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Table 1 Indications and contraindications to VLCKD of ADI (Associazione Italiana di Dietetica e Nutrizione Clinica) and SIE (Società Italiana di Endocrinologia)

From: The management of very low-calorie ketogenic diet in obesity outpatient clinic: a practical guide

Indications Morbid obesity or complicated (type 2 diabetes, dyslipidemia, hypertension, metabolic syndrome, OSAS, bone diseases or severe arthropathy)
Severe obesity with bariatric surgery indication (in the preoperative period)
Patients with severe comorbidities needing a rapid weight loss
Non-alcoholic fatty liver disease (NAFLD)
Drug-resistant epilepsy
Severe obesity
Management of severe obesity before bariatric surgery
Sarcopenic obesity
Obesity associated with type 2 diabetes (preserved beta cell function)
Obesity associated with hypertriglyceridemia
Obesity associated with hypertension
Pediatric obesity associated with epilepsy and/or with a high level of insulin resistance and/or comorbidities, not responsive to standardized diet
Contraindications Pregnancy and lactation
History of mental disorders and behavioral problems, abuse of alcohol and other substances
Hepatic or renal failure
Type 1 Diabetes
Porphyria, unstable angina, recent myocardial infarction
Type 1 diabetes mellitus
Latent autoimmune diabetes in adults
β-cell failure in type 2 diabetes mellitus
Use of sodium/glucose cotransporter 2 (SGLT2) inhibitors (risk for euglycemic diabetic ketoacidosis)
Pregnancy and breastfeeding
Kidney failure and moderate-to-severe chronic kidney disease
Liver failure
Hearth failure (NYHA III-IV)
Respiratory failure
Unstable angina, recent stroke or myocardial infarction (or myocardial infarction (or myocardial infarction (< 12 months)
Cardiac arrhythmias
Eating disorders and other severe mental illnesses, alcohol and substance abuse
Active/severe infections
Frail elderly patients
48 h prior to elective surgery or invasive procedures and perioperative period
Rare disorders: porphyria, carnitine deficiency, carnitine palmitoyltransferase deficiency, carnitine-acylcarnitine translocase deficiency, mitochondrial fatty acid β-oxidation disorders, pyruvate carboxylase deficiency