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

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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.

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Most cited references 90

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Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man.

D. Matthews, J Hosker, A Rudenski … (1985)

The steady-state basal plasma glucose and insulin concentrations are determined by their interaction in a feedback loop. A computer-solved model has been used to predict the homeostatic concentrations which arise from varying degrees beta-cell deficiency and insulin resistance. Comparison of a patient's fasting values with the model's predictions allows a quantitative assessment of the contributions of insulin resistance and deficient beta-cell function to the fasting hyperglycaemia (homeostasis model assessment, HOMA). The accuracy and precision of the estimate have been determined by comparison with independent measures of insulin resistance and beta-cell function using hyperglycaemic and euglycaemic clamps and an intravenous glucose tolerance test. The estimate of insulin resistance obtained by homeostasis model assessment correlated with estimates obtained by use of the euglycaemic clamp (Rs = 0.88, p less than 0.0001), the fasting insulin concentration (Rs = 0.81, p less than 0.0001), and the hyperglycaemic clamp, (Rs = 0.69, p less than 0.01). There was no correlation with any aspect of insulin-receptor binding. The estimate of deficient beta-cell function obtained by homeostasis model assessment correlated with that derived using the hyperglycaemic clamp (Rs = 0.61, p less than 0.01) and with the estimate from the intravenous glucose tolerance test (Rs = 0.64, p less than 0.05). The low precision of the estimates from the model (coefficients of variation: 31% for insulin resistance and 32% for beta-cell deficit) limits its use, but the correlation of the model's estimates with patient data accords with the hypothesis that basal glucose and insulin interactions are largely determined by a simple feed back loop.

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Homeostasis model assessment: insulin resistance and ?-cell function from fasting plasma glucose and insulin concentrations in man

D. Matthews, J Hosker, A Rudenski … (1985)

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Is Open Access

Waist circumference as a vital sign in clinical practice: a Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity

Robert Ross, Ian Neeland, Shizuya Yamashita … (2020)

Despite decades of unequivocal evidence that waist circumference provides both independent and additive information to BMI for predicting morbidity and risk of death, this measurement is not routinely obtained in clinical practice. This Consensus Statement proposes that measurements of waist circumference afford practitioners with an important opportunity to improve the management and health of patients. We argue that BMI alone is not sufficient to properly assess or manage the cardiometabolic risk associated with increased adiposity in adults and provide a thorough review of the evidence that will empower health practitioners and professional societies to routinely include waist circumference in the evaluation and management of patients with overweight or obesity. We recommend that decreases in waist circumference are a critically important treatment target for reducing adverse health risks for both men and women. Moreover, we describe evidence that clinically relevant reductions in waist circumference can be achieved by routine, moderate-intensity exercise and/or dietary interventions. We identify gaps in the knowledge, including the refinement of waist circumference threshold values for a given BMI category, to optimize obesity risk stratification across age, sex and ethnicity. We recommend that health professionals are trained to properly perform this simple measurement and consider it as an important ‘vital sign’ in clinical practice.

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Author and article information

Contributors

M. Caprio:

ORCID: http://orcid.org/0000-0003-0722-7163

massimiliano.caprio@sanraffaele.it

G. Muscogiuri: giovanna.muscogiuri@unina.it

Journal

Journal ID (nlm-ta): J Endocrinol Invest

Journal ID (iso-abbrev): J Endocrinol Invest

Title: Journal of Endocrinological Investigation

Publisher: Springer International Publishing (Cham )

ISSN (Print): 0391-4097

ISSN (Electronic): 1720-8386

Publication date (Electronic): 18 January 2024

Publication date PMC-release: 18 January 2024

Publication date (Print): 2024

Volume: 47

Issue: 3

Pages: 487-500

Affiliations

[1 ]Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Centro Direzionale, Via Porzio Isola F2, 80143 Naples, Italy

[2 ]Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele, ( https://ror.org/006x48140) Rome, Italy

[3 ]Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, ( https://ror.org/02rwycx38) 00166 Rome, Italy

[4 ]Department of Public Health, University “Federico II” of Naples, ( https://ror.org/05290cv24) 80138 Naples, Italy

[5 ]Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, ( https://ror.org/027ynra39) Bari, Italy

[6 ]GRID grid.16563.37, ISNI 0000000121663741, Endocrinology, Department of Translational Medicine, , Università del Piemonte Orientale, ; 28100 Novara, Italy

[7 ]GRID grid.16563.37, ISNI 0000000121663741, Department of Health Sciences, , University of Piemonte Orientale, ; 28100 Novara, Italy

[8 ]GRID grid.6292.f, ISNI 0000 0004 1757 1758, Division of Endocrinology and Diabetes Prevention and Care, , IRCCS Azienda Ospedaliero-Universitaria di Bologna, ; Bologna, Italy

[9 ]Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, ( https://ror.org/01111rn36) Bologna, Italy

[10 ]Department of Experimental Medicine, Sapienza University of Rome, ( https://ror.org/02be6w209) Viale Regina Elena 324, 00161 Rome, Italy

[11 ]Dipartimento di Medicina Clinica e Chirurgia, Endocrinologia, Unità di Diabetologia e Andrologia, Università degli Studi di Napoli Federico II, ( https://ror.org/05290cv24) Via Sergio Pansini 5, 80131 Naples, Italy

[12 ]Centro Italiano per la Cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, ( https://ror.org/05290cv24) Naples, Italy

[13 ]Cattedra Unesco “Educazione Alla Salute e Allo Sviluppo Sostenibile”, Università degli Studi di Napoli Federico II, ( https://ror.org/05290cv24) Naples, Italy

Author information

M. Caprio http://orcid.org/0000-0003-0722-7163

Article

Publisher ID: 2258

DOI: 10.1007/s40618-023-02258-2

PMC ID: 10904420

PubMed ID: 38238506

SO-VID: ef4b3635-c65e-41ee-a3ee-f744f570001d

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 20 September 2023

Date accepted : 22 November 2023

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Keywords: ketogenic diet,vlckd,meal replacements,ketone bodies,weight loss,cardiovascular risk,type 2 diabetes,cardiovascular rehabilitation

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Keywords: ketogenic diet, vlckd, meal replacements, ketone bodies, weight loss, cardiovascular risk, type 2 diabetes, cardiovascular rehabilitation

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Most cited references 90

Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man.

Homeostasis model assessment: insulin resistance and ?-cell function from fasting plasma glucose and insulin concentrations in man

Waist circumference as a vital sign in clinical practice: a Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity

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