Very Low-Calorie Ketogenic Diet: A Safe and Effective Tool for Weight Loss in Patients with Obesity and Mild Kidney Failure

Abstract

Very low-calorie ketogenic diets (VLCKD) are an effective and increasingly used tool for weight loss. Traditionally considered high protein, ketogenic diets are often looked at with concern by clinicians due to the potential harm they pose to kidney function. We herein evaluated the efficacy and safety of a VLCKD in patients with obesity and mild kidney failure. A prospective observational real-life study was conducted on ninety-two patients following a VLCKD for approximately 3 months. Thirty-eight had mild kidney failure and fifty-four had no renal condition and were therefore designated as control. Anthropometric parameters, bioelectrical impedance and biochemistry data were collected before and at the end of the dietary intervention. The average weight loss was nearly 20% of initial weight, with a significant reduction in fat mass. We report an improvement of metabolic parameters and no clinically relevant variation regarding liver and kidney function. Upon stratification based on kidney function, no differences in the efficacy and safety outcomes were found. Interestingly, 27.7% of patients with mild renal failure reported normalization of glomerular filtrate after dietary intervention. We conclude that, when conducted under the supervision of healthcare professionals, a VLCKD is an effective and safe treatment for weight loss in patients with obesity, including those affected by mild kidney failure.

Effectiveness of a Very Low Calorie Ketogenic Diet on Testicular Function in Overweight/Obese Men

“…Even more recently, a systematic review and meta-analysis of 12 studies, including a total of 801 patients, highlighted significant improvements in body weight, BMI, and waist circumference after VLCKD [ 7 ]. Bruci et al have also recently reported similar results upon evaluating 92 consecutively obese patients undergoing VLCKD; among these individuals, after dietary intervention, body weight, BMI, and fat mass were significantly lower than at baseline [ 17 ].…”

“…Moreover, this dietary regimen is contraindicated in the case of kidney failure and moderate-to-severe kidney disease and all patients enrolled in our study were screened for renal function before starting VLCKD. However, a recent study suggests that under clinician supervision, this diet is an effective and safe tool against obesity that can also be used in patients with mild kidney failure (estimated glomerular filtration rate: 60–80 mL/min) [ 17 ].…”

The psychological impact of COVID-19 pandemic on patients included in a bariatric surgery program

“…The strong connection between mental status and food behavior warrants first of all an accurately targeted psychological support in order to favor compliance to dietary treatments. However, some dietary manipulations including certain foods [34,35], food supplements [36,37], and dietary patterns [38][39][40][41][42][43] together with pharmacological treatment [44,45] have been shown to impact appetite and mood and/ or proved particularly beneficial in subjects with severe obesity and in post-bariatric patients. Such measures should be therefore taken into consideration in the next months in order to favor dietary adherence and metabolic improvement, leveraging a multidisciplinary approach to treat those severely obese seeking bariatric surgery and those who have lost weight but need lifelong follow-up after bariatric surgery [46].…”

Scientific evidence underlying contraindications to the ketogenic diet: An update

“…71 Moreover, we previously showed that kidney function is not altered by VLCKD in patients with mild chronic kidney disease (GFR > 60), with almost one third even presenting GFR normalization after the dietary intervention. 10 Noteworthy, VLCKDs rely on meal replacements whose protein source is whey and plant derived, and, when gradual reintroduction of other protein sources occurs, fish, poultry and dairy are strongly recommended over red meat, with total protein intake being always equal to or lower than Recent stroke or myocardial infarction Preclinical evidence suggests ketone bodies to be protective on ischaemic brain and heart damage. No clinical data are available yet.…”