were assessed. Analysis of lipoprotein subclasses and proinflammatory cytokines, in order to identify the impact of VLEKT, is still ongoing. At baseline, the two groups did not differ significantly in terms of gender distribution, or mean age. However, patients in the MetS group had higher body weight (97.2 ± 12.5 kg vs. 106.0 ± 13.6 kg, p = 0.027). After the VLEKT phase, patients with MetS experienced significant improvements in several metabolic parameters. Body weight (BW) significantly decreased from baseline to the end of the VLEKT phase (88.4 ± 11.1 kg vs. 97.6 ± 12.1 kg, p = 0.011), with a concomitant reduction in BMI. A notable improvement in diastolic blood pressure was observed (70.0 mmHg vs. 80.0 mmHg, p = 0.016), while systolic blood pressure did not show a significant change. In terms of lipid profile, no significant changes were observed in LDL cholesterol between the two groups, but triglyceride (TG) levels showed a marked reduction in the MetS group. Following the LCD phase, BW continued to decrease significantly in the MetS group compared to the control group (84.9 ± 10.9 kg vs. 92.8 ± 11.9 kg, p = 0.023). Interestingly, TG levels increased significantly in the MetS group compared to the control group after the LCD phase (103.0 mg/dL vs. 72.0 mg/dL, p = 0.006). Our study confirms that the VLEKT led to significant improvements in metabolic parameters in patients with MetS, particularly in terms of weight loss and blood pressure improvement. However, despite overall improvements, TG levels were still higher in the MetS group compared to controls after the LCD phase, emphasizing the importance of the proper reintroduction of carbohydrates and tailoring the protocol to each patient. Presentation: Monday, July 14, 2025