Changes in liver volume and body composition during 4 weeks of low calorie diet before laparoscopic gastric bypass

Background: Weight loss before laparoscopic Roux-en-Y gastric bypass (LRYGB) is desirable, because it can reduce liver volume and thereby facilitate the procedure. The optimal duration of a low-calorie diet (LCD) has not been established. The objective of this study was to assess changes in liver volume and body composition during 4 weeks of LCD. Methods: Ten women (aged 43 +/- 8.9 years, 114 +/- 12.1 kg, and body mass index 42 +/- 2.6 kg/m(2)) were examined on days 0, 3, 7, 14, and 28 after commencing the LCD. At each evaluation, body composition was assessed through bioelectric impedance analysis, and liver volume and intrahepatic fat content were assessed by magnetic resonance imaging. Serum and urine samples were obtained. Questionnaires regarding quality of life and LCD-related symptoms were administered. Results: In total, mean weight decreased by 7.4 +/- 1.2 kg (range 5.7-9.1 kg), and 71% of the weight loss consisted of fat mass according to bioelectric impedance analysis. From day 0 to day 3, the weight loss (2.0 kg) consisted mainly of water. Liver volume decreased by 18% +/- 6.2%, from 2.1 to 1.7 liters (P < .01), during the first 2 weeks with no further change thereafter. A continuous 51% +/- 16% decrease was seen in intrahepatic fat content. Systolic blood pressure, insulin, and lipids improved, while liver enzymes, glucose levels, and quality of life were unaffected. Conclusion: A significant decrease in liver volume (18%) occurred during the first 2 weeks of LCD treatment, and intrahepatic fat gradually decreased throughout the study period. A preoperative 2-week LCD treatment seems sufficient in similar patients. (C) 2015 American Society for Metabolic and Bariatric Surgery. All rights reserved.