Very low calorie ketogenic diet and common rheumatic disorders: A case report

Table 1 Structure of the PronoKal PnK method

Intervention (80% of the target weight loss)			Dietary re-education (20% of the target weight loss)		Maintenance
Weight loss					New lifestyle
Step 1: 40% of the target weight loss	Step 2: 20% of the target weight loss	Step 3: 20% of the target weight loss	Step 4: 10% of the target weight loss	Step 5: 10% of the target weight loss
Very low calorie ketogenic diet (630-700 kcal/day)			Low-calorie diet (800-1500 kcal/day)		Balanced diet (1500-2000 kcal/day)

Table 2 Composition of the vitamin and mineral supplementation during the very low calorie ketogenic diet

	In 2 sachets
Vitamin A (μg)	800
Vitamin D (μg)	5
Vitamin E (mg)	12
Vitamin K (μg)	75
Vitamin C (mg)	80
Thiamine (mg)	1.1
Riboflavin (mg)	1.4
Niacin (mg)	16
Vitamin B6 (mg)	1.4
Folic acid (μg)	200
Vitamin B12 (μg)	2.5
Biotin (μg)	50
Pantothenic acid (mg)	6
Potassium (mg)	2000
Calcium (mg)	800
Magnesium (mg)	375
Iron (g)	14
Zinc (mg)	10
Copper (mg)	1
Manganese (mg)	1
Selenium (μg)	55
Chrome (μg)	40
Molybdenum (μg)	50
Iodine (μg)	150

Table 3 Changes in the anthropometric parameters during dietary treatment

	Base-line	First follow-up visit during LCD	Second follow-up visit during LCD	VLCKD, end Step 1	VLCKD, end Step 2	End of step 3 of intervention phase	End of step 4 of intervention phase	End of step 5 of intervention phase
Body weight (kg)	78.3	78	79.9	72	69	69	72.8	73
BMI (kg/m2)	30.8	30.7	31.3	28.3	27.1	27.1	28.6	28.7
Waist circumference (cm)	80	80	82	75	72	/	73	73
Fat mass (%)	35.9	35.6	36.9	35.1	33.6	/	33.7	/
Fat mass (kg)	28.1	27.8	29.4	25.3	23.2	/	24.5	/
Fat free mass (kg)	45.7	45.8	45.7	42.6	41.9	/	44.2	/
VAT (kg)	3.5	3.4	3.8	3.0	2.7	/	2.9	/

LCD: Low-calorie diet; VLCKD: Very low calorie ketogenic diet; VAT: Visceral adipose tissue.

Table 4 Serum inflammatory markers during dietary treatment

	During the LCD	During the VLCKD	Laboratory reference range
Erythrocyte sedimentation rate (mm/h)	95	31	< 15
C-reactive protein (mg/L)	17	< 5	< 5
Complement component C3 (g/L)	1.34	1.15	0.90-1.80
Complement component C4 (g/L)	0.26	0.19	0.10-0.40
Silica clotting time (ratio)	1.08	0.96	≤ 1.16
Russell’s viper venom time (ratio)	1.24	1.05	< 1.20

LCD: Low-calorie diet; VLCKD: Very low calorie ketogenic diet.