Validation of protocol for the treatment of obesity by the ketogenic diet, vitamin D and metabolic activators: a systematic umbrella review

Introduction: Obesity remains a major health risk worldwide, with a burden of comorbidities and mortality of up to 2.8 million people per year. However, implementing appropriate dietary regimens for weight reduction can potentially mitigate the epidemic of obesity and its comorbidities. Among these regimens, vitamin D, ketogenic diet, L-carnitine, morosil®, inositol, taurine, and coenzyme Q10 stand out. Objective: To present the main clinical studies, meta-analyses, consensuses, and guidelines to support the efficacy and safety of the treatment protocol for obesity and its comorbidities. Methods: The PRISMA Platform systematic review rules were followed. The search was conducted from January to February 2025 in the Web of Science, Scopus, Embase, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument, and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 153 articles were found, and 54 articles were evaluated in full, and 34 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 16 studies with a high risk of bias and 26 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X2=87.8% >50%. It was concluded that the main clinical studies, meta-analyses, consensuses, and guidelines published to date indicate promising results to support the efficacy and safety of the treatment protocol for obesity and its comorbidities, with the most solid results being presented by studies of vitamin D, ketogenic diet, and L-carnitine. The studies revealed that morosyl, inositol, taurine, coenzyme Q10, and chromium picolinate present better results in treating obesity when associated with other metabolic activators. Therefore, the proposal of the present treatment protocol can be validated by the associated use of these compounds in the treatment of patients with obesity.