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Journal of Endocrinological Investigation

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)

Published: 18 January 2024

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.

The NHS and its partner Diabetes UK are delivering a new programme which provides a low calorie, total diet replacement treatment for people who are living with type 2 diabetes and obesity or overweight: the NHS Type 2 Diabetes Path to Remission Programme.

The programme, previously referred to as the NHS Low Calorie Diet Programme, is based on research showing that a 3-month specially formulated ‘soup and shake’ diet followed by healthy lifestyle support helped people living with type 2 diabetes and obesity or overweight to lose over 10kg in weight, improve their blood sugar levels, reduce diabetes-related medication and, in almost half of participants, put their type 2 diabetes into remission.

The programme is being offered to eligible people in selected areas and the learning from the programme will help to build knowledge and understanding about the use of interventions such as this and the impact that they might have on the treatment of people living with type 2 diabetes in the future.