Over the past few decades, there has been a major increase in type 2 diabetes (T2D) prevalence, a long-term medical condition in which your body doesn't use insulin properly in most regions of the world. After adjusting for the impact of aging populations, diabetes prevalence in adults (85–95% T2D) almost doubled between 1980 and 2020 worldwide. Increases were more pronounced in low- and middle-income countries and in men compared to women. The aim of this study is to evaluate the performance of a very low-calories ketogenic diet (VLCKD) as an effective nutritional approach for both TD2 and obesity. A ketogenic diet (KD) positively affects blood glucose levels, body weight, glycosylated hemoglobin, neurological disorders, and plasma lipid profiles. We combined ClinicalTrials.gov data and data from PubMed from 2020 to 2022. Only published papers that met the requirements of reporting clinical trials investigating an adult sample of T2D obese patients were included. The review shows the beneficial therapeutic value of a VLCKD in the management of T2D and long-term obesity and its capacity to help achieve disease remission. Evidence from the literature underlines the need to redefine guidelines to offer a dietary and low-carb option to combat insulin resistance (IR) and related diseases.

Cardiovascular disease (CVD) stands as the leading global cause of mortality, underscoring the critical need for practical tools to assess CVD risk at an early stage. An accessible approach involves the evaluation of bloodwork alongside simple anthropometric measurements. This narrative review seeks to establish the appropriateness of common parameters used in the outpatient setting in assessing the risk of developing CVD. These parameters encompass bloodwork values employed to characterize insulin resistance (IR) and dyslipidemia, as well as anthropometric measurements used to describe issues related to overweight and fat distribution. A particular emphasis is placed on understanding how Mediterranean and ketogenic diets influence these parameters. In the realm of bloodwork, findings indicate that the triglycerides (TG) to high-density lipoproteins (HDL) ratio serves as a valuable tool for assessing both IR and dyslipidemia. Less emphasis should be placed on total cholesterol and low-density lipoproteins (LDL) because the existing literature lacks consistency and fails to establish a clear, direct correlation between cholesterol levels, CVD, and mortality. On the other hand, numerous studies consistently demonstrate a direct correlation between CVD, mortality, and the levels of small-dense LDL (sdLDL), which represent the oxidized form of LDL. Regarding anthropometric parameters, the body mass index (BMI) falls short in value as it neglects to consider fat distribution and lean mass. More informative are anthropometric parameters that account for a single measure of fat mass and another for lean mass, such as the waist-height ratio (WHtR) or the waist-hip ratio (WHR). Both Mediterranean and ketogenic diets demonstrate improvements across major parameters used to evaluate CVD and mortality risk. The ketogenic diet, in particular, yields superior results in most aspects, except cholesterol levels. Further studies are recommended to refine dyslipidemia characterization and its connection to health outcomes.

Epidemiological studies have reported an association between obesity/metabolic syndrome (MetS) and male reproductive disorders. Endocrine dysfunctions, direct testicular damage, chronic low-grade inflammation, and insulin resistance (IR) are involved in the occurrence of male obesity secondary hypogonadism (MOSH) which in turn alters the metabolic imbalance, creating a sort of vicious circle. Since IR and chronic inflammation state play a pivotal role in MOSH, low-calorie and low-carbohydrate diet protocols may be administered in obese men to improve their metabolic and hormonal profile. The ketogenic diet (KD) has been reported to determine positive effects on body weight, IR, cardio-metabolic risk, hypothalamic-pituitary-testicular (HPT) axis, and prostate with possible improvement of plasma androgens levels, sexual function (SF), and male fertility. This review aims to evaluate the effectiveness of KD on testicular function. Emerging evidence reports that very low-calorie KD (VLCKD) may revert MOSH by restoring HPT axis function and testosterone (T) levels. Moreover, VLCKD could improve SF, prostate health and lower urinary tract symptoms (LUTSs) in overweight/obese male patients. VLCKD may also positively impact spermatogenesis although evidence is still poor. Future studies are warranted to clarify the effectiveness of KD on testicular and prostate gland function.