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

Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166, Rome, Italy. massimiliano.caprio@sanraffaele.it. Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy. massimiliano.caprio@sanraffaele.it. Unit of Endocrinology and Metabolic Diseases, Department of Systems Medicine, CTO A. Alesini Hospital, ASL Roma 2, University of Rome Tor Vergata, Rome, Italy. Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166, Rome, Italy. Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy. Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology and Diabetology Unit, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy. Section of Health Sciences, Department of Movement, Human and Health Sciences, "Foro Italico" University of Rome, Rome, Italy. Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy. Endocrinology Unit, Obesity and Lipodystrophy Center, University Hospital of Pisa, Pisa, Italy. Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy. Endocrinology Unit and Center for Applied Biomedical Research, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy. Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, AOU Careggi, Florence, Italy. Endocrinology, Department of Translational Medicine and Department of Health Sciences, University of Piemonte Orientale, Novara, Italy. Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy. Department of Medicine, Internal Medicine 3, University Hospital of Padova, Padua, Italy. Section of Endocrinology, Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy.

Journal of endocrinological investigation. 2019;(11):1365-1386
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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.