We thank the authors of the comment [...]

Camajani, Elisabetta

Caprio, Massimiliano

Fabbri, Andrea

Lenzi, Andrea

Moriconi, Eleonora

English

PubMed

Eleonora Moriconi

Multidisciplinary Digital Publishing Institute

Reply to Berk et al. Comment on “Moriconi et al. Very-Low-Calorie Ketogenic Diet as a Safe and Valuable Tool for Long-Term Glycemic Management in Patients with Obesity and Type 2 Diabetes. Nutrients 2021, 13, 758”

nutrientsReplyReply to Berk et al. Comment on “Moriconi et al.Very-Low-Calorie Ketogenic Diet as a Safe and Valuable Toolfor Long-Term Glycemic Management in Patients with Obesityand Type 2 Diabetes. Nutrients 2021, 13, 758”Eleonora Moriconi 1,2, Elisabetta Camajani 2,3, Andrea Fabbri 4 , Andrea Lenzi 5 and Massimiliano Caprio 1,3,*Citation: Moriconi, E.; Camajani, E.;Fabbri, A.; Lenzi, A.; Caprio, M.Reply to Berk et al. Comment on“Moriconi et al. Very-Low-CalorieKetogenic Diet as a Safe and ValuableTool for Long-Term GlycemicManagement in Patients with Obesityand Type 2 Diabetes. Nutrients 2021,13, 758”. Nutrients 2021, 13, 3639.https://doi.org/10.3390/nu13103639Received: 2 August 2021Accepted: 12 October 2021Published: 18 October 2021Publisher’s Note: MDPI stays neutralwith regard to jurisdictional claims inpublished maps and institutional affil-iations.Copyright: © 2021 by the authors.Licensee MDPI, Basel, Switzerland.This article is an open access articledistributed under the terms andconditions of the Creative CommonsAttribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).1 Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Pisana, 00166 Rome, Italy;eleonoramoriconi87@gmail.com2 PhD Programme in Endocrinological Sciences, Sapienza University of Rome, 00161 Rome, Italy;elisabetta.camajani@uniroma5.it3 Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University,00166 Rome, Italy4 Division of Endocrinology, CTO Andrea Alesini Hospital, ASL Roma 2, Department of Systems Medicine,University of Rome “Tor Vergata”, 00133 Rome, Italy; andrea.fabbri@uniroma2.it5 Section of Medical Pathophysiology and Endocrinology, Department of Experimental Medicine, SapienzaUniversity of Rome, 00161 Rome, Italy; andrea.lenzi@uniroma1.it* Correspondence: massimiliano.caprio@sanraffaele.itWe thank the authors of the comment [1] for their expressed interest in our article [2].It is true that ketogenic diets significantly differ in macronutrient composition [3],encompassing different dietary models that can achieve various degrees of nutritionalketosis. This is why such nutritional approach represents a viable tool in different clinicalcontexts, ranging from neurologic diseases to metabolic derangements. However, inour work, we clearly defined the characteristics of the ketogenic diet used in the study.Nowadays, very low calorie ketogenic diets (VLCKD) represent a validated approach in thecontext of obesity and type 2 diabetes, and authoritative scientific societies (Italian Societyof Endocrinology, European Association for the Study of Obesity) have published recentposition statements clearly defining their characteristics in terms of nutrient compositionand temporal structure [4,5]. Moreover, a consensus report on nutrition therapy from theAmerican Diabetes Association suggested very low carbohydrate diets for patients withtype 2 diabetes not meeting glycemic targets, or requiring a reduction in antiglycemicmedications [6].In the Materials and Methods section of the paper, we did provide a clear description ofthe nutritional intervention, characterizing macronutrient and micronutrient compositionin the different phases during the study period, and highlighting that the length of VLCKDphases was personalized according to the weight loss target. Capillary blood ketone levelswere monitored during the first 3 months from the beginning of the nutritional intervention(i.e., during the ketogenic phases and at the first visit of the re-educational stage) andranged between 0.5 and 1.2 mmol/L in the active ketosis phases, reaching lower levelsafter the reintroduction of carbohydrates. Therefore, we did confirm a mild ketosis stateduring the nutritional intervention with VLCKD, in line with previous reports using thesame nutritional approach [7]. Patients who did not reach and maintain the minimumthreshold value for nutritional ketosis (0.5 mmol/L) were not selected for the study.Data from patients eligible for the study were collected during a time period spanningfrom April 2018 to June 2020. We agree with the authors about the relevant differences inbaseline anthropometric measures between the study groups; this aspect has been, in fact,reported as a limitation of the study. Given that subjects were free to choose the dietaryintervention, it is not surprising that patients affected by more severe degrees of obesityNutrients 2021, 13, 3639. https://doi.org/10.3390/nu13103639 https://www.mdpi.com/journal/nutrientsNutrients 2021, 13, 3639 2 of 2were more likely to accept and adhere to a nutritional regimen with a higher promise forrapid weight loss.However, we believe that this aspect does not jeopardize the significance of our work,which was based on a retrospective observational study, and therefore should be consideredas a simple observation of a real-world clinical practice setting, evaluating the efficacyof different nutritional strategies for the management of patients with obesity and type2 diabetes. On the other hand, diabetic patients are known to adhere poorly to nutritionalinterventions and lifestyle modifications, irrespective of their body mass index, with obesesubjects showing even less adherence and motivation to improve their health status.However, we fully agree with the authors on the consideration that adequately con-trolled clinical trials are necessary to draw solid conclusions on this delicate issue and toconfirm our data.Funding: This paper was funded by MIUR (Progetti di Ricerca di Interesse Nazionale 2017—Projectcode 2017A5TXC3—to MC, Work Package Leader).Institutional Review Board Statement: Not applicable.Informed Consent Statement: Informed consent was obtained from all subjects involved in theoriginal study.Data Availability Statement: Data sharing is not applicable to this article.Conflicts of Interest: The authors declare no conflict of interest.References1. Berk, K.A.; van der Louw, E.J.T.M.; Olieman, J.F.; van der Lely, A.J. Comment on Moriconi et al. Very-Low-Calorie Ketogenic Dietas a Safe and Valuable Tool for Long-Term Glycemic Management in Patients with Obesity and Type 2 Diabetes. Nutrients 2021,13, 758. Nutrients 2021, 13, 3613. [CrossRef]2. Moriconi, E.; Camajani, E.; Fabbri, A.; Lenzi, A.; Caprio, M. Very-Low-Calorie Ketogenic Diet as a Safe and Valuable Tool forLong-Term Glycemic Management in Patients with Obesity and Type 2 Diabetes. Nutrients 2021, 13, 758.[CrossRef]3. Trimboli, P.; Castellana, M.; Bellido, D.; Casanueva, F.F. Confusion in the nomenclature of ketogenic diets blurs evidence. Rev.Endocr. Metab. Disord. 2020, 21, 1–3. [CrossRef] [PubMed]4. Caprio, M.; Infante, M.; Moriconi, E.; Armani, A.; Fabbri, A.; Mantovani, G.; Mariani, S.; Lubrano, C.; Poggiogalle, E.; Migliaccio,S.; et al. Very-Low-Calorie Ketogenic Diet (VLCKD) in the Management of Metabolic Diseases: Systematic Review and ConsensusStatement from the Italian Society of Endocrinology (SIE). J. Endocrinol. Investig. 2019, 42, 1365–1386. [CrossRef] [PubMed]5. Muscogiuri, G.; El Ghoch, M.; Colao, A.; Hassapidou, M.; Yumuk, V.; Busetto, L. Obesity Management Task Force (OMTF) ofthe European Association for the Study of Obesity (EASO)European Guidelines for Obesity Management in Adults with a VeryLow-Calorie Ketogenic Diet: A Systematic Review and Meta-Analysis. Obes. Facts 2021, 14, 222–245. [CrossRef] [PubMed]6. Evert, A.B.; Dennison, M.; Gardner, C.D.; Garvey, W.T.; Lau, K.H.K.; MacLeod, J.; Mitri, J.; Pereira, R.F.; Rawlings, K.; Robinson, S.;et al. Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report. Diabetes Care 2019, 42, 731–754. [CrossRef][PubMed]7. Gomez-Arbelaez, D.; Crujeiras, A.B.; Castro, A.I.; Martinez-Olmos, M.A.; Canton, A.; Ordoñez-Mayan, L.; Sajoux, I.; Galban, C.;Bellido, D.; Casanueva, F.F. Resting metabolic rate of obese patients under very low calorie ketogenic diet. Nutr. Metab. (Lond.)2018, 17, 15–18. [CrossRef] [PubMed]

Reply to Berk et al. Comment on "Moriconi et al. Very-low-calorie ketogenic diet as a safe and valuable tool for long-term glycemic management in patients with obesity and type 2 diabetes. Nutrients 2021, 13, 758"

Reply to Berk et al. Comment on "Moriconi et al. Very-low-calorie ketogenic diet as a safe and valuable tool for long-term glycemic management in patients with obesity and type 2 diabetes. Nutrients 2021, 13, 758"

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