Evidence map›Paper›PMID 39791264›Full record

ArticleDiabetes, obesity & metabolism2025

Impact of a very low-calorie ketogenic diet on metabolic and microbiota outcomes in post-bariatric patients and bariatric-Naïve individuals: A comparative pilot study.

Ilaria Ernesti, Maria Chiara Massari, Fiammetta Cipriani, Davide Masi, Krzysztof Glaser, Martina Genco, Dario Tuccinardi, Carla Lubrano, Stefania Mariani, Antonio Angeloni and 3 more

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Diabetes, obesity & metabolism, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Trial
  3. Review
  4. Article
  5. Article
  6. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Ilaria ErnestiDepartment of Surgical Sciences, Sapienza University, Rome, Italy.
Maria Chiara MassariSection of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University, Rome, Italy.
Fiammetta CiprianiSection of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University, Rome, Italy.ORCID 0009-0002-5983-7211
Davide MasiSection of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University, Rome, Italy.
Krzysztof GlaserDepartment of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznań, Poland.ORCID 0009-0007-7027-2553
Martina GencoUnicamillus-Saint Camillus International University of Health Sciences, Rome, Italy.
Dario TuccinardiResearch Unit of Endocrinology and Diabetology, Department of Medicine and Surgery, Università Campus Bio-Medico, Rome, Italy.
Carla LubranoSection of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University, Rome, Italy.
Stefania MarianiSection of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University, Rome, Italy.
Antonio AngeloniDepartment of Experimental Medicine, Sapienza University, Rome, Italy.
Lucio GnessiSection of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University, Rome, Italy.ORCID 0000-0001-8217-2372
Sabrina BascianiSection of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University, Rome, Italy.
Mikiko WatanabeSection of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University, Rome, Italy.ORCID 0000-0003-2225-8814

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsTo date, bariatric surgery (BS) is the most effective long-term treatment for obesity, but weight regain (WR) is common. The very low-calorie ketogenic diet (VLCKD) is effective for weight loss and may influence gut microbiota (GM) composition, but it has been scarcely evaluated in post-bariatric patients. This study compared the efficacy and safety of a VLCKD in patients with WR post-bariatric surgery (BS+) and in bariatric surgery-naïve patients (BS-).

methodsIn this prospective, case-control study, 33 patients (15 BS+, 18 BS-) underwent an 8-week-long VLCKD. Outcomes included weight loss, metabolic profile, safety and GM composition.

resultsBoth groups achieved significant weight loss (BS+: -6.9%, BS-: -8.3%), but the BS+ group showed slightly less metabolic improvement, particularly in insulin resistance and triglycerides. GM composition differed at baseline, reflecting the lasting effects of BS, and VLCKD led to significant changes in both groups. Microbial diversity and specific taxonomic shifts were more pronounced in BS- patients. Mild renal function changes were noted in BS+ patients, though these remained within clinically acceptable ranges.

conclusionVLCKD is effective in both BS+ and BS- patients, though metabolic and microbial responses may be less robust post-surgery, possibly due to anatomical and physiological changes. Tailored approaches may be therefore needed to optimize outcomes in post-bariatric patients.

Indexed as

Bariatric SurgeryCaloric RestrictionDiet, KetogenicGastrointestinal MicrobiomeObesityObesity, MorbidAdultCase-Control StudiesFemaleHumansMaleMiddle AgedPilot ProjectsProspective StudiesTreatment OutcomeWeight Lossbariatric surgerydietary interventionobesity careobservational studyweight controlweight management

Identifiers

PMID39791264
PMCPMC11885101

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.