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Nutrients
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Very-Low-Calorie Ketogenic Diet in the Management of Metabolic Diseases
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Very-Low-Calorie Ketogenic Diet in the Management of Metabolic Diseases

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutrition and Metabolism".

Deadline for manuscript submissions: closed (30 June 2023) | Viewed by 25491

Special Issue Editors

Dr. Giovanna Muscogiuri

E-Mail Website
Guest Editor
Unit of Endocrinology, Dipartimento di Medicina Clinica e Chirurgia, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131 Naples, Italy
Interests: endocrinology; obesity; metabolism; nutrition; diet; diabetes; insulin resistance; metabolic syndrome; dyslipidemia; chrononutrition; circadian rhythms; vitamin D; PCOS
Special Issues, Collections and Topics in MDPI journals
Dr. Luigi Barrea

E-Mail Website
Guest Editor
1. Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Via Porzio, Centro Direzionale, Isola F2, 80143 Napoli, Italy
2. Centro Italiano per la Cura e il Benessere del Paziente con Obesità (C.I.B.O), Unit of Endocrinology, Dipartimento di Medicina Clinica e Chirurgia, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131 Napoli, Italy
Interests: metabolic endocrinology; metabolism; nutritional and metabolic diseases; nutrition; clinical endocrinology; clinical nutrition; human nutrition; body composition analysis; dietetics; body composition; bariatric surgery; insulin resistance; anthropometric measurements
Special Issues, Collections and Topics in MDPI journals
Dr. Ludovica Verde

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Guest Editor
Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Endocrinology Unit, Department of Clinical Medicine and Surgery, University Medical School of Naples, Via Sergio Pansini 5, 80131 Naples, Italy
Interests: obesity; nutrition; diet; diabetes; metabolic syndrome; dyslipidemia; chrononutrition; circadian rhythms
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In recent decades, the worldwide prevalence of obesity and metabolic diseases such as type 2 diabetes has increased dramatically, resulting in a global epidemic. Weight loss is a milestone in the prevention and management of obesity and its comorbidities. In this context, the very-low-calorie ketogenic diet (VLCKD) has recently attracted increasing interest for the treatment of obesity and metabolic diseases. Although the clinical benefits of the VLCKD are becoming increasingly apparent, concerns remain about its potential risks and long-term use due to the paucity of clinical trials.

The aim of this Special Issue titled 'Very-Low-Calorie Ketogenic Diet in the Management of Metabolic Diseases' is to publish selected articles on VLCKD as a nutritional approach for obesity and metabolic diseases. Special attention is paid to papers (reviews, epidemiological/clinical/experimental studies) that examine the efficacy and safety of VLCKD in the management of metabolic diseases.

Dr. Giovanna Muscogiuri
Dr. Luigi Barrea
Dr. Ludovica Verde
Guest Editors

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Keywords

  • very-low-calorie ketogenic diet
  • ketone bodies
  • metabolic diseases
  • obesity
  • type 2 diabetes mellitus
  • insulin resistance
  • weight loss
  • nutrition
  • diet

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Published Papers (4 papers)

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Research

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11 pages, 464 KiB  
Article
Revised Protein Sparing Diet in Obesity and Type 2 Diabetes Mellitus
by Raffaele Ivan Cincione, Francesca Losavio, Giuseppe Cibelli, Giovanni Messina, Rita Polito, Elias Casula, Pamela Pia Cincione, Marco Amatruda and Pierpaolo Limone
Nutrients 2022, 14(24), 5325; https://doi.org/10.3390/nu14245325 - 15 Dec 2022
Cited by 5 | Viewed by 3289
Abstract
Effective nutrition therapy is a pressing issue in obesity and type 2 diabetes mellitus (T2DM) management. As such, this research aimed to determine the performance of a revised dietary strategy built on the protein-sparing diet in obesity and type 2 diabetes mellitus with [...] Read more.
Effective nutrition therapy is a pressing issue in obesity and type 2 diabetes mellitus (T2DM) management. As such, this research aimed to determine the performance of a revised dietary strategy built on the protein-sparing diet in obesity and type 2 diabetes mellitus with regard to obtaining a rapid and stable improvement in glucometabolic control, body weight, body composition, and energy metabolism when applying the strategy in just twenty-one days. The revised protein-sparing diet differs from the traditional protein-sparing modified fast (PSMF) because it does not include foods. The daily calorie intake of this diet is exclusively derived from Isolate whey protein in addition to a formulation of Isolate whey protein enriched with essential amino acids in free form, with the addition of lipids such as extra virgin olive oil and coconut oil as a source of medium chain fatty acids, where the latter is taken for only the first four days of the diet, together with the use, for the same duration, of extended-release metformin, as the only antihyperglycemic allowed. Anthropometric measurements, bioimpedance analysis, indirect calorimetry, and blood chemistry assessments were conducted at the beginning of the study, time 0 (T0), and at the end, time 1 (T1), i.e., on the 21st day. The main outcomes of the revised protein-sparing diet after only twenty-one days were a reduction in body weight with the predominant loss of visceral atherogenic abdominal fat and, therefore, a possible contextual reduction in ectopic fat deposits together with a simultaneous reduction in insulin resistance and normalization of insulin levels, maintenance of free fat mass and basal metabolism, restoration of metabolic flexibility, and improvement of the glucometabolic and lipidic parameters. These results demonstrate the promising potential of the revised protein-sparing diet as an “etiologic tool” in the integrated nutritional treatment of metabolic diseases such as obesity and type 2 diabetes mellitus. Full article
(This article belongs to the Special Issue Very-Low-Calorie Ketogenic Diet in the Management of Metabolic Diseases)
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Review

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26 pages, 4007 KiB  
Review
Effect of Dietary Approaches on Glycemic Control in Patients with Type 2 Diabetes: A Systematic Review with Network Meta-Analysis of Randomized Trials
by Tiantian Jing, Shunxing Zhang, Mayangzong Bai, Zhongwan Chen, Sihan Gao, Sisi Li and Jing Zhang
Nutrients 2023, 15(14), 3156; https://doi.org/10.3390/nu15143156 - 15 Jul 2023
Cited by 15 | Viewed by 12360
Abstract
Background: Dietary patterns play a critical role in diabetes management, while the best dietary pattern for Type 2 diabetes (T2DM) patients is still unclear. The aim of this network meta-analysis was to compare the impacts of various dietary approaches on the glycemic control [...] Read more.
Background: Dietary patterns play a critical role in diabetes management, while the best dietary pattern for Type 2 diabetes (T2DM) patients is still unclear. The aim of this network meta-analysis was to compare the impacts of various dietary approaches on the glycemic control of T2DM patients. Methods: Relevant studies were retrieved from PubMed, Embase, Web of Knowledge, Cochrane Central Register of Controlled Trials (CENTRAL), and other additional records (1949 to 31 July 2022). Eligible RCTs were those comparing different dietary approaches against each other or a control diet in individuals with T2DM for at least 6 months. We assessed the risk of bias of included studies with the Cochrane risk of bias tool and confidence of estimates with the Grading of Recommendations Assessment, Development, and Evaluation approach for network meta-analyses. In order to determine the pooled effect of each dietary approach relative to each other, we performed a network meta-analysis (NMA) for interventions for both HbA1c and fasting glucose, which enabled us to estimate the relative intervention effects by combing both direct and indirect trial evidence. Results: Forty-two RCTs comprising 4809 patients with T2DM were included in the NMA, comparing 10 dietary approaches (low-carbohydrate, moderate-carbohydrate, ketogenic, low-fat, high-protein, Mediterranean, Vegetarian/Vegan, low glycemic index, recommended, and control diets). In total, 83.3% of the studies were at a lower risk of bias or had some concerns. Findings of the NMA revealed that the ketogenic, low-carbohydrate, and low-fat diets were significantly effective in reducing HbA1c (viz., −0.73 (−1.19, −0.28), −0.69 (−1.32, −0.06), and −1.82 (−2.93, −0.71)), while moderate-carbohydrate, low glycemic index, Mediterranean, high-protein, and low-fat diets were significantly effective in reducing fasting glucose (viz., −1.30 (−1.92, −0.67), −1.26 (−2.26, −0.27), −0.95 (−1.51, −0.38), −0.89 (−1.60, −0.18) and −0.75 (−1.24, −0.27)) compared to a control diet. The clustered ranking plot for combined outcomes indicated the ketogenic, Mediterranean, moderate-carbohydrate, and low glycemic index diets had promising effects for controlling HbA1c and fasting glucose. The univariate meta-regressions showed that the mean reductions of HbA1c and fasting glucose were only significantly related to the mean weight change of the subjects. Conclusions: For glycemic control in T2DM patients, the ketogenic diet, Mediterranean diet, moderate-carbohydrate diet, and low glycemic index diet were effective options. Although this study found the ketogenic diet superior, further high-quality and long-term studies are needed to strengthen its credibility. Full article
(This article belongs to the Special Issue Very-Low-Calorie Ketogenic Diet in the Management of Metabolic Diseases)
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13 pages, 942 KiB  
Review
The Impact of a Very-Low-Calorie Ketogenic Diet in the Gut Microbiota Composition in Obesity
by Ana Karina Zambrano, Santiago Cadena-Ullauri, Patricia Guevara-Ramírez, Evelyn Frias-Toral, Viviana A. Ruiz-Pozo, Elius Paz-Cruz, Rafael Tamayo-Trujillo, Sebastián Chapela, Martha Montalván, Gerardo Sarno, Claudia V. Guerra and Daniel Simancas-Racines
Nutrients 2023, 15(12), 2728; https://doi.org/10.3390/nu15122728 - 13 Jun 2023
Cited by 11 | Viewed by 4896
Abstract
The very-low-calorie KD (VLCKD) is characterized by a caloric intake of under 800 kcal/day divided into less than 50 g/day of carbohydrate (13%) and 1 to 1.5 g of protein/kg of body weight (44%) and 43% of fat. This low carbohydrate intake changes [...] Read more.
The very-low-calorie KD (VLCKD) is characterized by a caloric intake of under 800 kcal/day divided into less than 50 g/day of carbohydrate (13%) and 1 to 1.5 g of protein/kg of body weight (44%) and 43% of fat. This low carbohydrate intake changes the energy source from glucose to ketone bodies. Moreover, clinical trials have consistently shown a beneficial effect of VLCKD in several diseases, such as heart failure, schizophrenia, multiple sclerosis, Parkinson’s, and obesity, among others. The gut microbiota has been associated with the metabolic conditions of a person and is regulated by diet interactions; furthermore, it has been shown that the microbiota has a role in body weight homeostasis by regulating metabolism, appetite, and energy. Currently, there is increasing evidence of an association between gut microbiota dysbiosis and the pathophysiology of obesity. In addition, the molecular pathways, the role of metabolites, and how microbiota modulation could be beneficial remain unclear, and more research is needed. The objective of the present article is to contribute with an overview of the impact that VLCKD has on the intestinal microbiota composition of individuals with obesity through a literature review describing the latest research regarding the topic and highlighting which bacteria phyla are associated with obesity and VLCKD. Full article
(This article belongs to the Special Issue Very-Low-Calorie Ketogenic Diet in the Management of Metabolic Diseases)
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23 pages, 777 KiB  
Review
Very Low-Calorie Ketogenic Diet (VLCKD) as Pre-Operative First-Line Dietary Therapy in Patients with Obesity Who Are Candidates for Bariatric Surgery
by Luigi Barrea, Ludovica Verde, Luigi Schiavo, Gerardo Sarno, Elisabetta Camajani, Antonio Iannelli, Massimiliano Caprio, Vincenzo Pilone, Annamaria Colao and Giovanna Muscogiuri
Nutrients 2023, 15(8), 1907; https://doi.org/10.3390/nu15081907 - 14 Apr 2023
Cited by 7 | Viewed by 4095
Abstract
Bariatric surgery is currently the most effective method for achieving long-term weight loss and reducing the risk of comorbidities and mortality in individuals with severe obesity. The pre-operative diet is an important factor in determining patients’ suitability for surgery, as well as their [...] Read more.
Bariatric surgery is currently the most effective method for achieving long-term weight loss and reducing the risk of comorbidities and mortality in individuals with severe obesity. The pre-operative diet is an important factor in determining patients’ suitability for surgery, as well as their post-operative outcomes and success in achieving weight loss. Therefore, the nutritional management of bariatric patients requires specialized expertise. Very low-calorie diets and intragastric balloon placement have already been studied and shown to be effective in promoting pre-operative weight loss. In addition, the very low-calorie ketogenic diet has a well-established role in the treatment of obesity and type 2 diabetes mellitus, but its potential role as a pre-operative dietary treatment prior to bariatric surgery has received less attention. Thus, this article will provide a brief overview of the current evidence on the very low-calorie ketogenic diet as a pre-operative dietary treatment in patients with obesity who are candidates for bariatric surgery. Full article
(This article belongs to the Special Issue Very-Low-Calorie Ketogenic Diet in the Management of Metabolic Diseases)
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