{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T07:43:13Z","timestamp":1771659793850,"version":"3.50.1"},"reference-count":93,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T00:00:00Z","timestamp":1747612800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endocrines"],"abstract":"<jats:p>Lipedema is a chronic disease of the subcutaneous adipose tissue that mostly affects women. The etiopathogenesis of the disease is still poorly understood. Lipedema typically develops after major hormonal changes, such as puberty, pregnancy, and menopause. Alongside genetic susceptibility, the pathophysiological mechanism involving hormonal changes is mostly linked to aberrantly expressed estrogen receptors in adipose tissue. Lipedema has no known cure, and current therapies aim primarily to reduce symptoms, avoid complications, and slow the disease progression. Achieving or maintaining a healthy body composition, preserving or regaining mobility and functionality, preventing the progression of disease, and reducing pain and other symptoms are all possible outcomes of proper nutrition and weight management. Since nutrition may provide a long-term solution to control almost constant inflammation, it should be a major part of lipedema treatment. Despite the lack of a specific, scientifically supported diet for lipedema patients, several dietary approaches have been suggested. In this comprehensive narrative review, supported by published revisions and peer-reviewed studies following scrutiny of digital medical databases, the current state of knowledge and theories regarding the hormonal etiopathogenesis of lipedema are presented, as well as the role of nutritional intervention in reducing its symptoms and progression.<\/jats:p>","DOI":"10.3390\/endocrines6020024","type":"journal-article","created":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T06:31:29Z","timestamp":1747636289000},"page":"24","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Lipedema: From Women\u2019s Hormonal Changes to Nutritional Intervention"],"prefix":"10.3390","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4660-0645","authenticated-orcid":false,"given":"In\u00eas","family":"Tomada","sequence":"first","affiliation":[{"name":"Hospital CUF Porto, 4100-180 Porto, Portugal"},{"name":"Centre of Biotechnology and Fine Chemistry (CBQF), Faculty of Biotechnology, Universidade Cat\u00f3lica Portuguesa, 4169-005 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,19]]},"reference":[{"key":"ref_1","first-page":"1303","article-title":"S2k guideline lipedema","volume":"22","author":"Faerber","year":"2024","journal-title":"J. Dtsch. Dermatol. Ges."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1002\/oby.24026","article-title":"Effect of a low-carbohydrate diet on pain and quality of life in female patients with lipedema: A randomized controlled trial","volume":"32","author":"Lundanes","year":"2024","journal-title":"Obesity"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.cjprs.2024.06.005","article-title":"Lipedema: A common though often unrecognized condition","volume":"6","author":"Carvalho","year":"2024","journal-title":"Chin. J. Plast. Reconstr. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e1043","DOI":"10.1097\/GOX.0000000000001043","article-title":"Lipedema: A relatively common disease with extremely common misconceptions","volume":"4","author":"Buck","year":"2016","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1567","DOI":"10.1002\/oby.22597","article-title":"Lipedema: A Call to Action!","volume":"27","author":"Buso","year":"2019","journal-title":"Obesity"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"389","DOI":"10.2147\/IJWH.S106227","article-title":"Lipedema: Diagnostic and management challenges","volume":"8","author":"Peled","year":"2016","journal-title":"Int. J. Womens Health"},{"key":"ref_7","first-page":"1","article-title":"Lipedema: Friend and foe","volume":"33","author":"Torre","year":"2018","journal-title":"Horm. Mol. Biol. Clin. Investig."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e20240025","DOI":"10.1590\/1677-5449.202400252","article-title":"Lipedema: Exploring pathophysiology and treatment strategies\u2014State of the art","volume":"23","author":"Kamamoto","year":"2024","journal-title":"J. Vasc. Bras."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1007\/s11136-015-1080-x","article-title":"Quality of life in women with lipoedema: A contextual behavioral approach","volume":"25","author":"Dudek","year":"2016","journal-title":"Qual. Life Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1177\/0268355516639421","article-title":"First Dutch guidelines on lipedema using the international classification of functioning, disability and health","volume":"32","author":"Halk","year":"2017","journal-title":"Phlebology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1038\/aps.2011.153","article-title":"Rare adipose disorders (RADs) masquerading as obesity","volume":"33","author":"Herbst","year":"2012","journal-title":"Acta Pharmacol. Sin."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1177\/153537020422901107","article-title":"Role of estrogens in adipocyte development and function","volume":"229","author":"Cooke","year":"2004","journal-title":"Exp. Biol. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1016\/j.mehy.2014.08.011","article-title":"Pathophysiological dilemmas of lipedema","volume":"83","author":"Groma","year":"2014","journal-title":"Med. Hypotheses"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Katzer, K., Hill, J.L., McIver, K.B., and Foster, M.T. (2021). Lipedema and the potential role of estrogen in excessive adipose tissue accumulation. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms222111720"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1111\/j.1758-8111.2012.00045.x","article-title":"Lipedema: An overview of its clinical manifestations, diagnosis and treatment of the disproportional fatty deposition syndrome\u2014Systematic review","volume":"2","author":"Szolnoky","year":"2012","journal-title":"Clin. Obes."},{"key":"ref_16","first-page":"396","article-title":"Lipedema\u2014Pathogenesis, diagnosis and treatment options","volume":"117","author":"Kruppa","year":"2020","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1002\/ajmg.a.33313","article-title":"Lipedema: An inherited condition","volume":"152A","author":"Child","year":"2010","journal-title":"Am. J. Med. Genet."},{"key":"ref_18","first-page":"5581","article-title":"Genetics of lipedema: New perspectives on genetic research and molecular diagnoses","volume":"23","author":"Paolacci","year":"2019","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"100092","DOI":"10.1016\/j.obpill.2023.100092","article-title":"Obesity, thrombosis, venous disease, lymphatic disease, and lipedema: An obesity medicine association (OMA) clinical practice statement (CPS) 2023","volume":"8","author":"Bindlish","year":"2023","journal-title":"Obes. Pillars"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Marsh, C. (2024). Reproductive landmarks and lipedema: Lessons to be learned about women hormones throughout life. Sex Steroid Hormones\u2014Impact on Reproductive Physiology, IntechOpen.","DOI":"10.5772\/intechopen.1004954"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.physbeh.2009.02.017","article-title":"Sex differences in the regulation of body weight","volume":"97","author":"Shi","year":"2009","journal-title":"Physiol. Behav."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1710","DOI":"10.1194\/jlr.R086975","article-title":"Determinants of body fat distribution in humans may provide insight about obesity-related health risks","volume":"60","author":"Frank","year":"2019","journal-title":"J. Lipid Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.biochi.2013.09.023","article-title":"Prolactin and adipose tissue","volume":"97","author":"Binart","year":"2014","journal-title":"Biochimie"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"5320156","DOI":"10.1155\/2019\/5320156","article-title":"Determinants of Maternal Insulin Resistance during Pregnancy: An Updated Overview","volume":"2019","author":"Kampmann","year":"2019","journal-title":"J. Diabetes Res."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Patton, L., Ricolfi, L., Bortolon, M., Gabriele, G., Zolesio, P., Cione, E., and Cannataro, R. (2024). Observational study on a large italian population with lipedema: Biochemical and hormonal profile, anatomical and clinical evaluation, self-reported history. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25031599"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"615917","DOI":"10.1155\/2014\/615917","article-title":"Estrogen signaling in metabolic inflammation","volume":"2014","author":"Monteiro","year":"2014","journal-title":"Mediat. Inflamm."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Steiner, B.M., and Berry, D.C. (2022). The regulation of adipose tissue health by estrogens. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.889923"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1210\/er.2012-1055","article-title":"The role of estrogens in control of energy balance and glucose homeostasis","volume":"34","author":"Clegg","year":"2013","journal-title":"Endocr. Rev."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"C655","DOI":"10.1152\/ajpcell.00321.2003","article-title":"Evidence for functional estrogen receptors alpha and beta in human adipose cells: Regional specificities and regulation by estrogens","volume":"286","author":"Leneveu","year":"2004","journal-title":"Am. J. Physiol. Cell Physiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1111\/j.1748-1716.2010.02237.x","article-title":"Obesity, insulin resistance and diabetes: Sex differences and role of oestrogen receptors","volume":"203","author":"Meyer","year":"2011","journal-title":"Acta Physiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1016\/j.metabol.2013.02.010","article-title":"Estrogen receptor protein content is different in abdominal than gluteal subcutaneous adipose tissue of overweight-to-obese premenopausal women","volume":"62","author":"Gavin","year":"2013","journal-title":"Metabolism"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.prostaglandins.2009.05.001","article-title":"Signaling, physiological functions and clinical relevance of the G proteincoupled estrogen receptor GPER","volume":"89","author":"Prossnitz","year":"2009","journal-title":"Prostaglandins Other Lipid Mediat."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1172\/JCI27987","article-title":"Estrogen receptors and human disease","volume":"116","author":"Deroo","year":"2006","journal-title":"J. Clin. Investig."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Eaton, S.A., and Sethi, J.K. (2019). Immunometabolic links between estrogen, adipose tissue and female reproductive metabolism. Biology, 8.","DOI":"10.3390\/biology8010008"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2393","DOI":"10.1038\/oby.2008.389","article-title":"Role of estrogen receptor-alpha and -beta in regulating leptin expression in 3T3-L1 adipocytes","volume":"16","author":"Yi","year":"2008","journal-title":"Obesity"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Grewal, T., Kempa, S., and Buechler, C. (2025). Lipedema: A Disease Triggered by M2 Polarized Macrophages?. Biomedicines, 13.","DOI":"10.3390\/biomedicines13030561"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Felmerer, G., Stylianaki, A., Hollm\u00e9n, M., Str\u00f6bel, P., Stepniewski, A., Wang, A., Frueh, F.S., Kim, B.S., Giovanoli, P., and Lindenblatt, N. (2020). Increased levels of VEGF-C and macrophage infiltration in lipedema patients without changes in lymphatic vascular morphology. Sci. Rep., 10.","DOI":"10.1038\/s41598-020-67987-3"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Kruppa, P., Gohlke, S., \u0141api\u0144ski, K., Garcia-Carrizo, F., Soultoukis, G.A., Infanger, M., Schulz, T.J., and Ghods, M. (2023). Lipedema stage affects adipocyte hypertrophy, subcutaneous adipose tissue inflammation and interstitial fibrosis. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1223264"},{"key":"ref_39","first-page":"8747461","article-title":"Dilated blood and lymphatic microvessels, angiogenesis, increased macrophages, and adipocyte hypertrophy in lipedema thigh skin and fat tissue","volume":"2019","author":"Cromer","year":"2019","journal-title":"J. Obes."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.mce.2003.11.022","article-title":"Cytokines and steroidogenesis","volume":"215","author":"Bornstein","year":"2004","journal-title":"Mol. Cell. Endocrinol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.it.2010.03.001","article-title":"Innate immunity and adipose tissue biology","volume":"31","year":"2010","journal-title":"Trends Immunol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e6288","DOI":"10.1097\/GOX.0000000000006288","article-title":"Transcriptomics of Subcutaneous Tissue of Lipedema Identified Differentially Expressed Genes Involved in Adipogenesis, Inflammation, and Pain","volume":"12","author":"Streubel","year":"2024","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Di Renzo, L., Cinelli, G., Romano, L., Zomparelli, S., Lou De Santis, G., Nocerino, P., Bigioni, G., Arsini, L., Cenname, G., and Pujia, A. (2021). Potential effects of a modified Mediterranean diet on body composition in lipoedema. Nutrients, 13.","DOI":"10.3390\/nu13020358"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Bereshchenko, O., Bruscoli, S., and Riccardi, C. (2018). Glucocorticoids, sex hormones, and immunity. Front. Immunol., 9.","DOI":"10.3389\/fimmu.2018.01332"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1016\/j.imbio.2017.05.007","article-title":"Ovarian hormones in innate inflammation","volume":"222","author":"Stubelius","year":"2017","journal-title":"Immunobiology"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1210\/er.2007-0001","article-title":"The complex role of estrogens in inflammation","volume":"28","author":"Straub","year":"2007","journal-title":"Endocr. Rev."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"86","DOI":"10.31080\/ASNH.2020.04.0781","article-title":"Lipedema and nutrition: What\u2019s the link?","volume":"4","author":"Cannataro","year":"2020","journal-title":"Acta Sci. Nutr. Health"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"bnaa004","DOI":"10.1210\/endrev\/bnaa004","article-title":"Metabolically Healthy Obesity","volume":"41","year":"2020","journal-title":"Endocr Rev."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1016\/j.tem.2024.04.004","article-title":"Is the endotoxin-complement cascade the major driver in lipedema?","volume":"35","author":"Kruglikov","year":"2024","journal-title":"Trends Endocrinol. Metab."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"24705470221076390","DOI":"10.1177\/24705470221076390","article-title":"The role of lipopolysaccharide-induced cell signalling in chronic inflammation","volume":"6","author":"Page","year":"2022","journal-title":"Chronic Stress"},{"key":"ref_51","first-page":"3461","article-title":"Dysbiosis of Gram-negative gut microbiota and the associated serum lipopolysaccharide exacerbates inflammation in type 2 diabetic patients with chronic kidney disease","volume":"18","author":"Salguero","year":"2019","journal-title":"Exp. Ther. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1177\/02683555211015887","article-title":"Standard of care for lipedema in the United States","volume":"36","author":"Herbst","year":"2021","journal-title":"Phlebology"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Grylls, A., Seidler, K., and Neil, J. (2021). Link between microbiota and hypertension: Focus on LPS\/TLR4 pathway in endothelial dysfunction and vascular inflammation, and therapeutic implication of probiotics. Biomed. Pharmacother., 137.","DOI":"10.1016\/j.biopha.2021.111334"},{"key":"ref_54","first-page":"E169","article-title":"Dietary supplements for lipedema","volume":"63","author":"Bonetti","year":"2022","journal-title":"J. Prev. Med. Hyg."},{"key":"ref_55","first-page":"27","article-title":"Muscle strength and functional exercise capacity in patients with lipoedema and obesity: A comparative study","volume":"12","author":"Damstra","year":"2017","journal-title":"J. Lymphoedema"},{"key":"ref_56","first-page":"84","article-title":"Lipoedema-myths and facts. Part 1","volume":"47","author":"Bertsch","year":"2018","journal-title":"Phlebologie"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1007\/s13679-023-00536-x","article-title":"Ketogenic diet: A nutritional therapeutic tool for lipedema?","volume":"12","author":"Verde","year":"2023","journal-title":"Curr. Obes. Rep."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Poojari, A., Dev, K., and Rabiee, A. (2022). Lipedema: Insights into morphology, pathophysiology, and challenges. Biomedicines, 10.","DOI":"10.3390\/biomedicines10123081"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1111\/j.1600-0560.2009.01256.x","article-title":"Adipose tissue remodeling in lipedema: Adipocyte death and concurrent regeneration","volume":"36","author":"Suga","year":"2009","journal-title":"J. Cutan. Pathol."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Pagani, A., Duscher, D., Kempa, S., Ghods, M., and Prantl, L. (2024). Preliminary Single-Cell RNA-Sequencing Analysis Uncovers Adipocyte Heterogeneity in Lipedema. Cells, 13.","DOI":"10.3390\/cells13121028"},{"key":"ref_61","first-page":"1179","article-title":"Body mass index vs. waist-to-height-ratio in patients with lipohyperplasia dolorosa (vulgo lipedema)","volume":"21","author":"Brenner","year":"2023","journal-title":"J. Dtsch. Dermatol. Ges."},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Lundanes, J., G\u00e5rseth, M., Taylor, S., Crescenzi, R., Pridmore, M., Wagnild, R., Hyldmo, \u00c5.A., Martins, C., and Nymo, S. (2024). The effect of a low-carbohydrate diet on subcutaneous adipose tissue in females with lipedema. Front. Nutr., 11.","DOI":"10.3389\/fnut.2024.1484612"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"036001","DOI":"10.1117\/1.JMI.10.3.036001","article-title":"Semiautomated segmentation of lower extremity MRI reveals distinctive subcutaneous adipose tissue in lipedema: A pilot study","volume":"10","author":"Taylor","year":"2023","journal-title":"J. Med. Imaging"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1002\/osp4.580","article-title":"Effect of a ketogenic diet on pain and quality of life in patients with lipedema: The LIPODIET pilot study","volume":"8","author":"Hyldmo","year":"2022","journal-title":"Obes. Sci. Pract."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"S44","DOI":"10.12968\/bjcn.2017.22.Sup10.S44","article-title":"Best practice guidelines for the management of lipoedema","volume":"22","author":"Hardy","year":"2017","journal-title":"Br. J. Community Nurs."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s11154-019-09514-y","article-title":"Efficacy and safety of very low-calorie ketogenic diet (VLCKD) in patients with overweight and obesity: A systematic review and meta-analysis","volume":"21","author":"Castellana","year":"2020","journal-title":"Rev. Endocr. Metab. Disord."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Al-Ghadban, S., Herbst, K.L., and Bunnell, B.A. (2019). Lipedema: A Painful Adipose Tissue Disorder. Adipose Tissue\u2014An Update, IntechOpen.","DOI":"10.5772\/intechopen.88632"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.clnesp.2024.11.018","article-title":"Gastrointestinal hormones and subjective ratings of appetite after low-carbohydrate vs low-fat low-energy diets in females with lipedema\u2014A randomized controlled trial","volume":"65","author":"Lundanes","year":"2025","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1055\/s-2005-872851","article-title":"Association of interleukin-6, C-reactive protein, interleukin-10 and adiponectin plasma concentrations with measures of obesity, insulin sensitivity and glucose metabolism","volume":"113","author":"Fasshauer","year":"2005","journal-title":"Exp. Clin. Endocrinol. Diabetes"},{"key":"ref_70","first-page":"1","article-title":"Is lipedema a unique entity?","volume":"2","author":"Amato","year":"2020","journal-title":"EC Clin. Med. Cases Rep."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"110435","DOI":"10.1016\/j.mehy.2020.110435","article-title":"Ketogenic diet as a potential intervention for lipedema","volume":"146","author":"Keith","year":"2021","journal-title":"Med. Hypotheses"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1080\/07315724.2015.1080105","article-title":"Anti-inflammatory diets","volume":"34","author":"Sears","year":"2015","journal-title":"J. Am. Coll. Nutr."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1186\/s42269-019-0238-z","article-title":"Physiological process of fat loss","volume":"43","author":"Sibaii","year":"2019","journal-title":"Bull. Natl. Res. Cent."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"847","DOI":"10.2174\/1389557043403503","article-title":"Cellular and physiological effects of medium-chain Triglycerides","volume":"4","author":"Wanten","year":"2004","journal-title":"Mini Rev. Med. Chem."},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Maher, T., Sampson, A., Goslawska, M., Pangua-Irigaray, C., Shafat, A., and Clegg, M.E. (2019). Food intake and satiety response after medium-chain triglycerides ingested as solid or liquid. Nutrients, 11.","DOI":"10.3390\/nu11071638"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1007\/s13679-022-00481-1","article-title":"Mediterranean diet and obesity-related disorders: What is the evidence?","volume":"11","author":"Muscogiuri","year":"2022","journal-title":"Curr. Obes. Rep."},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Cannataro, R., Michelini, S., Ricolfi, L., Caroleo, M., Gallelli, L., de Sarro, G., Onorato, A., and Cione, E. (2021). Management of lipedema with ketogenic diet: 22-month follow-up. Life, 11.","DOI":"10.3390\/life11121402"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"2545","DOI":"10.2147\/DMSO.S377720","article-title":"The Effect of a Low-Carbohydrate, High-Fat Diet versus Moderate-Carbohydrate and Fat Diet on Body Composition in Patients with Lipedema","volume":"15","author":"Jeziorek","year":"2022","journal-title":"Diabetes Metab. Syndr. Obes."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"e934406","DOI":"10.12659\/AJCR.934406","article-title":"Lipedema can be treated non-surgically: A report of 5 cases","volume":"22","author":"Amato","year":"2021","journal-title":"Am. J. Case Rep."},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"Cannataro, R., Caroleo, M.C., Fazio, A., La Torre, C., Plastina, P., Gallelli, L., Lauria, G., and Cione, E. (2019). Ketogenic diet and microRNAs linked to antioxidant biochemical homeostasis. Antioxidants, 8.","DOI":"10.3390\/antiox8080269"},{"key":"ref_81","doi-asserted-by":"crossref","unstructured":"Jeziorek, M., Szuba, A., Sowicz, M., Adaszy\u0144ska, A., Kujawa, K., and Chachaj, A. (2023). The effect of a low-carbohydrate high-fat diet on laboratory parameters in women with lipedema in comparison to overweight\/obese women. Nutrients, 15.","DOI":"10.3390\/nu15112619"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/s11745-007-3132-7","article-title":"Comparison of low fat and low carbohydrate diets on circulating fatty acid composition and markers of inflammation","volume":"43","author":"Forsythe","year":"2008","journal-title":"Lipids"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1016\/j.cmet.2016.12.022","article-title":"Multi-dimensional roles of ketone bodies in fuel metabolism, signaling, and therapeutics","volume":"25","author":"Puchalska","year":"2017","journal-title":"Cell Metab."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"194","DOI":"10.3390\/biom5010194","article-title":"Advanced glycation end products and oxidative stress in type 2 diabetes mellitus","volume":"5","author":"Nowotny","year":"2015","journal-title":"Biomolecules"},{"key":"ref_85","doi-asserted-by":"crossref","unstructured":"Cardoso-Silva, D., Delbue, D., Itzlinger, A., Moerkens, R., Withoff, S., Branchi, F., and Schumann, M. (2019). Intestinal barrier function in gluten-related disorders. Nutrients, 11.","DOI":"10.3390\/nu11102325"},{"key":"ref_86","doi-asserted-by":"crossref","unstructured":"Fassio, F., Facioni, M.S., and Guagnini, F. (2018). Lactose maldigestion, malabsorption, and intolerance: A comprehensive review with a focus on current management and future perspectives. Nutrients, 10.","DOI":"10.3390\/nu10111599"},{"key":"ref_87","doi-asserted-by":"crossref","unstructured":"Amato, A.C.M., Amato, J.L.S., and Benitti, D.A. (2024). The efficacy of ketogenic diets (low carbohydrate; high fat) as a potential nutritional intervention for lipedema: A systematic review and meta-analysis. Nutrients, 16.","DOI":"10.3390\/nu16193276"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.atherosclerosis.2020.09.015","article-title":"The ketogenic diet: Pros and cons","volume":"292","author":"Raggi","year":"2020","journal-title":"Atherosclerosis"},{"key":"ref_89","doi-asserted-by":"crossref","unstructured":"Di Renzo, L., Gualtieri, P., Zomparelli, S., De Santis, G.L., Seraceno, S., Zuena, C., Frank, G., Cianci, R., Centofanti, D., and De Lorenzo, A. (2023). Modified Mediterranean-Ketogenic Diet and Carboxytherapy as Personalized Therapeutic Strategies in Lipedema: A Pilot Study. Nutrients, 15.","DOI":"10.3390\/nu15163654"},{"key":"ref_90","doi-asserted-by":"crossref","unstructured":"Piccolella, S., Crescente, G., Candela, L., and Pacifico, S. (2019). Nutraceutical polyphenols: New analytical challenges and opportunities. J. Pharm. Biomed. Anal., 175.","DOI":"10.1016\/j.jpba.2019.07.022"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"270","DOI":"10.3390\/nutraceuticals2040020","article-title":"Nutritional Supplements and Lipedema: Scientific and Rational Use","volume":"2","author":"Cannataro","year":"2022","journal-title":"Nutraceuticals"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1042\/BST20160474","article-title":"Omega-3 fatty acids and inflammatory processes: From molecules to man","volume":"45","author":"Calder","year":"2017","journal-title":"Biochem. Soc. Trans."},{"key":"ref_93","first-page":"184","article-title":"Lipedema of the legs: A syndrome characterized by fat legs and orthostatic edema","volume":"15","author":"Allen","year":"1940","journal-title":"Proc. Staff. Meet. 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