Evidence Intelligence™
- EvidenceScore™
- 57
- Emerging
- ImpactScore™
- 100
- Very Positive
- ConsistencyScore™
- unclear
- Not enough independent studies
Supporting studies: Based on 1 study
Add to Evidence TrackerNutrition & DietPrecision Medicine
Research Summary
Analyzed using Evidence Intelligence™
Mediterranean ketogenic eating matched VLCKD for weight loss over 3 months
Last updated May 27, 2026
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.
Quick read
Study at a glance
The essential study design details in one scan.
EvidenceScore™
Moderate
Study type
non-randomized clinical trial (non-RCT or NRCT)
Follow-up
Short-Term (≤3 mo)
Risk of bias
Some Concerns
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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
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
3
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
3
Related topics
19
Evidence pairs
585
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 3 direct semantic evidence topics
Topic contributions
Evidence topic
Contributes evidence
Evidence topic
Contributes evidence
Evidence topic
Contributes evidence
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Primary evidence
Evidence relationship
Ketogenic Diets and Body Composition
Related evidence
Evidence relationship
Ketogenic Diets and Insulin Resistance
Save evidence
Evidence relationship
Ketogenic Diets and Adipokine and Angiogenic Markers
Save evidence
Core evidence
Study findings
The primary outcomes reported in this study.
Evidence Intelligence™
- EvidenceScore™
- 57
- Emerging
- ImpactScore™
- 100
- Very Positive
- ConsistencyScore™
- unclear
- Not enough independent studies
Supporting studies: Based on 1 study
Add to Evidence TrackerEvidence Intelligence™
- EvidenceScore™
- 57
- Emerging
- ImpactScore™
- 55
- Slightly Positive
- ConsistencyScore™
- unclear
- Not enough independent studies
Supporting studies: Based on 1 study
Add to Evidence TrackerHDL cholesterol
Mediterranean ketogenic diet → HDL cholesterol
Mediterranean ketogenic diet → HDL cholesterol
Evidence Intelligence™
- EvidenceScore™
- 57
- Emerging
- ImpactScore™
- 55
- Slightly Positive
- ConsistencyScore™
- unclear
- Not enough independent studies
Supporting studies: Based on 1 study
Add to Evidence TrackerInsulin resistance
Mediterranean ketogenic diet → Insulin resistance
Mediterranean ketogenic diet → Insulin resistance
Evidence Intelligence™
- EvidenceScore™
- 57
- Emerging
- ImpactScore™
- 50
- Neutral
- ConsistencyScore™
- unclear
- Not enough independent studies
Supporting studies: Based on 1 study
Add to Evidence TrackerLDL cholesterol
Mediterranean ketogenic diet → LDL cholesterol
Mediterranean ketogenic diet → LDL cholesterol
Evidence Intelligence™
- EvidenceScore™
- 57
- Emerging
- ImpactScore™
- 55
- Slightly Positive
- ConsistencyScore™
- unclear
- Not enough independent studies
Supporting studies: Based on 1 study
Add to Evidence TrackerSerum creatinine
Mediterranean ketogenic diet → Serum creatinine
Mediterranean ketogenic diet → Serum creatinine
Evidence Intelligence™
- EvidenceScore™
- 57
- Emerging
- ImpactScore™
- 50
- Neutral
- ConsistencyScore™
- unclear
- Not enough independent studies
Supporting studies: Based on 1 study
Add to Evidence TrackerTotal cholesterol
Mediterranean ketogenic diet → Total cholesterol
Mediterranean ketogenic diet → Total cholesterol
Evidence Intelligence™
- EvidenceScore™
- 57
- Emerging
- ImpactScore™
- 55
- Slightly Positive
- ConsistencyScore™
- unclear
- Not enough independent studies
Supporting studies: Based on 1 study
Add to Evidence TrackerTriglycerides
Mediterranean ketogenic diet → Triglycerides
Mediterranean ketogenic diet → Triglycerides
Evidence Intelligence™
- EvidenceScore™
- 57
- Emerging
- ImpactScore™
- 55
- Slightly Positive
- ConsistencyScore™
- unclear
- Not enough independent studies
Supporting studies: Based on 1 study
Add to Evidence TrackerWaist circumference
Mediterranean ketogenic diet → Waist circumference
Mediterranean ketogenic diet → Waist circumference
Evidence Intelligence™
- EvidenceScore™
- 57
- Emerging
- ImpactScore™
- 100
- Very Positive
- ConsistencyScore™
- unclear
- Not enough independent studies
Supporting studies: Based on 1 study
Add to Evidence TrackerEvidence Intelligence™
- EvidenceScore™
- 57
- Emerging
- ImpactScore™
- 100
- Very Positive
- ConsistencyScore™
- unclear
- Not enough independent studies
Supporting studies: Based on 1 study
Add to Evidence TrackerBody weight
Very-low-calorie ketogenic diet → Body weight
Very-low-calorie ketogenic diet → Body weight
Evidence Intelligence™
- EvidenceScore™
- 57
- Emerging
- ImpactScore™
- 100
- Very Positive
- ConsistencyScore™
- unclear
- Not enough independent studies
Supporting studies: Based on 1 study
Add to Evidence TrackerEvidence Intelligence™
- EvidenceScore™
- 57
- Emerging
- ImpactScore™
- 55
- Slightly Positive
- ConsistencyScore™
- unclear
- Not enough independent studies
Supporting studies: Based on 1 study
Add to Evidence TrackerHDL cholesterol
Very-low-calorie ketogenic diet → HDL cholesterol
Very-low-calorie ketogenic diet → HDL cholesterol
Evidence Intelligence™
- EvidenceScore™
- 57
- Emerging
- ImpactScore™
- 55
- Slightly Positive
- ConsistencyScore™
- unclear
- Not enough independent studies
Supporting studies: Based on 1 study
Add to Evidence TrackerInsulin resistance
Very-low-calorie ketogenic diet → Insulin resistance
Very-low-calorie ketogenic diet → Insulin resistance
Evidence Intelligence™
- EvidenceScore™
- 57
- Emerging
- ImpactScore™
- 50
- Neutral
- ConsistencyScore™
- unclear
- Not enough independent studies
Supporting studies: Based on 1 study
Add to Evidence TrackerLDL cholesterol
Very-low-calorie ketogenic diet → LDL cholesterol
Very-low-calorie ketogenic diet → LDL cholesterol
Evidence Intelligence™
- EvidenceScore™
- 57
- Emerging
- ImpactScore™
- 55
- Slightly Positive
- ConsistencyScore™
- unclear
- Not enough independent studies
Supporting studies: Based on 1 study
Add to Evidence TrackerTotal cholesterol
Very-low-calorie ketogenic diet → Total cholesterol
Very-low-calorie ketogenic diet → Total cholesterol
Evidence Intelligence™
- EvidenceScore™
- 57
- Emerging
- ImpactScore™
- 55
- Slightly Positive
- ConsistencyScore™
- unclear
- Not enough independent studies
Supporting studies: Based on 1 study
Add to Evidence TrackerTriglycerides
Very-low-calorie ketogenic diet → Triglycerides
Very-low-calorie ketogenic diet → Triglycerides
Evidence Intelligence™
- EvidenceScore™
- 57
- Emerging
- ImpactScore™
- 55
- Slightly Positive
- ConsistencyScore™
- unclear
- Not enough independent studies
Supporting studies: Based on 1 study
Add to Evidence TrackerWaist circumference
Very-low-calorie ketogenic diet → Waist circumference
Very-low-calorie ketogenic diet → Waist circumference
Evidence Intelligence™
- EvidenceScore™
- 68
- Moderate
- ImpactScore™
- 100
- Very Positive
- ConsistencyScore™
- 100
- consistent
Supporting studies: Based on 2 studies
Add to Evidence TrackerEvidence Library
Build your evidence library
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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
Evidence Library
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Save research, organize studies, and quickly find important evidence again.
Connected Evidence
Explore related studies, evidence collections, and research questions.
Relationships organized using the Dediabetes Evidence Intelligence™ framework.
This study contributes to evidence on Ketogenic Diets and Body Composition, Ketogenic Diets and Body Mass Index.
Related evidence relationships
Explore in Evidence ExplorerThis study contributes to the evidence on the following intervention-outcome relationships.
Diet and Nutrition
Ketogenic Diets → Body Composition
Diet and Nutrition
Evidence Intelligence™
- EvidenceScore™
- 68
- Moderate
- ImpactScore™
- 100
- Very Positive
- ConsistencyScore™
- 100
- consistent
Supporting studies: Based on 2 studies
View evidenceDiet and Nutrition
Ketogenic Diets → Body Mass Index
Diet and Nutrition
Evidence Intelligence™
- EvidenceScore™
- 57
- Emerging
- ImpactScore™
- 100
- Very Positive
- ConsistencyScore™
- unclear
- Not enough independent studies
Supporting studies: Based on 1 study
View evidenceDiet and Nutrition
Ketogenic Diets → Body Weight
Diet and Nutrition
Evidence Intelligence™
- EvidenceScore™
- 57
- Emerging
- ImpactScore™
- 100
- Very Positive
- ConsistencyScore™
- unclear
- Not enough independent studies
Supporting studies: Based on 1 study
View evidenceIncluded in these evidence collections
Curated evidence collections and hubs this study is part of.
Body Composition Evidence Hub
All studies measuring Body Composition
2 studies
outcome_hubMeasures Body Composition as a key outcome.
Ketogenic Diets Evidence Hub
All studies on Ketogenic Diets
2 studies
intervention_hubContributes to Ketogenic Diets evidence base.
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.
Explore more in Evidence Explorer
Jump to pre-filtered views in Evidence Explorer.
All studies on Very-low-calorie ketogenic diet and Waist circumference
Intervention: Very-low-calorie ketogenic dietOutcome: Waist circumference
2 results
All studies on Mediterranean ketogenic diet and BMI
Intervention: Mediterranean ketogenic dietOutcome: BMI
1 results
All studies on Very-low-calorie ketogenic diet
Intervention: Very-low-calorie ketogenic diet
2 results
All studies on Mediterranean ketogenic diet
Intervention: Mediterranean ketogenic diet
1 results
All studies measuring Waist circumference
Outcome: Waist circumference
2 results
Questions answered by this study
Generated from the study's connected evidence using Evidence Intelligence™.
Does Ketogenic Diets improve insulin resistance?
Moderate Evidence
Ketogenic Diets may worsen Insulin Resistance or be associated with harm.
ConsistencyScore™: Results are mixed and should be interpreted cautiously.
Evidence caveat: The available evidence reports mixed findings.
Ranked evidence signals
- 1
Insulin resistance
EvidenceScore™ Emerging | EvidenceScore™ 56.6 | neutral | ConsistencyScore™ Unclear | 1 study
Why this answer: This answer is cautious because the available studies report mixed findings.
Limitations
- Only a small number of supporting studies are available.
- Population details are unavailable.
Does Ketogenic Diets improve body composition?
Moderate Evidence
Ketogenic Diets appears to improve Body Composition.
ConsistencyScore™: Results are consistent across studies.
Ranked evidence signals
- 1
Waist circumference
EvidenceScore™ Moderate | EvidenceScore™ 68.0 | strong positive | ConsistencyScore™ Consistent | 1 study
Why this answer: This answer is based on a small number of supporting studies and should be interpreted cautiously.
Limitations
- Only a small number of supporting studies are available.
- Population details are unavailable.
Does Ketogenic Diets affect body weight?
Emerging Evidence
Ketogenic Diets appears to improve Body Weight.
ConsistencyScore™: Consistency cannot yet be determined from the available evidence.
Ranked evidence signals
- 1
Body weight
EvidenceScore™ Emerging | EvidenceScore™ 56.6 | strong positive | ConsistencyScore™ 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 kidney function?
Emerging Evidence
Current evidence does not show a clear benefit of Ketogenic Diets for Kidney Function.
ConsistencyScore™: Consistency cannot yet be determined from the available evidence.
Ranked evidence signals
- 1
Serum creatinine
EvidenceScore™ Emerging | EvidenceScore™ 56.6 | neutral | ConsistencyScore™ 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.
Next steps
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