The Impact of a Very-Low-Calorie Ketogenic Diet on Monocyte Subsets of Patients with Obesity: A Pilot Study

Background/Objectives: Obesity is closely linked to chronic low-grade inflammation and the development of cardio-metabolic comorbidities. Monocyte subsets, which are crucial in immune responses, have been reported to be altered in individuals with obesity, potentially exacerbating inflammation. Although very-low-calorie ketogenic diets (VLCKDs) are recognized for their efficacy in promoting weight loss and improving metabolic health, their impact on circulating monocyte subsets remains poorly understood. The objective of our study is to investigate the impact of VLCKDs on monocyte subset distribution in people with obesity. Methods: Thirty-six participants were divided into four groups-healthy controls, individuals with obesity and no dietary intervention, and individuals with obesity following either a low-calorie diet (LCD) or VLCKD for 28 days. Blood samples were analyzed to assess the distribution of classical monocytes (CMs), intermediate monocytes (IMs), and non-classical monocytes (NCMs) using flow cytometry. Results: Individuals with obesity exhibited significant increases in IMs and NCMs, alongside a decrease in CMs compared to healthy controls. The VLCKD led to a notable shift in monocyte distribution, with increased CMs and reduced IMs and NCMs, restoring levels closer to those observed in healthy individuals. In contrast, the LCD group showed no significant changes in monocyte subsets. Conclusions: VLCKDs may exert anti-inflammatory effects by modulating monocyte subset distribution, offering potential therapeutic benefits in mitigating obesity-related inflammation. These preliminary findings suggest that VLCKDs could be an effective strategy for improving immune function in individuals with obesity.