Table 2.
Indications and contraindications for VLCKD prescription
| Indications | Contraindications |
|---|---|
| Obesity (BMI ≥ 30.0 kg/m2) | Pregnancy and breastfeeding |
| Obesity with one or more comorbidities (T2DMa, locomotors system disorder, NAFLD) | Childhoodb |
| Overweight (BMI = 25.0–29.9 kg/m2) with abdominal obesity (waist circumference > 102 cm in men and > 88 cm in women) | Rare metabolic disorders (porphyria, carnitine deficiency, carnitine palmitoyltransferase deficiency, carnitine-acylcarnitine translocase deficiency, mitochondrial fatty acid β-oxidation disorders, and pyruvate carboxylase deficiency) |
| Overweight/obesity, PCOS and hypogonadism | Type 1 diabetes, type 2 diabetes with beta cell failure or concomitant treatment with SGLT2 inhibitors |
| Weight loss before bariatric surgery or in case of weight regain after bariatric surgery | Organ failure (liver, kidney, or heart NYHA III e IV) |
| Overweight/obesity and neurological/neurodegenerative disorders (Parkinson, Alzheimer, amyotrophic lateral sclerosis, epilepsy) | Recent myocardial infarction or cerebrovascular stroke |
| Overweight/obesity and pulmonary dysfunctions (OSAS, COPD, OHS, asthma) | Severe psychiatric disorders |
| Overweight/obesity and psoriasis | Severe eating disorders |
| Alcohol and substance abuse |
T2DM type 2 diabetes mellitus; NAFLD non-alcoholic fatty liver disease; OSAS obstructive sleep apnoea syndrome; PCOS polycystic ovary syndrome; OSAS obstructive sleep apnoea syndrome; COPD chronic obstructive pulmonary diseases; OHS obesity hypoventilation syndrome
aUse of sodium/glucose cotransporter 2 (SGLT2) inhibitors or insulin therapy is forbidden
bDuring childhood VLCKD could be prescribed in particular condition (epilepsy, high insulin resistance)