Very-low-calorie ketogenic diet (VLCKD) in the management of metabolic diseases: systematic review and consensus statement from the Italian Society of Endocrinology (SIE)

Abstract

Background Weight loss is a milestone in the prevention of chronic diseases associated with high morbility and mortality in industrialized countries. Very-low calorie ketogenic diets (VLCKDs) are increasingly used in clinical practice for weight loss and management of obesity-related comorbidities. Despite evidence on the clinical benefits of VLCKDs is rapidly emerging, some concern still exists about their potential risks and their use in the long-term, due to paucity of clinical studies. Notably, there is an important lack of guidelines on this topic, and the use and implementation of VLCKDs occurs vastly in the absence of clear evidence-based indications. Purpose We describe here the biochemistry, benefits and risks of VLCKDs, and provide recommendations on the correct use of this therapeutic approach for weight loss and management of metabolic diseases at different stages of life.

Effects of a ketogenic diet in overweight women with polycystic ovary syndrome

“…Other data describe several mechanisms consistent with the favourable effects of such diet therapy [30][31][32]. A recent position statement of the Italian Society of Endocrinology suggested a weight-loss program with a very low calorie ketogenic diet for overweight/obese patients with PCOS) not responsive to multicomponent standardized diet to improve insulin resistance, ovulatory dysfunctions and hyperandrogenemia, even if further controlled studies are deemed necessary to confirm the beneficial effects of KD in this clinical context [28].…”

“…The therapeutic role of KD has been investigated for a long time and several works have supported the thesis that physiological ketosis can be useful in many pathological conditions, such as epilepsy, neurological diseases, cancer (with a ketogenic isocaloric diet) [25] and obesity, type 2 diabetes, acne, and the amelioration of respiratory and cardiovascular disease risk factors (with a generally low calorie ketogenic diet) [26][27][28]. This is an important aim, since the use of food as a drug has very relevant social and economic implications, both in economic and social terms.…”

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

“…Patients with obesity accessing the Centre had medical history collected, physical exam and laboratory work performed (hematology, biochemistry) as part of the routine all patients accessing the center undergo for initial evaluation. Those willing to undergo a VLCKD for weight loss purposes were enrolled, so long as they were in absence of contraindications according to national guidelines, such as known hypersensitivity to one or more components used in the meal replacement products; history of cardiac, cerebrovascular, or major gastrointestinal diseases; psychiatric disturbances; diagnosis of insulin-dependent diabetes mellitus (IDDM); pregnancy; lactation; CKD with an estimated glomerular filtration rate (eGFR) <60 [16]. Based on renal function, the patients were stratified in two groups: MCKD (Mild Chronic Kidney Disease) with an eGFR between 60 and 89 mL/min/1.73m 2 , and NKF (Normal Kidney Function) subjects, with an eGFR ≥ 90 mL/min/1.73 m 2 .…”

“…Total caloric intake was between 450 and 800/day based on calculated ideal body weight. To avoid micronutrients deficiency, mineral and vitamin supplements were recommended throughout the dietary intervention as per current guidelines [16]. During the first step, only meal replacements and a set amount and quality of vegetables were allowed, and during the second step one meal consisted of a protein dish, with one less replacement meal provided.…”

“…Among the advantages of a VLCKD are the rapid weight loss obtained, satiety induction and muscle mass preservation, all of these resulting in increased compliance [15]. VLCKDs are currently recommended as an effective and feasible dietary intervention in subjects with obesity [16]. However, due to the relative abundance of proteins compared to carbohydrates and fats, VLCKDs are often regarded as possibly damaging kidney function, and are usually not recommended in subjects with reduced filtration.…”