Isocaloric Ketogenic Diet in Adults with High-Grade Gliomas: A Prospective Metabolic Study

Foppiani, Andrea; Amicis, Ramona De; Lessa, Chiara; Ravella, Simone; Ciusani, Emilio; Silvani, Antonio; Zuccoli, Giulio; Battezzati, Alberto; Lamperti, E.; Bertoli, Simona

doi:10.1080/01635581.2020.1779759

Cited by 9 publications

(28 citation statements)

References 44 publications

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“…It changed metabolism, increased blood ketone body, and decreased level of insulin. No change in fasting blood glucose was observed [ 60 ]. A meta-analysis of the effect of ketogenic diets on blood glucose in patients with obesity or overweight showed that there was no significant decrease in blood glucose index in a ketogenic diet group compared with the control group.…”

Section: Discussionmentioning

confidence: 99%

Effect of Ketogenic Diets on Body Composition and Metabolic Parameters of Cancer Patients: A Systematic Review and Meta-Analysis

et al. 2022

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A ketogenic diet characterized by high fat and low carbohydrate can drive the body to produce a large number of ketone bodies, altering human metabolism. Unlike normal cells, tumor cells have difficulty in consuming ketone bodies. Therefore, the application of ketogenic diets in cancer therapy is gaining attention. However, the effect of ketogenic diets on body parameters of cancer patients is not well established. This meta-analysis aimed to summarize the effects of ketogenic diets on cancer patients in earlier controlled trials. PubMed, Embase, and Cochrane Library were searched for clinical trials that enrolled cancer patients who received ketogenic diets intervention. Ten controlled trials were included in this meta-analysis. Data were extracted and checked by three authors independently. Pooled effect sizes revealed a significant effect of ketogenic diets on body weight (SMD −1.83, 95% CI −2.30 to −1.35; p < 0.00001) and fat mass (SMD −1.52, 95% CI −1.92 to −1.07; p < 0.00001). No significant effect on blood glucose, insulin, or lipid profile except triglycerides was found in the analysis. It had no effect on liver and kidney function except that GGT were decreased a little. There were no significant changes in IGF-1 and TNF-α related to tumor growth. Mental health improvement of cancer patients was supported by several trials. Taken together, findings in this study confirmed that the ketogenic diet was a safe approach for cancer patients reducing body weight and fat mass. In addition, cancer treatment-related indicators changed insignificantly. Ketogenic diets may be beneficial to the quality of life of cancer patients. However, intervention duration in most studies is shorter than 6 months, and the effect of a long-term ketogenic diet is still required further validation. More trials with a larger sample size are necessary to give a more conclusive result; PROSPERO registration number: CRD42021277559.

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Section: Discussionmentioning

confidence: 99%

Effect of Ketogenic Diets on Body Composition and Metabolic Parameters of Cancer Patients: A Systematic Review and Meta-Analysis

et al. 2022

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“…efficacy against some cancers, clinical studies have been limited in glioma patients, and have so far mostly focused on feasibility, not outcomes [15,[21][22][23][24][25][26]. At the preclinical level, some studies showed that mice engrafted with IDH1 wt GBM did not benefit from KD [13,27], although others have suggested otherwise [28], and to the best of our knowledge, there has not yet been a direct experimental comparison of IDH1 wt and IDH1 mut gliomas exposed to KD.…”

Section: Plos Onementioning

confidence: 99%

The efficacy of an unrestricted cycling ketogenic diet in preclinical models of IDH wild-type and IDH mutant glioma

et al. 2022

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Infiltrative gliomas are the most common neoplasms arising in the brain, and remain largely incurable despite decades of research. A subset of these gliomas contains mutations in isocitrate dehydrogenase 1 (IDH1mut) or, less commonly, IDH2 (together called “IDHmut”). These mutations alter cellular biochemistry, and IDHmut gliomas are generally less aggressive than IDH wild-type (IDHwt) gliomas. Some preclinical studies and clinical trials have suggested that various forms of a ketogenic diet (KD), characterized by low-carbohydrate and high-fat content, may be beneficial in slowing glioma progression. However, adherence to a strict KD is difficult, and not all studies have shown promising results. Furthermore, no study has yet addressed whether IDHmut gliomas might be more sensitive to KD. The aim of the current study was to compare the effects of a unrestricted, cycling KD (weekly alternating between KD and standard diet) in preclinical models of IDHwt versus IDHmut gliomas. In vitro, simulating KD by treatment with the ketone body β-hydroxybutyrate had no effect on the proliferation of patient-derived IDHwt or IDHmut glioma cells, either in low or normal glucose conditions. Likewise, an unrestricted, cycling KD had no effect on the in vivo growth of patient-derived IDHwt or IDHmut gliomas, even though the cycling KD did result in persistently elevated circulating ketones. Furthermore, this KD conferred no survival benefit in mice engrafted with Sleeping-Beauty transposase-engineered IDHmut or IDHwt glioma. These data suggest that neither IDHwt nor IDHmut gliomas are particularly responsive to an unrestricted, cycling form of KD.

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“…The four major types of KD are the Classic Ketogenic Diet (CKD), the Ketogenic Diet with Medium-Chain Triglycerides (MCT), the Modified Atkins Diet (MAD), and the Low Glycemic Index Diet (LGID). The classical type is classified by a ratio of 3:1 to 4:1, that is, 3 to 4 grams of lipids for every 1 gram of carbohydrate and protein [ 4 , 5 ]. The utilization of MCT as an energy source is due to the greater production of ketone bodies compared to long-chain fatty acids.…”

Section: Introductionmentioning

confidence: 99%

“…Gliomas are primary, heterogeneous, invasive, and aggressive malignancies, which encompass most central nervous system tumors [ 1 , 5 , 13 ]. They originate from glial cells or stem cells, and after neoplastic transformation, acquire glial cell characteristics [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of the Ketogenic Diet in the Treatment of Gliomas: A Systematic Review

et al. 2022

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The ketogenic diet (KD) is a restrictive therapeutic diet, distinguished by being hyperlipidic, normoproteic, and hypoglucidic. This diet simulates biochemical changes related to fasting periods to achieve systemic ketosis. The metabolic particularities of glioma tumors motivated the rise in investigations and nutritional strategies, such as KD, to modulate the glycemic response as a treatment. This systematic review followed the PRISMA recommendations and was published in PROSPERO, with the identification CRD42021264173. The databases used were EMBASE, PubMed/Medline, Scopus, and Web of Science, and the studies were analyzed using the web-based application Rayyan. To analyze the risk of bias, Cochrane RevMan 5 software was used. For the analysis and treatment of statistical data, Microsoft® Excel® was used. A total of nine original articles were included. Data on survival, symptomology, and quality of life were collected. Mean overall survival was 15.9 months. Constipation and fatigue were the most reported symptoms. In 44.4% of the studies, an improvement in the quality of life was found. The KD is supported by most published studies as an effective therapy in the treatment of malignant gliomas due to its positive effects on patient survival. It was not possible to conclude the effectiveness of KD on quality of life.

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Isocaloric Ketogenic Diet in Adults with High-Grade Gliomas: A Prospective Metabolic Study

Cited by 9 publications

References 44 publications

Effect of Ketogenic Diets on Body Composition and Metabolic Parameters of Cancer Patients: A Systematic Review and Meta-Analysis

Effect of Ketogenic Diets on Body Composition and Metabolic Parameters of Cancer Patients: A Systematic Review and Meta-Analysis

The efficacy of an unrestricted cycling ketogenic diet in preclinical models of IDH wild-type and IDH mutant glioma

Effects of the Ketogenic Diet in the Treatment of Gliomas: A Systematic Review

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