Efficacy of a Very Low Calories Ketogenic Diet in Obese Patients With Fibromyalgia or Symptomatic Knee Osteoarthritis

Prior treatment

• 48 h prior to elective surgery or invasive procedures and perioperative period

Other illness

• Past diagnosis of kidney failure and moderate-to-severe chronic kidney disease, liver failure, hearth failure NYHA III-IV, respiratory failure
• Past diagnosis of unstable angina
• Recent stroke or myocardial infarction (\< 12 months)
• Cardiac arrhythmias
• Past diagnosis of eating disorders and other severe mental illnesses, alcohol and substance abuse
• Active/severe infections
• Past diagnosis of rare disorders: porphyria, carnitine deficiency, carnitine palmitoyltransferase deficiency, carnitine-acylcarnitine translocase deficiency, mitochondrial fatty acid β-oxidation disorders, pyruvate carboxylase deficiency
• Allergy to protein-preparations ingredients
• Past or current history of gallstones

Lab values

• Past diagnosis of type 1 diabetes mellitus, latent autoimmune diabetes in adults, β-cell failure in type 2 diabetes mellitus, use of sodium/glucose cotransporter 2 inhibitors (risk for euglycemic diabetic ketoacidosis)

Age

• Age \< 18 or \> 65 years

Other

• Currently pregnant or breastfeeding

• Age \> 18 years and \< 65 years
• Body mass index ≥ 30 kg/m2
• Failed to achieve weight loss with standard low-calories diet
• Any of the following conditions:
  • BMI ≥ 35 kg/m2 Past diagnosis of type 2 diabetes without β-cell failure Hypertriglyceridemia (fasting triglycerides ≥ 150 mg/dL) or taking lipid-lowering medications Hypercholesterolemia (total cholesterol \> 200 mg/dL) or taking lipid-lowering medications Past diagnosis of arterial hypertension or taking blood pressure-lowering medications Past diagnosis of non-alcoholic fatty liver disease Past diagnosis of heart failure class NYHA I-II Past history of myocardial infarction (\> 12 months), stroke/minor stroke (\> 12 months) Past diagnosis of carotid atherosclerosis Past diagnosis of polycystic ovary syndrome (PCOS) Past diagnosis of neurodegenerative disorders
• Fibromyalgia classified according to 2016 Revisions to the 2010/2011 European League Against Rheumatism/ American College of Rheumatology OR
• Symptomatic knee osteoarthritis