Very low-calorie ketogenic diet reduces left ventricular mass and epicardial adipose tissue in post-menopausal women with essential hypertension and obesity: a single-center, prospective, open-label, clinical study

Background and aim: Obesity and hypertension may impair left ventricular (LV) mass, promote LV dysfunction, and affect epicardial adipose tissue (EAT) composition and function. The study aimed to assess the effects of different dietary regimens on LV mass and geometries, diastolic function, and EAT in post-menopausal women with hypertension and obesity. Methods and results: In the present analysis, 43 menopausal women with uncomplicated hypertension and obesity underwent echocardiographic assessment of LV mass and geometries, diastolic function and EAT thickness. Anthropometric evaluation, bio-impedance analyses, and laboratory tests were also performed at baseline and predefined time intervals. Participants were assigned to one of three dietary regimens: very low-calorie ketogenic diet (VLCKD), intermittent fasting (IF) or free diet (FD). All parameters were recorded before and after six months of dietary restriction. At baseline no significant differences were observed among different dietary groups for echocardiographic parameters. After 6 months, significant decrease in LV mass indexed by height (from 90.71 ± 7.35 to 81.29 ± 11.32 g/m; P = 0.01), RWT (from 0.43 ± 0.04 to 0.40 ± 0.04; p = 0.03), and EAT (from 7.00 ± 0.82 to 4.76 ± 0.40; p < 0.01) were observed in the VLCKD compared to baseline values. Spearman analysis revealed a strong correlation between EAT and fat body percentage (r = 0.53; p < 0.01), along with a moderate negative correlation with phase angle (r = -0.54; p < 0.01); the cutoff values for these correlations were 30.95 and 5.85, respectively. Conclusions: In this sample of post-menopausal women with hypertension and obesity, we firstly demonstrated that VLKD induced significant reduction in LV mass and EAT, whilst no significant changes were observed with IF and FD.