Journal of Endocrinological Investigation

, Volume 42, Issue 11, pp 1365–1386 | Cite as

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

  • M. CaprioEmail author
  • M. Infante
  • E. Moriconi
  • A. Armani
  • A. Fabbri
  • G. Mantovani
  • S. Mariani
  • C. Lubrano
  • E. Poggiogalle
  • S. Migliaccio
  • L. M. Donini
  • S. Basciani
  • A. Cignarelli
  • E. Conte
  • G. Ceccarini
  • F. Bogazzi
  • L. Cimino
  • R. A. Condorelli
  • S. La Vignera
  • A. E. Calogero
  • A. Gambineri
  • L. Vignozzi
  • F. Prodam
  • G. Aimaretti
  • G. Linsalata
  • S. Buralli
  • F. Monzani
  • A. Aversa
  • R. Vettor
  • F. Santini
  • P. Vitti
  • L. Gnessi
  • U. Pagotto
  • F. Giorgino
  • A. Colao
  • A. Lenzi
  • the Cardiovascular Endocrinology Club of the Italian Society of Endocrinology
Consensus Statement



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.


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.


Obesity Ketone bodies Weight loss Cardiovascular risk Type 2 diabetes Cardiovascular rehabilitation 



We would like to thank all the members of the Cardiovascular Endocrinology Club of the Italian Society of Endocrinology, for the scientific support during the writing of the manuscript. The Cardiovascular Endocrinology Club of the Italian Society of Endocrinology: Massimiliano Caprio (coordinator), Fausto Bogazzi (coordinator), Guglielmo Beccuti, Bernadette Biondi, Salvatore Cannavò, Iacopo Chiodini, Giuseppe De Feudis, Simona Di Francesco, Aldo Di Gregorio, Francesco Fallo, Carlo Foresta, Gilberta Giacchetti, Riccarda Granata, Andrea M. Isidori, Paolo Magni, Pasquale Maiellaro, Mirko Parasiliti Caprino, Rosario Pivonello, Riccardo Pofi, Alfredo Pontecorvi, Chiara Simeoli and all authors of the manuscript.


The study was not funded.

Compliance with ethical standards

Conflict of interest

MC. gave talks in symposia sponsored by Therascience, Eli Lilly, Novo Nordisk and New Penta, participated to advisory board for Therascience and Sanofi, and received research grants from Bayer AG; G.M. participated to advisory boards for Novartis and Shire and received honoraria for courses sponsored by Pfizer; S.B. gave talks in symposia sponsored by New Penta; L.C. and R.V. gave talks in symposia sponsored by Therascience; F.P. received grants by Difass International, Nutricia Research Foundation, and Probiotical; G.A. received honoraria from Astra Zeneca and Sanofi. All the other authors have nothing to disclose, related to this publication.

Research involving human or animals participants

This consensus statement does not contain any study with human participants or animals performed by any of the authors.

Informed consent

Not applicable.


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Copyright information

© Italian Society of Endocrinology (SIE) 2019

Authors and Affiliations

  • M. Caprio
    • 1
    • 2
    Email author
  • M. Infante
    • 3
  • E. Moriconi
    • 1
    • 4
  • A. Armani
    • 1
  • A. Fabbri
    • 3
  • G. Mantovani
    • 5
  • S. Mariani
    • 4
  • C. Lubrano
    • 4
  • E. Poggiogalle
    • 4
  • S. Migliaccio
    • 6
  • L. M. Donini
    • 4
  • S. Basciani
    • 4
  • A. Cignarelli
    • 7
  • E. Conte
    • 7
  • G. Ceccarini
    • 8
  • F. Bogazzi
    • 9
  • L. Cimino
    • 10
  • R. A. Condorelli
    • 10
  • S. La Vignera
    • 10
  • A. E. Calogero
    • 10
  • A. Gambineri
    • 11
  • L. Vignozzi
    • 12
  • F. Prodam
    • 13
  • G. Aimaretti
    • 13
  • G. Linsalata
    • 14
  • S. Buralli
    • 14
  • F. Monzani
    • 14
  • A. Aversa
    • 15
  • R. Vettor
    • 16
  • F. Santini
    • 8
  • P. Vitti
    • 9
  • L. Gnessi
    • 4
  • U. Pagotto
    • 11
  • F. Giorgino
    • 7
  • A. Colao
    • 17
  • A. Lenzi
    • 4
  • the Cardiovascular Endocrinology Club of the Italian Society of Endocrinology
  1. 1.Laboratory of Cardiovascular EndocrinologyIRCCS San Raffaele PisanaRomeItaly
  2. 2.Department of Human Sciences and Promotion of the Quality of LifeSan Raffaele Roma Open UniversityRomeItaly
  3. 3.Unit of Endocrinology and Metabolic Diseases, Department of Systems Medicine, CTO A. Alesini Hospital, ASL Roma 2University of Rome Tor VergataRomeItaly
  4. 4.Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental MedicineSapienza University of RomeRomeItaly
  5. 5.Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Endocrinology and Diabetology Unit, Department of Clinical Sciences and Community HealthUniversity of MilanMilanItaly
  6. 6.Section of Health Sciences, Department of Movement, Human and Health Sciences“Foro Italico” University of RomeRomeItaly
  7. 7.Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ TransplantationUniversity of Bari Aldo MoroBariItaly
  8. 8.Endocrinology Unit, Obesity and Lipodystrophy CenterUniversity Hospital of PisaPisaItaly
  9. 9.Endocrinology Unit, Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
  10. 10.Department of Clinical and Experimental MedicineUniversity of CataniaCataniaItaly
  11. 11.Endocrinology Unit and Center for Applied Biomedical Research, Department of Medical and Surgical SciencesUniversity of Bologna, S. Orsola-Malpighi HospitalBolognaItaly
  12. 12.Andrology, Women’s Endocrinology and Gender Incongruence Unit, Department of Biomedical, Experimental and Clinical SciencesUniversity of Florence, AOU CareggiFlorenceItaly
  13. 13.Endocrinology, Department of Translational Medicine and Department of Health SciencesUniversity of Piemonte OrientaleNovaraItaly
  14. 14.Geriatrics Unit, Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
  15. 15.Department of Experimental and Clinical MedicineMagna Graecia University of CatanzaroCatanzaroItaly
  16. 16.Department of Medicine, Internal Medicine 3University Hospital of PadovaPaduaItaly
  17. 17.Section of Endocrinology, Department of Clinical Medicine and SurgeryUniversity “Federico II” of NaplesNaplesItaly

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