{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T08:23:25Z","timestamp":1792571005376,"version":"4.5.0"},"reference-count":34,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2020,9,9]],"date-time":"2020-09-09T00:00:00Z","timestamp":1599609600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010607","name":"Universit\u00e0 degli Studi di Perugia","doi-asserted-by":"publisher","award":["Fondo Ricerca di Base 2018"],"award-info":[{"award-number":["Fondo Ricerca di Base 2018"]}],"id":[{"id":"10.13039\/501100010607","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Very low-carbohydrate ketogenic diets (VLCKDs) are an emerging nutritional treatment for severe obesity and are associated with a significant improvement in non-alcoholic fatty liver disease (NAFLD). Little is known about the effect of sex differences on weight loss induced by following a VLCKD. The aim of this study was to investigate the effects of sex differences on weight loss and NAFLD improvement in patients with severe obesity undergoing a VLCKD. Forty-two females and 28 males with severe obesity underwent a 25-day VLCKD. Anthropometric parameters, bioimpedentiometry, degree of liver steatosis measured by ultrasonography, liver function tests, and glucose homeostasis were measured before and after the VLCKD. Males experienced a significantly larger excess body weight loss (EBWL) and a greater reduction in \u03b3-glutamyl transferase (\u03b3GT) than females. Dividing the female group by menopausal status, a significant difference between males and pre-menopausal females was found for both EBWL and \u03b3GT. No significant difference between groups was observed for improvement in the Edmonton stage or in the degree of steatosis. We conclude that the efficacy of following a VLCKD in severe obesity is affected by sex differences and, for females, by menopausal status. Males seem to experience larger benefits than females in terms of EBWL and NAFLD improvement. These differences are attenuated after menopause, probably because of changes in hormonal profile and body composition.<\/jats:p>","DOI":"10.3390\/nu12092748","type":"journal-article","created":{"date-parts":[[2020,9,9]],"date-time":"2020-09-09T09:01:09Z","timestamp":1599642069000},"page":"2748","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":71,"title":["Very Low-Carbohydrate Ketogenic Diet for the Treatment of Severe Obesity and Associated Non-Alcoholic Fatty Liver Disease: The Role of Sex Differences"],"prefix":"10.3390","volume":"12","author":[{"given":"Marco","family":"D\u2019Abbondanza","sequence":"first","affiliation":[{"name":"Internal Medicine, Department of Medicine, Universit\u00e0 degli Studi di Perugia, 06129 Perugia, Italy"},{"name":"Internal Medicine, \u201cSanta Maria\u201d University Hospital, Azienda Ospedaliera di Terni, 05100 Terni, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Ministrini","sequence":"additional","affiliation":[{"name":"Internal Medicine, Department of Medicine, Universit\u00e0 degli Studi di Perugia, 06129 Perugia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0180-859X","authenticated-orcid":false,"given":"Giacomo","family":"Pucci","sequence":"additional","affiliation":[{"name":"Internal Medicine, Department of Medicine, Universit\u00e0 degli Studi di Perugia, 06129 Perugia, Italy"},{"name":"Internal Medicine, \u201cSanta Maria\u201d University Hospital, Azienda Ospedaliera di Terni, 05100 Terni, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Nulli Migliola","sequence":"additional","affiliation":[{"name":"Internal Medicine, Department of Medicine, Universit\u00e0 degli Studi di Perugia, 06129 Perugia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva-Edvige","family":"Martorelli","sequence":"additional","affiliation":[{"name":"Internal Medicine, Department of Medicine, Universit\u00e0 degli Studi di Perugia, 06129 Perugia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vito","family":"Gandolfo","sequence":"additional","affiliation":[{"name":"Internal Medicine, Department of Medicine, Universit\u00e0 degli Studi di Perugia, 06129 Perugia, Italy"},{"name":"Internal Medicine, \u201cSanta Maria\u201d University Hospital, Azienda Ospedaliera di Terni, 05100 Terni, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donatella","family":"Siepi","sequence":"additional","affiliation":[{"name":"Internal Medicine, Department of Medicine, Universit\u00e0 degli Studi di Perugia, 06129 Perugia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graziana","family":"Lupattelli","sequence":"additional","affiliation":[{"name":"Internal Medicine, Department of Medicine, Universit\u00e0 degli Studi di Perugia, 06129 Perugia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaetano","family":"Vaudo","sequence":"additional","affiliation":[{"name":"Internal Medicine, Department of Medicine, Universit\u00e0 degli Studi di Perugia, 06129 Perugia, Italy"},{"name":"Internal Medicine, \u201cSanta Maria\u201d University Hospital, Azienda Ospedaliera di Terni, 05100 Terni, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,9,9]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2020, July 01). 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