Ketogenic enteral nutrition for weight loss: a word of warning

  • Maria Letizia PetroniEmail author

In the current issue of Internal and Emergency Medicine, Papadia et al. [1] present retrospective data of 629 subjects with overweight or obesity that underwent a protocol of repeated 10-day cycles of a protein-sparing modified fast defined as “ketogenic enteral nutrition” and administered via nasogastric tube in order to achieve fast and substantial weight loss.

Despite its apparent efficacy, nevertheless the possible widespread clinical application of this protocol outside the research setting raises a number of concerns, and specifically:
  • the composition of the enteral mixture used

  • the invasiveness of the technique

  • the short-term and the potential long-term side effects of the KEN protocol

The Expert Panel of the European Food Safety Authority (EFSA) provided in 2015 a Scientific Opinion on the essential composition of total diet replacements for weight control [2]. EFSA recommended a minimum energy content of 600 kcal/day (2510 kJ), as compared with only 205–270 kcal/day...


Compliance with ethical standards

Conflict of interest

The author declares that she has no conflict of interest.


  1. 1.
    Papadia C, Bassett P, Cappello G, Forbes A, Lazarescu V, Shidrawi R (2019) Therapeutic action of ketogenic enteral nutrition in obese and overweight patients: a retrospective interventional study. Intern Emerg Med. CrossRefPubMedGoogle Scholar
  2. 2.
    EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies), 2015. Scientific Opinion on the essential composition of total diet replacements for weight control. EFSA J 2015;13:3957 (52)CrossRefGoogle Scholar
  3. 3.
    Caprio M, Infante M, Moriconi E, Armani A, Fabbri A, Mantovani G et al (2019) Very-low-calorie ketogenic diet (VLCKD) in the management of metabolic diseases: systematic review and consensus statement from the Italian Society of Endocrinology (SIE). J Endocrinol Invest 42:1365–1386. CrossRefPubMedGoogle Scholar
  4. 4.
    Gomez-Arbelaez D, Bellido D, Castro AI, Ordoñez-Mayan L, Carreira J, Galban C et al (2017) Body composition changes after very-low-calorie ketogenic diet in obesity evaluated by 3 standardized methods. J Clin Endocrinol Metab 102:488–498PubMedGoogle Scholar
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    Blumenstein I, Shastri YM, Stein J (2014) Gastroenteric tube feeding: techniques, problems and solutions. World J Gastroenterol 20:8505–8524. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Società Italiana di Medicina Interna (SIMI) 2019

Authors and Affiliations

  1. 1.Metabolic Diseases, Clinical Nutrition and Reference Center for Benign Intestinal InsufficiencyAlma Mater Studiorum University of BolognaBolognaItaly

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