Aggressive weight-loss program with a ketogenic induction phase for the treatment of chronic plaque psoriasis: A proof-of-concept, single-arm, open-label clinical trial

G. Castaldo; L. Rastrelli; G. Galdo; P. Molettieri; F. Rotondi Aufiero; E. Cereda

doi:10.1016/j.nut.2020.110757

Aggressive weight-loss program with a ketogenic induction phase for the treatment of chronic plaque psoriasis: A proof-of-concept, single-arm, open-label clinical trial

G. Castaldo, L. Rastrelli, G. Galdo, P. Molettieri, F. Rotondi Aufiero, E. Cereda

Research output: Contribution to journal › Article › peer-review

Abstract

Objectives: A very low-calorie ketogenic diet (VLCKD) has been associated with a significant reduction in visceral adipose tissue and ketone bodies that likely possess antiinflammatory properties. We evaluated the efficacy of an aggressive weight-loss (WL) program with a ketogenic induction phase as first-line treatment for chronic plaque psoriasis. Methods: Adult patients who were overweight or obese and drug-naïve (i.e., never treated, excluding the use of topical emollients; n = 37; 30% men; age: 43.1 ± 13.8 y) with stable chronic plaque psoriasis underwent a 10-wk, 2-phase WL program consisting of a 4-wk protein-sparing, VLCKD (

Original language	English
Journal	Nutrition
Volume	74
DOIs	https://doi.org/10.1016/j.nut.2020.110757
Publication status	Published - 2020

Keywords

chronic plaque psoriasis
ketogenic diet
Mediterranean diet
PASI
Weight loss
alanine aminotransferase
aspartate aminotransferase
creatine kinase
lactate dehydrogenase
milk protein
sodium
urate
adult
alanine aminotransferase blood level
Article
aspartate aminotransferase blood level
asthenia
bloating
clinical article
constipation
creatine kinase blood level
Dermatology Life Quality Index
dietary compliance
disease severity
dizziness
female
headache
heart palpitation
human
hunger
lactate dehydrogenase blood level
low calorie diet
male
muscle cramp
nausea
obesity
open study
priority journal
proof of concept
pruritus
Psoriasis Area and Severity Index
psoriasis vulgaris
sodium blood level
therapy effect
urea nitrogen blood level
uric acid blood level
very low calorie ketogenic diet
visual analog scale
weight loss program

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10.1016/j.nut.2020.110757

https://www.scopus.com/inward/record.uri?eid=2-s2.0-85082590327&doi=10.1016%2fj.nut.2020.110757&partnerID=40&md5=d0310f7c5aa60bf29123e2a7754a35b3

Cite this

@article{3a9b530a6a0144f781f11de4f1f53450,

title = "Aggressive weight-loss program with a ketogenic induction phase for the treatment of chronic plaque psoriasis: A proof-of-concept, single-arm, open-label clinical trial",

abstract = "Objectives: A very low-calorie ketogenic diet (VLCKD) has been associated with a significant reduction in visceral adipose tissue and ketone bodies that likely possess antiinflammatory properties. We evaluated the efficacy of an aggressive weight-loss (WL) program with a ketogenic induction phase as first-line treatment for chronic plaque psoriasis. Methods: Adult patients who were overweight or obese and drug-na{\"i}ve (i.e., never treated, excluding the use of topical emollients; n = 37; 30% men; age: 43.1 ± 13.8 y) with stable chronic plaque psoriasis underwent a 10-wk, 2-phase WL program consisting of a 4-wk protein-sparing, VLCKD (",

keywords = "chronic plaque psoriasis, ketogenic diet, Mediterranean diet, PASI, Weight loss, alanine aminotransferase, aspartate aminotransferase, creatine kinase, lactate dehydrogenase, milk protein, sodium, urate, adult, alanine aminotransferase blood level, Article, aspartate aminotransferase blood level, asthenia, bloating, clinical article, constipation, creatine kinase blood level, Dermatology Life Quality Index, dietary compliance, disease severity, dizziness, female, headache, heart palpitation, human, hunger, lactate dehydrogenase blood level, low calorie diet, male, muscle cramp, nausea, obesity, open study, priority journal, proof of concept, pruritus, Psoriasis Area and Severity Index, psoriasis vulgaris, sodium blood level, therapy effect, urea nitrogen blood level, uric acid blood level, very low calorie ketogenic diet, visual analog scale, weight loss program",

author = "G. Castaldo and L. Rastrelli and G. Galdo and P. Molettieri and {Rotondi Aufiero}, F. and E. Cereda",

note = "Cited By :5 Export Date: 2 February 2021 CODEN: NUTRE Correspondence Address: Castaldo, G.; Nutriketo Lab A.O.R.N. San Giuseppe Moscati, Italy; email: lavoronep@yahoo.it Chemicals/CAS: alanine aminotransferase, 9000-86-6, 9014-30-6; aspartate aminotransferase, 9000-97-9; creatine kinase, 9001-15-4; lactate dehydrogenase, 9001-60-9; lactate dehydrogenase A; sodium, 7440-23-5; urate, 1198-77-2, 3106-08-9, 59216-10-3 References: Armstrong, A.W., Psoriasis (2017) JAMA Dermatol, 153, p. 956; Di Meglio, P., Villanova, F., Nestle, F.O., Psoriasis (2014) Cold Spring Harb Perspect Med, 4; Budu-Aggrey, A., Brumpton, B., Tyrrell, J., Watkins, S., Modalsli, E.H., Celis-Morales, C., Evidence of a causal relationship between body mass index and psoriasis: a mendelian randomization study (2019) PLoS Med, 16; Davidovici, B.B., Sattar, N., Prinz, J., Puig, L., Emery, P., Barker, J.N., Psoriasis and systemic inflammatory diseases: potential mechanistic links between skin disease and comorbid conditions (2010) J Invest Dermatol, 130, pp. 1785-1796; Gisondi, P., Del Giglio, M., Girolomoni, G., Considerations for systemic treatment of psoriasis in obese patients (2016) Am J Clin Dermatol, 17, pp. 609-615; Lynch, M., Ahern, T., Sweeney, C.M., Malara, A., Tobin, A.M., O'Shea, D., Adipokines, psoriasis, systemic inflammation, and endothelial dysfunction (2017) Int J Dermatol, 56, pp. 1103-1118; Cao, H., Adipocytokines in obesity and metabolic disease (2014) J Endocrinol, 220, pp. T47-T59; Alexopoulos, N., Katritsis, D., Raggi, P., Visceral adipose tissue as a source of inflammation and promoter of atherosclerosis (2014) Atherosclerosis, 233, pp. 104-112; Kyriakou, A., Patsatsi, A., Sotiriadis, D., Goulis, D.G., Serum leptin, resistin, and adiponectin concentrations in psoriasis: a meta-analysis of observational studies (2017) Dermatology, 233, pp. 378-389; Kyriakou, A., Patsatsi, A., Sotiriadis, D., Goulis, D.G., Effects of treatment for psoriasis on circulating levels of leptin, adiponectin and resistin: a systematic review and meta-analysis (2018) Br J Dermatol, 179, pp. 273-281; Kocic, H., Damiani, G., Stamenkovic, B., Tirant, M., Jovic, A., Tiodorovic, D., Dietary compounds as potential modulators of microRNA expression in psoriasis (2019) Ther Adv Chronic Dis, 10; Gamret, A.C., Price, A., Fertig, R.M., Lev-Tov, H., Nichols, A.J., Complementary and alternative medicine therapies for psoriasis: a systematic review (2018) JAMA Dermatol, 154, pp. 1330-1337; Ford, A.R., Siegel, M., Bagel, J., Cordoro, K.M., Garg, A., Gottlieb, A., Dietary recommendations for adults with psoriasis or psoriatic arthritis from the medical board of the National Psoriasis Foundation: a systematic review (2018) JAMA Dermatol, 154, pp. 934-950; Mahil, S.K., McSweeney, S.M., Kloczko, E., McGowan, B., Barker, J.N., Smith, C.H., Does weight loss reduce the severity and incidence of psoriasis or psoriatic arthritis? A critically appraised topic (2019) Br J Dermatol, 181, pp. 946-953; Gisondi, P., Del Giglio, M., Di Francesco, V., Zamboni, M., Girolomoni, G., Weight loss improves the response of obese patients with moderate-to-severe chronic plaque psoriasis to low-dose cyclosporine therapy: a randomized, controlled, investigator-blinded clinical trial (2008) Am J Clin Nutr, 88, pp. 1242-1247; Naldi, L., Conti, A., Cazzaniga, S., Patrizi, A., Pazzaglia, M., Lanzoni, A., Diet and physical exercise in psoriasis: a randomized controlled trial (2014) Br J Dermatol, 170, pp. 634-642; Jensen, P., Zachariae, C., Christensen, R., Geiker, N.R., Schaadt, B.K., Stender, S., Effect of weight loss on the severity of psoriasis: a randomized clinical study (2013) JAMA Dermatol, 149, pp. 795-801; Al-Mutairi, N., Nour, T., The effect of weight reduction on treatment outcomes in obese patients with psoriasis on biologic therapy: a randomized controlled prospective trial (2014) Expert Opin Biol Ther, 14, pp. 749-756; Guida, B., Napoleone, A., Trio, R., Nastasi, A., Balato, N., Laccetti, R., Energy-restricted, n-3 polyunsaturated fatty acids-rich diet improves the clinical response to immuno-modulating drugs in obese patients with plaque-type psoriasis: a randomized control clinical trial (2014) Clin Nutr, 33, pp. 399-405; Bravata, D.M., Sanders, L., Huang, J., Krumholz, H.M., Olkin, I., Gardner, C.D., Efficacy and safety of low-carbohydrate diets: a systematic review (2003) JAMA, 289, pp. 1837-1850; Franz, M.J., VanWormer, J.J., Crain, A.L., Boucher, J.L., Histon, T., Caplan, W., Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up (2007) J Am Diet Assoc, 107, pp. 1755-1767; Chaston, T.B., Dixon, J.B., Factors associated with percent change in visceral versus subcutaneous abdominal fat during weight loss: findings from a systematic review (2008) Int J Obes (Lond), 32, pp. 619-628; Wycherley, T.P., Moran, L.J., Clifton, P.M., Noakes, M., Brinkworth, G.D., Effects of energy-restricted high-protein, low-fat compared with standard-protein, low-fat diets: a meta-analysis of randomized controlled trials (2012) Am J Clin Nutr, 96, pp. 1281-1298; Paoli, A., Rubini, A., Volek, J.S., Grimaldi, K.A., Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets (2013) Eur J Clin Nutr, 67, pp. 789-796; Cappello, G., Franceschelli, A., Cappello, A., De Luca, P., Weight loss and body composition changes following three sequential cycles of ketogenic enteral nutrition (2012) J Res Med Sci, 17, pp. 1114-1118; Sukkar, S.G., Signori, A., Borrini, C., Barisione, G., Ivaldi, C., Romeo, C., Feasibility of protein-sparing modified fast by tube (ProMoFasT) in obesity treatment: a phase II pilot trial on clinical safety and efficacy (appetite control, body composition, muscular strength, metabolic pattern, pulmonary function test) (2013) Med J Nutrition Metab, 6, pp. 165-176; Leonetti, F., Campanile, F.C., Coccia, F., Capoccia, D., Alessandroni, L., Puzziello, A., Very low-carbohydrate ketogenic diet before bariatric surgery: prospective evaluation of a sequential diet (2015) Obes Surg, 25, pp. 64-71; Monaco, L., Monaco, M., Di Tommaso, L., Stassano, P., Castaldo, L., Castaldo, G., Aortomesenteric fat thickness with ultrasound predicts metabolic diseases in obese patients (2014) Am J Med Sci, 347, pp. 8-13; Castaldo, G., Monaco, L., Castaldo, L., Sorrentino, P., A 2-week course of enteral treatment with a very low-calorie protein-based formula for the management of severe obesity (2015) Int J Endocrinol, 2015; Castaldo, G., Palmieri, V., Galdo, G., Castaldo, L., Molettieri, P., Vitale, A., Aggressive nutritional strategy in morbid obesity in clinical practice: safety, feasibility, and effects on metabolic and haemodynamic risk factors (2016) Obes Res Clin Pract, 10, pp. 169-177; Castaldo, G., Monaco, L., Castaldo, L., Galdo, G., Cereda, E., An observational study of sequential protein-sparing, very low-calorie ketogenic diet (Oloproteic diet) and hypocaloric Mediterranean-like diet for the treatment of obesity (2016) Int J Food Sci Nutr, 67, pp. 696-706; Youm, Y.H., Nguyen, K.Y., Grant, R.W., Goldberg, E.L., Bodogai, M., Kim, D., The ketone metabolite β-hydroxybutyrate blocks NLRP3 inflammasome-mediated inflammatory disease (2015) Nat Med, 21, pp. 263-269; Castaldo, G., Galdo, G., Rotondi Aufiero, F., Cereda, E., Very low-calorie ketogenic diet may allow restoring response to systemic therapy in relapsing plaque psoriasis (2016) Obes Res Clin Pract, 10, pp. 348-352; Damiani, G., Watad, A., Bridgewood, C., Pigatto, P.D.M., Pacifico, A., Malagoli, P., The impact of Ramadan fasting on the reduction of PASI score, in moderate-to-severe psoriatic patients: a real-life multicenter study (2019) Nutrients, 11, p. E277; Adawi, M., Damiani, G., Bragazzi, N.L., Bridgewood, C., Pacifico, A., Conic, R.R.Z., The impact of intermittent fasting (Ramadan fasting) on psoriatic arthritis disease activity, enthesitis, and dactylitis: a multicentre study (2019) Nutrients, 11, p. E601; Ibrahim, G.H., Buch, M.H., Lawson, C., Waxman, R., Helliwell, P.S., Evaluation of an existing screening tool for psoriatic arthritis in people with psoriasis and the development of a new instrument: the Psoriasis Epidemiology Screening Tool (PEST) questionnaire (2009) Clin Exp Rheumatol, 27, pp. 469-474; Physical status: The use and interpretation of anthropometry. Report of a WHO Expert Committee (1995) World Health Organ Tech Rep Ser, 854, pp. 1-452; Fredriksson, T., Pettersson, U., Severe psoriasis—oral therapy with a new retinoid (1978) Dermatologica, 157, pp. 238-244; Finlay, A.Y., Khan, G.K., Dermatology Life Quality Index (DLQI)—a simple practical measure for routine clinical use (1994) Clin Exp Dermatol, 19, pp. 210-216; Matthews, D.R., Hosker, J.P., Rudenski, A.S., Naylor, B.A., Treacher, D.F., Turner, R.C., Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man (1985) Diabetologia, 28, pp. 412-419; Whelton, P.K., Carey, R.M., Aronow, W.S., Casey, D.E., Jr, Collins, K.J., Dennison Himmelfarb, C., 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines (2018) Hypertension, 71, pp. e13-115; Cohen, J., A power primer (1992) Psychol Bull, 112, pp. 155-159; Armstrong, A.W., Siegel, M.P., Bagel, J., Boh, E.E., Buell, M., Cooper, K.D., From the medical board of the National Psoriasis Foundation: treatment targets for plaque psoriasis (2017) J Am Acad Dermatol, 76, pp. 290-298; Jensen, P., Christensen, R., Zachariae, C., Geiker, N.R., Schaadt, B.K., Stender, S., Long-term effects of weight reduction on the severity of psoriasis in a cohort derived from a randomized trial: a prospective observational follow-up study (2016) Am J Clin Nutr, 104, pp. 259-265; Hemmingsson, E., Johansson, K., Eriksson, J., Sundstrom, J., Neovius, M., Marcus, C., Weight loss and dropout during a commercial weight-loss program including a very-low-calorie diet, a low-calorie diet, or restricted normal food: observational cohort study (2012) Am J Clin Nutr, 96, pp. 953-961; Blackburn, G.L., Bistrian, B.R., Flatt, J.P., Role of a protein-sparing modified fast in a comprehensive weight reduction program (1975) Recent advances in obesity research, , A.N. Howard Newman Publishing, Ltd London, United Kingdom; Gardner, C.D., Kiazand, A., Alhassan, S., Kim, S., Stafford, R.S., Balise, R.R., Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A to Z weight loss study: A randomized trial (2007) JAMA, 297, pp. 969-977; Atkinson, R.L., Very low calorie diets: getting sick or remaining healthy on a handful of calories (1986) J Nutr, 116, pp. 918-920; Daud{\'e}n, E., Puig, L., Ferr{\'a}ndiz, C., S{\'a}nchez-Carazo, J.L., Hernanz-Hermosa JM; Spanish Psoriasis Group of the Spanish Academy of Dermatology and Venereology. Consensus document on the evaluation and treatment of moderate-to-severe psoriasis (2016) J Eur Acad Dermatol Venereol, 30, pp. 1-18",

year = "2020",

doi = "10.1016/j.nut.2020.110757",

language = "English",

volume = "74",

journal = "Nutrition",

issn = "0899-9007",

publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Aggressive weight-loss program with a ketogenic induction phase for the treatment of chronic plaque psoriasis: A proof-of-concept, single-arm, open-label clinical trial

AU - Castaldo, G.

AU - Rastrelli, L.

AU - Galdo, G.

AU - Molettieri, P.

AU - Rotondi Aufiero, F.

AU - Cereda, E.

N1 - Cited By :5 Export Date: 2 February 2021 CODEN: NUTRE Correspondence Address: Castaldo, G.; Nutriketo Lab A.O.R.N. San Giuseppe Moscati, Italy; email: lavoronep@yahoo.it Chemicals/CAS: alanine aminotransferase, 9000-86-6, 9014-30-6; aspartate aminotransferase, 9000-97-9; creatine kinase, 9001-15-4; lactate dehydrogenase, 9001-60-9; lactate dehydrogenase A; sodium, 7440-23-5; urate, 1198-77-2, 3106-08-9, 59216-10-3 References: Armstrong, A.W., Psoriasis (2017) JAMA Dermatol, 153, p. 956; Di Meglio, P., Villanova, F., Nestle, F.O., Psoriasis (2014) Cold Spring Harb Perspect Med, 4; Budu-Aggrey, A., Brumpton, B., Tyrrell, J., Watkins, S., Modalsli, E.H., Celis-Morales, C., Evidence of a causal relationship between body mass index and psoriasis: a mendelian randomization study (2019) PLoS Med, 16; Davidovici, B.B., Sattar, N., Prinz, J., Puig, L., Emery, P., Barker, J.N., Psoriasis and systemic inflammatory diseases: potential mechanistic links between skin disease and comorbid conditions (2010) J Invest Dermatol, 130, pp. 1785-1796; Gisondi, P., Del Giglio, M., Girolomoni, G., Considerations for systemic treatment of psoriasis in obese patients (2016) Am J Clin Dermatol, 17, pp. 609-615; Lynch, M., Ahern, T., Sweeney, C.M., Malara, A., Tobin, A.M., O'Shea, D., Adipokines, psoriasis, systemic inflammation, and endothelial dysfunction (2017) Int J Dermatol, 56, pp. 1103-1118; Cao, H., Adipocytokines in obesity and metabolic disease (2014) J Endocrinol, 220, pp. T47-T59; Alexopoulos, N., Katritsis, D., Raggi, P., Visceral adipose tissue as a source of inflammation and promoter of atherosclerosis (2014) Atherosclerosis, 233, pp. 104-112; Kyriakou, A., Patsatsi, A., Sotiriadis, D., Goulis, D.G., Serum leptin, resistin, and adiponectin concentrations in psoriasis: a meta-analysis of observational studies (2017) Dermatology, 233, pp. 378-389; Kyriakou, A., Patsatsi, A., Sotiriadis, D., Goulis, D.G., Effects of treatment for psoriasis on circulating levels of leptin, adiponectin and resistin: a systematic review and meta-analysis (2018) Br J Dermatol, 179, pp. 273-281; Kocic, H., Damiani, G., Stamenkovic, B., Tirant, M., Jovic, A., Tiodorovic, D., Dietary compounds as potential modulators of microRNA expression in psoriasis (2019) Ther Adv Chronic Dis, 10; Gamret, A.C., Price, A., Fertig, R.M., Lev-Tov, H., Nichols, A.J., Complementary and alternative medicine therapies for psoriasis: a systematic review (2018) JAMA Dermatol, 154, pp. 1330-1337; Ford, A.R., Siegel, M., Bagel, J., Cordoro, K.M., Garg, A., Gottlieb, A., Dietary recommendations for adults with psoriasis or psoriatic arthritis from the medical board of the National Psoriasis Foundation: a systematic review (2018) JAMA Dermatol, 154, pp. 934-950; Mahil, S.K., McSweeney, S.M., Kloczko, E., McGowan, B., Barker, J.N., Smith, C.H., Does weight loss reduce the severity and incidence of psoriasis or psoriatic arthritis? A critically appraised topic (2019) Br J Dermatol, 181, pp. 946-953; Gisondi, P., Del Giglio, M., Di Francesco, V., Zamboni, M., Girolomoni, G., Weight loss improves the response of obese patients with moderate-to-severe chronic plaque psoriasis to low-dose cyclosporine therapy: a randomized, controlled, investigator-blinded clinical trial (2008) Am J Clin Nutr, 88, pp. 1242-1247; Naldi, L., Conti, A., Cazzaniga, S., Patrizi, A., Pazzaglia, M., Lanzoni, A., Diet and physical exercise in psoriasis: a randomized controlled trial (2014) Br J Dermatol, 170, pp. 634-642; Jensen, P., Zachariae, C., Christensen, R., Geiker, N.R., Schaadt, B.K., Stender, S., Effect of weight loss on the severity of psoriasis: a randomized clinical study (2013) JAMA Dermatol, 149, pp. 795-801; Al-Mutairi, N., Nour, T., The effect of weight reduction on treatment outcomes in obese patients with psoriasis on biologic therapy: a randomized controlled prospective trial (2014) Expert Opin Biol Ther, 14, pp. 749-756; Guida, B., Napoleone, A., Trio, R., Nastasi, A., Balato, N., Laccetti, R., Energy-restricted, n-3 polyunsaturated fatty acids-rich diet improves the clinical response to immuno-modulating drugs in obese patients with plaque-type psoriasis: a randomized control clinical trial (2014) Clin Nutr, 33, pp. 399-405; Bravata, D.M., Sanders, L., Huang, J., Krumholz, H.M., Olkin, I., Gardner, C.D., Efficacy and safety of low-carbohydrate diets: a systematic review (2003) JAMA, 289, pp. 1837-1850; Franz, M.J., VanWormer, J.J., Crain, A.L., Boucher, J.L., Histon, T., Caplan, W., Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up (2007) J Am Diet Assoc, 107, pp. 1755-1767; Chaston, T.B., Dixon, J.B., Factors associated with percent change in visceral versus subcutaneous abdominal fat during weight loss: findings from a systematic review (2008) Int J Obes (Lond), 32, pp. 619-628; Wycherley, T.P., Moran, L.J., Clifton, P.M., Noakes, M., Brinkworth, G.D., Effects of energy-restricted high-protein, low-fat compared with standard-protein, low-fat diets: a meta-analysis of randomized controlled trials (2012) Am J Clin Nutr, 96, pp. 1281-1298; Paoli, A., Rubini, A., Volek, J.S., Grimaldi, K.A., Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets (2013) Eur J Clin Nutr, 67, pp. 789-796; Cappello, G., Franceschelli, A., Cappello, A., De Luca, P., Weight loss and body composition changes following three sequential cycles of ketogenic enteral nutrition (2012) J Res Med Sci, 17, pp. 1114-1118; Sukkar, S.G., Signori, A., Borrini, C., Barisione, G., Ivaldi, C., Romeo, C., Feasibility of protein-sparing modified fast by tube (ProMoFasT) in obesity treatment: a phase II pilot trial on clinical safety and efficacy (appetite control, body composition, muscular strength, metabolic pattern, pulmonary function test) (2013) Med J Nutrition Metab, 6, pp. 165-176; Leonetti, F., Campanile, F.C., Coccia, F., Capoccia, D., Alessandroni, L., Puzziello, A., Very low-carbohydrate ketogenic diet before bariatric surgery: prospective evaluation of a sequential diet (2015) Obes Surg, 25, pp. 64-71; Monaco, L., Monaco, M., Di Tommaso, L., Stassano, P., Castaldo, L., Castaldo, G., Aortomesenteric fat thickness with ultrasound predicts metabolic diseases in obese patients (2014) Am J Med Sci, 347, pp. 8-13; Castaldo, G., Monaco, L., Castaldo, L., Sorrentino, P., A 2-week course of enteral treatment with a very low-calorie protein-based formula for the management of severe obesity (2015) Int J Endocrinol, 2015; Castaldo, G., Palmieri, V., Galdo, G., Castaldo, L., Molettieri, P., Vitale, A., Aggressive nutritional strategy in morbid obesity in clinical practice: safety, feasibility, and effects on metabolic and haemodynamic risk factors (2016) Obes Res Clin Pract, 10, pp. 169-177; Castaldo, G., Monaco, L., Castaldo, L., Galdo, G., Cereda, E., An observational study of sequential protein-sparing, very low-calorie ketogenic diet (Oloproteic diet) and hypocaloric Mediterranean-like diet for the treatment of obesity (2016) Int J Food Sci Nutr, 67, pp. 696-706; Youm, Y.H., Nguyen, K.Y., Grant, R.W., Goldberg, E.L., Bodogai, M., Kim, D., The ketone metabolite β-hydroxybutyrate blocks NLRP3 inflammasome-mediated inflammatory disease (2015) Nat Med, 21, pp. 263-269; Castaldo, G., Galdo, G., Rotondi Aufiero, F., Cereda, E., Very low-calorie ketogenic diet may allow restoring response to systemic therapy in relapsing plaque psoriasis (2016) Obes Res Clin Pract, 10, pp. 348-352; Damiani, G., Watad, A., Bridgewood, C., Pigatto, P.D.M., Pacifico, A., Malagoli, P., The impact of Ramadan fasting on the reduction of PASI score, in moderate-to-severe psoriatic patients: a real-life multicenter study (2019) Nutrients, 11, p. E277; Adawi, M., Damiani, G., Bragazzi, N.L., Bridgewood, C., Pacifico, A., Conic, R.R.Z., The impact of intermittent fasting (Ramadan fasting) on psoriatic arthritis disease activity, enthesitis, and dactylitis: a multicentre study (2019) Nutrients, 11, p. E601; Ibrahim, G.H., Buch, M.H., Lawson, C., Waxman, R., Helliwell, P.S., Evaluation of an existing screening tool for psoriatic arthritis in people with psoriasis and the development of a new instrument: the Psoriasis Epidemiology Screening Tool (PEST) questionnaire (2009) Clin Exp Rheumatol, 27, pp. 469-474; Physical status: The use and interpretation of anthropometry. Report of a WHO Expert Committee (1995) World Health Organ Tech Rep Ser, 854, pp. 1-452; Fredriksson, T., Pettersson, U., Severe psoriasis—oral therapy with a new retinoid (1978) Dermatologica, 157, pp. 238-244; Finlay, A.Y., Khan, G.K., Dermatology Life Quality Index (DLQI)—a simple practical measure for routine clinical use (1994) Clin Exp Dermatol, 19, pp. 210-216; Matthews, D.R., Hosker, J.P., Rudenski, A.S., Naylor, B.A., Treacher, D.F., Turner, R.C., Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man (1985) Diabetologia, 28, pp. 412-419; Whelton, P.K., Carey, R.M., Aronow, W.S., Casey, D.E., Jr, Collins, K.J., Dennison Himmelfarb, C., 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines (2018) Hypertension, 71, pp. e13-115; Cohen, J., A power primer (1992) Psychol Bull, 112, pp. 155-159; Armstrong, A.W., Siegel, M.P., Bagel, J., Boh, E.E., Buell, M., Cooper, K.D., From the medical board of the National Psoriasis Foundation: treatment targets for plaque psoriasis (2017) J Am Acad Dermatol, 76, pp. 290-298; Jensen, P., Christensen, R., Zachariae, C., Geiker, N.R., Schaadt, B.K., Stender, S., Long-term effects of weight reduction on the severity of psoriasis in a cohort derived from a randomized trial: a prospective observational follow-up study (2016) Am J Clin Nutr, 104, pp. 259-265; Hemmingsson, E., Johansson, K., Eriksson, J., Sundstrom, J., Neovius, M., Marcus, C., Weight loss and dropout during a commercial weight-loss program including a very-low-calorie diet, a low-calorie diet, or restricted normal food: observational cohort study (2012) Am J Clin Nutr, 96, pp. 953-961; Blackburn, G.L., Bistrian, B.R., Flatt, J.P., Role of a protein-sparing modified fast in a comprehensive weight reduction program (1975) Recent advances in obesity research, , A.N. 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PY - 2020

Y1 - 2020

N2 - Objectives: A very low-calorie ketogenic diet (VLCKD) has been associated with a significant reduction in visceral adipose tissue and ketone bodies that likely possess antiinflammatory properties. We evaluated the efficacy of an aggressive weight-loss (WL) program with a ketogenic induction phase as first-line treatment for chronic plaque psoriasis. Methods: Adult patients who were overweight or obese and drug-naïve (i.e., never treated, excluding the use of topical emollients; n = 37; 30% men; age: 43.1 ± 13.8 y) with stable chronic plaque psoriasis underwent a 10-wk, 2-phase WL program consisting of a 4-wk protein-sparing, VLCKD (

AB - Objectives: A very low-calorie ketogenic diet (VLCKD) has been associated with a significant reduction in visceral adipose tissue and ketone bodies that likely possess antiinflammatory properties. We evaluated the efficacy of an aggressive weight-loss (WL) program with a ketogenic induction phase as first-line treatment for chronic plaque psoriasis. Methods: Adult patients who were overweight or obese and drug-naïve (i.e., never treated, excluding the use of topical emollients; n = 37; 30% men; age: 43.1 ± 13.8 y) with stable chronic plaque psoriasis underwent a 10-wk, 2-phase WL program consisting of a 4-wk protein-sparing, VLCKD (

KW - chronic plaque psoriasis

KW - ketogenic diet

KW - Mediterranean diet

KW - PASI

KW - Weight loss

KW - alanine aminotransferase

KW - aspartate aminotransferase

KW - creatine kinase

KW - lactate dehydrogenase

KW - milk protein

KW - sodium

KW - urate

KW - adult

KW - alanine aminotransferase blood level

KW - Article

KW - aspartate aminotransferase blood level

KW - asthenia

KW - bloating

KW - clinical article

KW - constipation

KW - creatine kinase blood level

KW - Dermatology Life Quality Index

KW - dietary compliance

KW - disease severity

KW - dizziness

KW - female

KW - headache

KW - heart palpitation

KW - human

KW - hunger

KW - lactate dehydrogenase blood level

KW - low calorie diet

KW - male

KW - muscle cramp

KW - nausea

KW - obesity

KW - open study

KW - priority journal

KW - proof of concept

KW - pruritus

KW - Psoriasis Area and Severity Index

KW - psoriasis vulgaris

KW - sodium blood level

KW - therapy effect

KW - urea nitrogen blood level

KW - uric acid blood level

KW - very low calorie ketogenic diet

KW - visual analog scale

KW - weight loss program

U2 - 10.1016/j.nut.2020.110757

DO - 10.1016/j.nut.2020.110757

M3 - Article

VL - 74

JO - Nutrition

JF - Nutrition

SN - 0899-9007

ER -

Aggressive weight-loss program with a ketogenic induction phase for the treatment of chronic plaque psoriasis: A proof-of-concept, single-arm, open-label clinical trial

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