StrongDecrease
BMI
Mediterranean ketogenic diet → BMI
Mediterranean ketogenic diet → BMI
Evidence profile
StrongDecreaseWeight & Anthropometrics
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Nutrition & DietPrecision Medicine
Research Summary
Mediterranean ketogenic eating matched VLCKD for weight loss over 3 months
Key finding
In adults with obesity, a whole-food Mediterranean ketogenic diet achieved about 15% weight loss in 3 months, similar to a very-low-calorie ketogenic diet, with comparable metabolic improvements and no severe adverse events.
This real-world 3-month study compared two ketogenic strategies in adults with obesity: a meal-replacement very-low-calorie ketogenic diet and a whole-food Mediterranean ketogenic diet. Both groups lost about 15% of body weight and improved waist measures and insulin resistance. The Mediterranean ketogenic approach performed similarly overall and may offer a more flexible option for personalized care.
Evidence strength
Moderate confidence
Study type
non-randomized clinical trial (non-RCT or NRCT)
Follow-up
Short-Term (≤3 mo)
Some Concerns bias
Last updated May 27, 2026Quick read
Study at a glance
The essential study design details in one scan.
Population
Europe (EU & UK)
Intervention
Very-low-calorie ketogenic diet, Mediterranean ketogenic diet
Study type
non-randomized clinical trial (non-RCT or NRCT)
Follow-up
Short-Term (≤3 mo)
Primary outcome
Body weight
Evidence
Moderate confidence
Plain-language summary
What this paper says
A plain-language read of the study's main message and where it applies.
Study focus
In adults with obesity, a whole-food Mediterranean ketogenic diet achieved about 15% weight loss in 3 months, similar to a very-low-calorie ketogenic diet, with comparable metabolic improvements and no severe adverse events.
Published in
Journal Reference
Publication details and source links for this paper.
Masi D, Spizzichini ML, Colonnello E, et al. Personalizing Obesity Treatment: Real-World Comparison of a Very-Low-Calorie Ketogenic Diet Versus a Whole-Food Mediterranean Ketogenic Diet. Metabolites. 2026;16(4):248. doi:10.3390/metabo16040248
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Main Effects
↓ Body weight by about 15% in both diet groups
↓ Waist circumference and waist-to-height ratio in both groups
↓ Insulin resistance (HOMA-IR) in both groups; larger drop in MedKD
≈ Similar lipid profile changes between VLCKD and MedKD
Evidence network
How this study fits
Understand where this research contributes within the broader evidence network.
Evidence Context
This study contributes evidence to Mediterranean ketogenic diet, Very-low-calorie ketogenic diet and BMI, Body weight, HDL cholesterol, and 7 more.
This study contributes evidence to
Primary intervention
Mediterranean ketogenic diet
Primary outcomes
- BMI
- Body weight
- HDL cholesterol
Evidence topics
Primary intervention
Primary outcomes
Evidence relationships
Intervention and outcome relationships this study adds to the evidence network.
19
Evidence pairs
19
Relationships
4
Evidence topics
contributes_evidence
Editorial context
Why this study matters
See why this paper is useful beyond its individual results.
Evidence network role
This section describes how the study fits into the current evidence network. It does not determine whether an intervention works on its own.
Moderate contributionModerate confidenceNetwork score: 54
4
Related topics
19
Evidence pairs
462
Related studies
High relevance in at least one topic
Why it is useful
- Contributes to 19 evidence relationships
- Uses a randomized study design signal
- Linked to 4 direct semantic evidence topics
Topic contributions
Evidence topic
Contributes evidence
Evidence topic
Contributes evidence
Evidence topic
Contributes evidence
Evidence topic
Contributes evidence
Core evidence
Study findings
The primary outcomes reported in this study.
StrongDecrease
Body weight
Mediterranean ketogenic diet → Body weight
Mediterranean ketogenic diet → Body weight
Evidence profile
StrongDecreaseWeight & Anthropometrics
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LimitedDecrease
HbA1c
Mediterranean ketogenic diet → HbA1c
Mediterranean ketogenic diet → HbA1c
Evidence profile
LimitedDecreaseGlycemic Control
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LimitedUncertain
HDL cholesterol
Mediterranean ketogenic diet → HDL cholesterol
Mediterranean ketogenic diet → HDL cholesterol
Evidence profile
LimitedUncertainMetabolic Health
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MixedDecrease
Insulin resistance
Mediterranean ketogenic diet → Insulin resistance
Mediterranean ketogenic diet → Insulin resistance
Evidence profile
MixedDecreaseMetabolic Health
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LimitedDecrease
LDL cholesterol
Mediterranean ketogenic diet → LDL cholesterol
Mediterranean ketogenic diet → LDL cholesterol
Evidence profile
LimitedDecreaseMetabolic Health
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MixedIncrease
Serum creatinine
Mediterranean ketogenic diet → Serum creatinine
Mediterranean ketogenic diet → Serum creatinine
Evidence profile
MixedIncreaseSafety
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LimitedDecrease
Total cholesterol
Mediterranean ketogenic diet → Total cholesterol
Mediterranean ketogenic diet → Total cholesterol
Evidence profile
LimitedDecreaseMetabolic Health
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LimitedDecrease
Triglycerides
Mediterranean ketogenic diet → Triglycerides
Mediterranean ketogenic diet → Triglycerides
Evidence profile
LimitedDecreaseMetabolic Health
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StrongDecrease
Waist circumference
Mediterranean ketogenic diet → Waist circumference
Mediterranean ketogenic diet → Waist circumference
Evidence profile
StrongDecreaseWeight & Anthropometrics
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StrongDecrease
BMI
Very-low-calorie ketogenic diet → BMI
Very-low-calorie ketogenic diet → BMI
Evidence profile
StrongDecreaseWeight & Anthropometrics
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StrongDecrease
Body weight
Very-low-calorie ketogenic diet → Body weight
Very-low-calorie ketogenic diet → Body weight
Evidence profile
StrongDecreaseWeight & Anthropometrics
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LimitedDecrease
HbA1c
Very-low-calorie ketogenic diet → HbA1c
Very-low-calorie ketogenic diet → HbA1c
Evidence profile
LimitedDecreaseGlycemic Control
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LimitedMixed
HDL cholesterol
Very-low-calorie ketogenic diet → HDL cholesterol
Very-low-calorie ketogenic diet → HDL cholesterol
Evidence profile
LimitedMixedMetabolic Health
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MixedDecrease
Insulin resistance
Very-low-calorie ketogenic diet → Insulin resistance
Very-low-calorie ketogenic diet → Insulin resistance
Evidence profile
MixedDecreaseMetabolic Health
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LimitedDecrease
LDL cholesterol
Very-low-calorie ketogenic diet → LDL cholesterol
Very-low-calorie ketogenic diet → LDL cholesterol
Evidence profile
LimitedDecreaseMetabolic Health
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LimitedDecrease
Total cholesterol
Very-low-calorie ketogenic diet → Total cholesterol
Very-low-calorie ketogenic diet → Total cholesterol
Evidence profile
LimitedDecreaseMetabolic Health
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LimitedDecrease
Triglycerides
Very-low-calorie ketogenic diet → Triglycerides
Very-low-calorie ketogenic diet → Triglycerides
Evidence profile
LimitedDecreaseMetabolic Health
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StrongDecrease
Waist circumference
Very-low-calorie ketogenic diet → Waist circumference
Very-low-calorie ketogenic diet → Waist circumference
Evidence profile
StrongDecreaseWeight & Anthropometrics
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Evidence Suggest
- A whole-food Mediterranean ketogenic approach can deliver short-term weight loss similar to VLCKD in clinical practice
- Both ketogenic strategies improved central adiposity and insulin resistance over 3 months
- Preference-based personalized diet selection may be feasible while maintaining substantial metabolic benefit
Who this applies to
Adults with obesity in a supervised clinical nutrition setting
Keep in Mind
Results come from real-world care, not randomized assignment
Between the Lines
- Non-randomized, preference-based allocation introduces selection bias
- Baseline imbalances existed, including higher diabetes prevalence and HOMA-IR in MedKD
- Short 3-month follow-up limits long-term durability conclusions
- No quantitative food intake tracking or standardized adherence score
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Connected Evidence
Explore related studies, evidence collections, and research questions.
This study contributes to evidence on Ketogenic Diets and Body Mass Index, Ketogenic Diets and Body Weight.
Related evidence relationships
Explore in Evidence ArchiveThis study contributes to the evidence on the following intervention-outcome relationships.
Included in these evidence collections
Curated evidence collections and hubs this study is part of.
Body Mass Index Evidence Hub
All studies measuring Body Mass Index
1 studies
outcome_hubMeasures Body Mass Index as a key outcome.
Body Weight Evidence Hub
All studies measuring Body Weight
1 studies
outcome_hubMeasures Body Weight as a key outcome.
Ketogenic Diets Evidence Hub
All studies on Ketogenic Diets
1 studies
intervention_hubContributes to Ketogenic Diets evidence base.
Explore more in the evidence archive
Jump to pre-filtered views in the evidence archive.
All studies on Mediterranean ketogenic diet and BMI
Intervention: Mediterranean ketogenic dietOutcome: BMI
1 results
All studies on Mediterranean ketogenic diet and Body weight
Intervention: Mediterranean ketogenic dietOutcome: Body weight
1 results
All studies on Mediterranean ketogenic diet
Intervention: Mediterranean ketogenic diet
1 results
All studies measuring BMI
Outcome: BMI
1 results
All studies measuring Body weight
Outcome: Body weight
1 results
Questions answered by this study
Does Ketogenic Diets affect body weight?
Emerging Evidence
Ketogenic Diets appears to improve Body Weight.
ConsensusScore™: Consistency cannot yet be determined from the available evidence.
Ranked evidence signals
- 1
Body weight
EvidenceScore™ Emerging | EvidenceScore™ 50.2 | strong positive | ConsensusScore™ Unclear | 1 study
Why this answer: This answer is based on a single supporting study.
Limitations
- Only one supporting study is available.
- Consistency cannot yet be determined.
- Population details are unavailable.
Does Ketogenic Diets improve body composition?
Emerging Evidence
Ketogenic Diets appears to improve Body Composition.
ConsensusScore™: Consistency cannot yet be determined from the available evidence.
Ranked evidence signals
- 1
Waist circumference
EvidenceScore™ Emerging | EvidenceScore™ 50.2 | strong positive | ConsensusScore™ Unclear | 1 study
Why this answer: This answer is based on a single supporting study.
Limitations
- Only one supporting study is available.
- Consistency cannot yet be determined.
- Population details are unavailable.
Does Ketogenic Diets affect body mass index?
Emerging Evidence
Ketogenic Diets appears to improve Body Mass Index.
ConsensusScore™: Consistency cannot yet be determined from the available evidence.
Ranked evidence signals
- 1
BMI
EvidenceScore™ Emerging | EvidenceScore™ 50.2 | strong positive | ConsensusScore™ Unclear | 1 study
Why this answer: This answer is based on a single supporting study.
Limitations
- Only one supporting study is available.
- Consistency cannot yet be determined.
- Population details are unavailable.
Does Ketogenic Diets improve HbA1c?
Limited Evidence
Ketogenic Diets may improve HbA1c.
ConsensusScore™: Consistency cannot yet be determined from the available evidence.
Ranked evidence signals
- 1
HbA1c
EvidenceScore™ Limited | EvidenceScore™ 34.5 | weak positive | ConsensusScore™ Unclear | 1 study
Why this answer: This answer is based on a single supporting study.
Limitations
- Only one supporting study is available.
- Consistency cannot yet be determined.
- Population details are unavailable.
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