OBJECTIVE: The aim of this study was to evaluate Italian dietitians’ expertise and clinical use of ketogenic dietary therapies (KDTs), with a specific emphasis on their use in inherited metabolic disorders (IMDs).

SUBJECTS AND METHODS: A 30-item multiple-choice questionnaire was distributed to Italian dietitians and physicians (including neurologists, pediatricians and endocrinologists) affiliated with the Italian Scientific Association for Food, Nutrition and Dietetics (ASAND) and/or the Italian Society for the Study of Inherited Metabolic Diseases and Neonatal Screening (SIMMESN) and/or the Italian League Against Epilepsy (ILAE). Participants were recruited from various clinical settings, including hospitals, private practices, and academic institutions. The survey explored professional experience, therapeutic clinical application of KDTs, follow-up strategies, and perceived barriers to implementation in IMDs. Descriptive statistics were used for data analysis.

RESULTS: A total of 175 responses were collected. The findings demonstrated substantial variability in expertise on KDTs and usage across different healthcare settings. Only 34.3% of respondents reported the presence of a dedicated ketogenic therapy team (“ketoteam”), whereas 33.7% indicated no available service within their institution. Most dietitians (66%) had fewer than five years of experience with KDTs, and 74.3% devoted less than 25% of their professional time to the management of KDTs. The most commonly employed protocol was the classic KD (39.4%), with minimal adoption of the Medium-chain triglyceride ketogenic diet (MCT-KD). Reported barriers included insufficient staffing (42.7%) and inadequate clinical infrastructure (31.7%).

CONCLUSIONS: This survey reveals notable variability in expertise on KDTs and clinical practice among Italian dietitians. KDTs are most frequently applied for obesity and weight management rather than for metabolic or neurological disorders. These findings underscore the need for targeted educational programs, enhanced multidisciplinary collaboration, and clearer delineation of the expertise required for use of KDTs in IMDs, taking into account the diversity of protocols and their underlying clinical rationales.