In women with ovarian or endometrial cancer, a KD results in selective loss of fat mass and retention of lean mass. Visceral fat mass and fasting serum insulin also are reduced by the KD, perhaps owing to enhanced insulin sensitivity. Elevated serum β-hydroxybutyrate may reflect a metabolic environment inhospitable to cancer proliferation. This trial was registered at www.clinicaltrials.gov as NCT03171506.

Ketogenic diets (KDs) are gaining attention as a potential adjuvant therapy for cancer, but data are limited for KDs’ effects on quality of life. We hypothesized that the KD would (1) improve mental and physical function, including energy levels, (2) reduce hunger, and (3) diminish sweet and starchy food cravings in women with ovarian or endometrial cancer. Participants were randomized to a KD (70:25:5 energy from fat, protein, and carbohydrate) or the American Cancer Society diet (ACS: high-fiber, lower-fat). Questionnaires were administered at baseline and after 12 weeks on the assigned diet to assess changes in mental and physical health, perceived energy, appetite, and food cravings. We assessed both between-group differences and within-group changes using ANCOVA and paired t-tests, respectively. After 12 weeks, there was a significant between-group difference in adjusted physical function scores (p < 0.05), and KD participants not receiving chemotherapy reported a significant within-group reduction in fatigue (p < 0.05). There were no significant between-group differences in mental function, hunger, or appetite. There was a significant between-group difference in adjusted cravings for starchy foods and fast food fats at 12 weeks (p < 0.05 for both), with the KD group demonstrating less frequent cravings than the ACS. In conclusion, in women with ovarian or endometrial cancer, a KD does not negatively affect quality of life and in fact may improve physical function, increase energy, and diminish specific food cravings. This trial was registered at as NCT03171506.

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Objectives There are well-established regional differences in obesity prevalence in the U.S., but relatively little is known about whether these differences impact efforts for weight loss. The objective of the study was to determine whether changes in body weight, engagement in physical activity (PA), and psychosocial factors differed in Colorado (CO) vs Alabama (AL) in response to a 16-week standardized behavioral weight management program. We hypothesized that weight loss would be greater in Colorado due to a more favorable physical and social environment. Methods This is an ancillary study to a weight loss intervention being conducted simultaneously in AL and CO with identical intervention content and delivery. Study participants (n = 70, 39 CO, 31 AL) were randomized to either a high protein (HP) or normal protein (NP) diet for 16 weeks and attended weekly group classes led by a trained coach targeting diet, mindset, and physical activity. Body weight, objective (accelerometry) and self-reported (International Physical Activity Questionnaire) PA, and responses to psychosocial questionnaires were collected at baseline and week 16. Psychosocial constructs included executive function, hedonic eating, stress, and social support. Results Both states lost a significant amount of weight (CO 13.2 ± 4.9 kg P = 0.0067; AL 12.5 ± 5.6 kg P = 0.0262) with no differences between states (P = 0.9315). Both states improved in all PA outcomes over time, with AL increasing significantly more in objective PA measures when compared to CO. AL had more favorable scores for hedonic eating at baseline (23.2 ± 2.4 vs 32.5 ± 1.8, P = 0.0017), which persisted to week 16 (19.0 ± 2.7 vs 29.7 ± 2.2, P = 0.0021). Finally, AL improved in several social support factors while CO did not. Conclusions While weight loss did not differ between states, AL experienced greater improvements in some factors known to improve long-term weight loss maintenance. Results from this study provide a strong rationale for investigating potential regional differences in the maintenance of lost weight that may not be apparent during the active weight loss phase of interventions. Future research in this area will require effective methods for tracking participants beyond the conclusion of most clinical trials. Funding Sources The parent clinical trial is supported by The Beef Checkoff.

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