Leptin/Adiponectin Ratio as a New Multidimensional Biomarker in Obese Patients with Liver Steatosis Undergoing VLEKT: Results From a Pilot Study

Why It Matters

LAR emerges as a multidimensional biomarker that captures adipose inflammation, hepatic and renal remodeling, giving clinicians a more comprehensive tool than HOMA alone to tailor ketogenic interventions and predict outcomes in obesity.

Key Takeaways

• VLEKT reduced weight, BMI, and liver stiffness.
• LAR dropped more than HOMA, indicating broader metabolic impact.
• Baseline LAR linked to renal markers and lean mass.
• HOMA changes correlated with lipid improvements.
• Combined LAR and HOMA may personalize VLEKT monitoring.

Pulse Analysis

Very‑Low Energy Ketogenic Therapy (VLEKT) has moved beyond a simple calorie‑restriction diet to become a targeted metabolic intervention for obesity, insulin resistance, and fatty liver disease. By inducing sustained nutritional ketosis, VLEKT shifts the body’s fuel preference toward ketone bodies, which act as signaling molecules that modulate inflammation, mitochondrial function, and hormone secretion. As clinicians adopt VLEKT more widely, the need for reliable biomarkers that reflect the therapy’s systemic impact has grown, prompting researchers to evaluate both traditional insulin‑sensitivity indices and emerging adipokine‑based metrics.

In this pilot study, the leptin‑to‑adiponectin ratio (LAR) proved to be a more versatile indicator than the conventional HOMA index. While HOMA captured expected improvements in insulin resistance and lipid profiles, LAR correlated with a broader spectrum of physiological changes, including reductions in hepatic fat (CAP), enhancements in renal markers such as creatinine and uric acid, and shifts in calcium homeostasis. The pronounced decline in leptin alongside modest changes in adiponectin drove the LAR decrease, reflecting a transition from a pro‑inflammatory to an anti‑inflammatory adipose environment. These multidimensional associations suggest that LAR can flag early metabolic remodeling that HOMA may miss, offering a richer picture of patient response.

The combined use of LAR and HOMA could usher in a more personalized approach to VLEKT monitoring, allowing clinicians to identify responders, adjust dietary protocols, and anticipate complications before they manifest. Future larger‑scale trials should validate LAR’s predictive power across diverse populations and longer follow‑up periods. Integrating these biomarkers into routine practice may enhance the precision of ketogenic therapies, ultimately improving outcomes for patients battling obesity‑related metabolic dysfunction.