Kortetermijneffect van een eucalorisch ketogeen dieet op de ziekte acromegalie

This will be a single-centre, prospective, proof-of-concept intervention study to assess the efficacy of two weeks eucaloric ketogenic diet on GH and IGF-I levels in acromegaly patients.

Several studies have shown in health subjects that when restricted carbohydrates are ingested, the decrease in portal vein insulin concentration can lead to a reduction in IGF-I synthesis by the liver. However, in pathophysiological states, including increased insulin resistance which is a frequent consequence of acromegaly, the hybrid receptor number is changed significantly, thus potentially abrogating the chance for IGF-I to alter glucose metabolism. To our knowledge, the effect of eucaloric ketogenic diet on GH and IGF-I secretion, including the effect of insulin on IGF-I levels, in acromegaly patients has not been studied yet.

Blood biochemistry: (t0 =baseline, t1= week 1 and t2= week 2) • IGF-1 levels • GH levels • IGF-BP1 levels • Fasting plasma glucose, insulin, HbA1c levels, HOMA-IR • Total cholesterol, HDL-cholesterol and LDL-cholesterol levels • Triglycerides, free fatty acids • AST, ALT, alkaline phosphatase, gamma-glutamyltransferase, lactate dehydrogenase (LDH) Note: all the following laboratory evaluations will be performed at the study site. Urine: (t1= week 1 and t2= week 2) One voided sample of urine will be collected at the study site. One dipstick strip is used to measure ketones. This test is used for monitoring the compliance during a ketogenic diet. Vital signs: (t0 =baseline, t1= week 1 and t2= week 2) Pulse rate and blood pressure were measured after 5 minutes of rest in the seated position at the outpatient clinic. Anthropometric measurements: (t0 =baseline, t1= week 1 and t2= week 2) Height and body weight were obtained at the outpatient clinic; patients will be weighted clothed without shoes. Body composition will be assessed at the outpatient.clinic by Body Impedance Assessment. Waist-to-hip ratio were measured as follows. The waist was defined as the minimal abdominal circumference located midway between the lower rib margin and the iliac crest. The hip was defined as the wides circumference over the great trochanters. Circumferences were measured with the subjects in the standing position using flexible tape measure and maintaining close contact with the skin without compression of underlying tissues. Questionnaire: (t1= week 1 and t2= week 2) One questionnaire will be filled out at the outpatient clinic(¡§Vragenlijst gebruik en effecten dieetproduct¡¨) Food diary: (t0 =baseline, t1= week 1 and t2= week 2) Three-day food records during baseline and after each week of diet will be filled out at the outpatient clinic (¡§3 dagen voedingsdagboek¡¨). Subject are instructed by the dietician how to fill it out.

All ten subjects will receive a ketogenic diet for two weeks