Sukkar Samir Giuseppe, Muscaritoli Maurizio
Unità Operativa Dipartimentale Dietetica e Nutrizione Clinica, Dipartimento Medicina Interna, Policlinico San Martino di Genova Istituto di Ricovero e Cura a Carattere Scientifico per l'Oncologia e la Neurologia, Genova, Italy.
Unità Operativa Complessa di Medicina Interna e Nutrizione Clinica, Dipartimento ad Attività Integrata di Medicina Interna Scienze Endocrino-Metaboliche e Malattie Infettive, Azienda Ospedaliera Universitaria Policlinico Umberto I, Rome, Italy.
Front Nutr. 2021 Jul 12;8:642628. doi: 10.3389/fnut.2021.642628. eCollection 2021.
Low carbohydrates diets (LCDs), which provide 20-120 g of carbohydrates per day, have long been used as therapeutic options in the treatment of severe obesity, type 2 diabetes mellitus and other morbid conditions, with good results in terms of weight loss and control of the main metabolic parameters, at least in the short and medium term. According to the caloric content and the macronutrient composition, we can classify LCDs in hypocaloric, normoproteic diets [such as the Very Low-Calorie Ketogenic Diet (VLCKD) or the protein-sparing modified fasting (PSMF)], hypocaloric, hyperproteic and hyperlipidic diets (e.g., Atkins, Paleo diets…) and normocaloric, normo-/hyperproteic diets (eucaloric KD), the latter mainly used in patients with brain tumors (gliomas) and refractory epilepsy. In addition to LCD diets, another interesting dietary approach which gained attention in the last few decades is fasting and its beneficial effects in terms of modulation of metabolic pathways, cellular processes and hormonal secretions. Due to the impossibility of using fasting regimens for long periods of time, several alternative strategies have been proposed that can mimic the effects, including calorie restriction, intermittent or alternating fasting, and the so-called fasting mimicking diets (FMDs). Recent preclinical studies have shown positive effects of FMDs in various experimental models of tumors, diabetes, Alzheimer Disease, and other morbid conditions, but to date, the scientific evidence in humans is limited to some opens studies and case reports. The purpose of our narrative review is to offer an overview of the characteristics of the main dietary regimens applied in the treatment of different clinical conditions as well as of the scientific evidence that justifies their use, focusing on low and zero-carb diets and on the different types of fasting.
低碳水化合物饮食（LCDs），即每天提供20 - 120克碳水化合物，长期以来一直被用作治疗严重肥胖、2型糖尿病和其他病态疾病的治疗选择，至少在短期和中期内，在减肥和控制主要代谢参数方面取得了良好效果。根据热量含量和宏量营养素组成，我们可以将LCDs分为低热量、正常蛋白质饮食[如极低热量生酮饮食（VLCKD）或蛋白质节省型改良禁食（PSMF）]、低热量、高蛋白和高脂饮食（如阿特金斯饮食、古饮食等）以及正常热量、正常/高蛋白饮食（等热量生酮饮食），后者主要用于脑肿瘤（胶质瘤）和难治性癫痫患者。除了LCD饮食外，另一种在过去几十年中受到关注的有趣饮食方法是禁食及其在调节代谢途径、细胞过程和激素分泌方面的有益作用。由于无法长时间采用禁食方案，人们提出了几种可以模拟其效果的替代策略，包括热量限制、间歇性或交替禁食以及所谓的禁食模拟饮食（FMDs）。最近的临床前研究表明，FMDs在各种肿瘤、糖尿病、阿尔茨海默病和其他病态疾病的实验模型中具有积极作用，但迄今为止，在人类中的科学证据仅限于一些开放性研究和病例报告。我们叙述性综述的目的是概述应用于治疗不同临床疾病的主要饮食方案的特点以及证明其使用合理性的科学证据，重点关注低碳水和零碳水饮食以及不同类型的禁食。
