Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 26, 2023; 11(9): 1985-1991
Published online Mar 26, 2023. doi: 10.12998/wjcc.v11.i9.1985
Very low calorie ketogenic diet and common rheumatic disorders: A case report
Mariangela Rondanelli, Zaira Patelli, Clara Gasparri, Francesca Mansueto, Cinzia Ferraris, Mara Nichetti, Tariq A Alalwan, Ignacio Sajoux, Roberto Maugeri, Simone Perna
Mariangela Rondanelli, Department of Public Health, Experimental and Forensic Medicine, Unit of Human and Clinical Nutrition, IRCCS Mondino Foundation, Pavia 27100, Italy
Zaira Patelli, Clara Gasparri, Francesca Mansueto, Mara Nichetti, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona ‘‘Istituto Santa Margherita’’, University of Pavia, Pavia 27100, Italy
Cinzia Ferraris, Food Education and Sport Nutrition Laboratory, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia 27100, Italy
Tariq A Alalwan, Simone Perna, Department of Biology, College of Science, University of Bahrain, Sakhir 32038, Bahrain
Ignacio Sajoux, Chief Scientific Office, Medical Department Pronokal Group, Barcelona 08001, Spain
Roberto Maugeri, Medical Direction, PronoKal Group, Savigliano 12038, Italy
Author contributions: Rondanelli M, Sajoux I, and Maugeri R are responsible for conceptualization; Patelli Z, Gasparri C, and Mansueto F are responsible for the investigation; Alalwan TA, and Perna S contributed to the data curation; Patelli Z, and Gasparri C wrote the original draft preparation; Ferraris C, and Nichetti M wrote the review and editing; Rondanelli M is responsible for visualization and project administration; Rondanelli M, Sajoux I, and Maugeri R contributed to the supervision; All authors have read and agreed to the published version of the manuscript.
Informed consent statement: Informed consent was obtained from the participant in the study.
Conflict-of-interest statement: I.S. and R.M. are employed by PronoKal Group. The remaining authors declare no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Clara Gasparri, MSc, Research Fellow, Endocrinology and Nutrition Unit, Azienda di Servizi alla Persona ‘‘Istituto Santa Margherita’’, University of Pavia, Via Emila 12, Pavia 27100, Italy.
Received: October 20, 2022
Peer-review started: October 20, 2022
First decision: October 31, 2022
Revised: November 10, 2022
Accepted: January 9, 2023
Article in press: January 9, 2023
Published online: March 26, 2023

The scientific literature provides evidence that nutritional ketosis can be an important support in the treatment of pathologies in which inflammation is present, as recent studies have shown that ketone bodies have anti-inflammatory activity in numerous diseases, including rheumatic diseases. We report the case of a 22-year-old woman with class I obesity and juvenile idiopathic arthritis who started treatment with a very low calorie ketogenic diet (VLCKD).


The patient was a 22-year-old woman diagnosed with juvenile idiopathic arthritis at age 4 years and with a body mass index (BMI) of 30.8 kg/m2, waist circumference (WC) 80 cm, fat mass (FM) 28.1 kg, free FM 45.7 kg, and visceral adipose tissue (VAT) 3.5 kg, assessed on bioimpedance analysis. She was treated using a commercial VLCKD weight-loss program (PNK® method); this program provides high-biological-value protein preparations and natural foods. Each protein preparation contains 15 g protein, 4 g carbohydrate, 3 g fat, and 50 mg omega-3 docosahexaenoic acid, with an energy content of 90–120 kcal. After four months on the program, the BMI was 28.6 kg/m2, WC 73 cm, FM 23.2 kg, free FM 41.9 kg, and VAT 2.9 kg.


VLCKD enabled the patient to reach her target weight and to reduce her joint pain and headaches. Laboratory inflammatory indices also normalized.

Keywords: Very low calorie ketogenic diet, Inflammation, PNK® method, Weight loss, Obesity, Rheumatic disorders, Case report

Core Tip: A commercial weight-loss program (PNK® method) was used, based on a very low calorie ketogenic diet (VLCKD). VLCKD allowed the patient to achieve weight goal, better management of joint pain, headache episodes and normalization of inflammatory indices.