Ketogenic nutritional therapy (KeNuT)—a multi-step dietary model with meal replacements for the management of obesity and its related metabolic disorders: a consensus statement from the working group of the Club of the Italian Society of Endocrinology (SIE)—diet therapies in endocrinology and metabolism

Abstract

Purpose The ketogenic nutritional therapy (KeNuT) is an effective dietary treatment for patients with obesity and obesity-related comorbidities, including type 2 diabetes, dyslipidaemia, hypertension, coronary artery disease, and some type of cancers. However, to date an official document on the correct prescription of the ketogenic diet, validated by authoritative societies in nutrition or endocrine sciences, is missing. It is important to emphasize that the ketogenic nutritional therapy requires proper medical supervision for patient selection, due to the complex biochemical implications of ketosis and the need for a strict therapeutic compliance, and an experienced nutritionist for proper personalization of the whole nutritional protocol. Methods This practical guide provides an update of main clinical indications and contraindications of ketogenic nutritional therapy with meal replacements and its mechanisms of action. In addition, the various phases of the protocol involving meal replacements, its monitoring, clinical management and potential side effects, are also discussed. Conclusion This practical guide will help the healthcare provider to acquire the necessary skills to provide a comprehensive care of patients with overweight, obesity and obesity-related diseases, using a multistep ketogenic dietary treatment, recognized by the Club of the Italian Society of Endocrinology (SIE)—Diet Therapies in Endocrinology and Metabolism.

Very low-calorie ketogenic diet (VLCKD): a therapeutic nutritional tool for acne?

“…According to EASO guidelines [ 34 ] and the consensus statement from the working group of the Club of the Italian Society of Endocrinology (SIE)-diet therapies in endocrinology and metabolism [ 55 ], VLCKD consists of different phases (active—ketogenic—, re-education—non-ketogenic—, and maintenance). This study evaluated only the active phase, the ketogenic one.…”

Higher-Level Steatosis Is Associated with a Greater Decrease in Metabolic Dysfunction-Associated Steatoic Liver Disease after Eight Weeks of a Very Low-Calorie Ketogenic Diet (VLCKD) in Subjects Affected by Overweight and Obesity

“…Assessments of anthropometric parameters through lab tests (biochemistry) were made, and the medical histories of all patients with overweight or obesity who made an appointment at our clinic were checked. The National and European guidelines’ list of contraindications for VLCKD was followed [ 27 , 28 , 30 ]. Based on the American and European recommendations, daily alcohol consumption was examined by asking patients directly about the number of glasses of alcohol they drank per day, as written in our previous studies.…”

“…All participants received the VLCKD in accordance with the two-step protocol strategy from New Penta, Cuneo, Italy. According to the ketogenic nutritional therapy (KeNuT), a multi-step dietary model with meal replacements for the management of obesity and its related metabolic disorders [ 28 ], the VLCKD was a very low-calorie (650–800 kcal/day), low-fat (only 20 g per day), and low-carbohydrate (<30 g per day from vegetables) diet; the hallmarks of the initial phase of the VLCKD are based on olive oil. It has been established that 1–1.4 g of protein per kg of ideal body weight represents a fixed range per day that can maintain lean mass and meet the body’s minimum daily requirement.…”

“…Internationally recognized as a successful weight loss intervention, the ketogenic diet (KD) is typified by a sharp decrease in carbohydrate intake. Specifically, a very low-calorie ketogenic diet (VLCKD) is frequently regarded as a safe and effective therapeutic intervention for individuals with obesity [ 27 , 28 , 29 , 30 , 31 ]. The rapid mobilization of fat from adipose tissue and the weight loss resulting from a VLCKD offers a very useful option for decreasing liver steatosis and treating MASLD [ 31 , 32 , 33 ].…”

Dietary Influence on Drug Efficacy: A Comprehensive Review of Ketogenic Diet–Pharmacotherapy Interactions

“…Furthermore, in instances where patients present with various comorbidities, particularly those with liver and kidney dysfunction, it is imperative to prescribe the KD under rigorous medical oversight, accompanied by strict clinical and laboratory surveillance. This surveillance should encompass the monitoring of beta-hydroxybutyrate levels and drug plasma concentrations [ 37 ].…”