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According to IKDSG guidelines, KD use is strictly contraindicated in patients with a deficiency of carnitine (primary), carnitine palmitoyltransferase (CPT) 1 or 2, carnitine translocase, pyruvate carboxylase, medium-chain acyl-coenzyme A (CoA) dehydrogenase (MCAD), long-chain acyl-CoA dehydrogenase (LCAD), short-chain acyl-CoA dehydrogenase (SCAD), and disorders of fatty acid -oxidation and porphyria

Apoptotic cell death is observed both in liver and in peripheral tissues in NAFLD patients (142, 143)

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Repeated inadvertent ingestion of supratherapeutic doses may be especially dangerous, due to subacute depletion of hepatic glutathione stores