Clinical and nutritional management of very-low-calorie ketogenic diet (VLCKD) in patients with psoriasis and obesity: a practical guide for the nutritionist.

Luigi Barrea, Massimiliano Caprio, Elisabetta Camajani, Ludovica Verde, Ausilia Elce, Evelyn Frias-Toral, Florencia Ceriani, Gabriela Cucalón, Eloisa Garcia-Velasquez, Marwan El Ghoch, Annamaria Colao, Silvia Savastano, Giovanna Muscogiuri

Journal: Critical reviews in food science and nutrition 2023;63(31):10775-10791

PMID: 35653127

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Abstract

Psoriasis is an immune-mediated inflammatory skin disease associated with multiple comorbidities. Considered one of the most common inflammatory skin diseases among the general population, it not only affects the skin, but also negatively impacts other organs and joints. In addition, psoriasis has been associated with several chronic cardio-metabolic diseases such as obesity, which would seem to be (i) a risk factor for the onset of psoriasis and (ii) a worsening factor of the severity of the disease. Weight loss appears to improve severity in overweight patients. Recently proposed as an obesity management nutritional strategy, the very-low-calorie ketogenic diet (VLCKD) has demonstrated significant effects in reducing inflammatory processes. In the current review, we describe the evidence available on psoriasis and VLCKD, and provide a practical guide to the prescription of VLCKD in the different phases, evaluation and management of possible adverse events, and the importance of physical activity as a lifestyle modification to reduce psoriasis and associated comorbidities. Randomized control trials are, however, necessary to determine the most effective VLCKD protocol for patients with obesity and psoriasis, optimal protocol duration, composition of micronutrients and macronutrients, choice of special supplements, and management of carbohydrate reintroduction.

Address: Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Napoli, Italy.; Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Naples, Italy.; Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Roma, Rome, Italy.; Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy.; Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy.; PhD Programme in Endocrinological Sciences, Sapienza University of Rome, Rome, Italy.; Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Naples, Italy.; Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Naples, Italy.; Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Napoli, Italy.; Clinical Research Associate Professor for Palliative Care Residency from Universidad Católica Santiago de Guayaquil, Guayaquil, Ecuador.; Escuela de Nutrición, Universidad de la República, Montevideo, Uruguay.; Escuela Superior Politécnica del Litoral, ESPOL, Lifescience Faculty, ESPOL Polytechnic University, Guayaquil, Ecuador.; Clinical Nutrition Service, San Francisco Clinic Hospital, Guayaquil, Ecuador.; Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, Riad El Solh, Beirut, Lebanon.; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.; Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Naples, Italy.; Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Naples, Italy.; Cattedra Unesco "Educazione alla salute e allo sviluppo sostenibile", University Federico II, Naples, Italy.

DOI: 10.1080/10408398.2022.2083070

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MeSH Terms: Humans, Diet, Ketogenic, Nutritionists, Obesity, Overweight, Psoriasis