MRI estimated changes in visceral adipose tissue and liver fat fraction in patients with obesity during a very low-calorie-ketogenic diet compared to a standard low-calorie diet

Clin Radiol. 2020 Jul;75(7):526-532. doi: 10.1016/j.crad.2020.02.014. Epub 2020 Mar 20.


Aim: To compare the changes in visceral adipose tissue (VAT), liver fat fraction, and liver stiffness using quantitative magnetic resonance imaging (MRI) during a very-low-calorie ketogenic (VLCK) diet and a standard low-calorie diet (LC).

Materials and methods: The study involved secondary analysis of prospective collected clinical data. Patients undergoing weight loss interventions were randomised to either a LC or a VLCK diet. VAT, liver fat fraction, and stiffness were measured at baseline and after 2 months.

Results: Forty-six patients were included; 39 patients were evaluated at baseline and at 2 months follow-up. Mean weight loss was -9.7±3.8 kg (interquartile range [IQR]: -12.3; -7 kg) in the VLCK group and -1.67±2.2 kg (IQR: -3.3, -0.1 kg) in the LC group (p<0.0001). Mean VAT reductions were -39.3±40 cm2 (IQR: -52, -10 cm2) and -12.5±38.3 cm2 (IQR: -29, 5 cm2; p=0.0398), and mean liver proton density fat fraction (PDFF) reductions were -4.77±4.2% (IQR: -7.3, -1.7%) and -0.79±1.7%, (IQR: -1.8, -0.4%; p<0.005) in the VLCK group and in the LC group, respectively. No significant changes in liver stiffness occurred from baseline to follow-up.

Conclusion: A VLCK diet resulted in greater weight loss than a standard low-calorie diet and in significantly greater reduction in liver PDFF. As anthropometric measurements may not correlate with liver fat changes, it may be advantageous to include quantitative MRI to the monitoring strategies of patients undergoing weight-loss programmes.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Caloric Restriction*
  • Diet, Ketogenic*
  • Female
  • Humans
  • Intra-Abdominal Fat / diagnostic imaging*
  • Intra-Abdominal Fat / pathology
  • Liver / diagnostic imaging*
  • Liver / pathology
  • Magnetic Resonance Imaging*
  • Male
  • Obesity / diagnostic imaging
  • Obesity / diet therapy
  • Obesity / pathology*