Promising Effect of a New Ketogenic Diet Regimen in Patients with Advanced Cancer - PubMed (original) (raw)
. 2020 May 19;12(5):1473.
doi: 10.3390/nu12051473.
Katsufumi Kajimoto 1, Satoshi Osaga 2, Naoko Nagai 3, Eku Shimosegawa 4, Hideyuki Nakata 1, Hitomi Saito 1, Mai Nakano 1, Mariko Takeuchi 1, Hideaki Kanki 1, Kuriko Kagitani-Shimono 5, Takashi Kijima 6
Affiliations
- PMID: 32438645
- PMCID: PMC7284721
- DOI: 10.3390/nu12051473
Promising Effect of a New Ketogenic Diet Regimen in Patients with Advanced Cancer
Keisuke Hagihara et al. Nutrients. 2020.
Abstract
A ketogenic diet is expected to be an effective support therapy for patients with cancer, but the degree and duration of carbohydrate restriction are unclear. We performed a case series study of a new ketogenic diet regimen in patients with different types of stage IV cancer. Carbohydrates were restricted to 10 g/day during week one, 20 g/day from week two for three months, and 30 g/day thereafter. A total of 55 patients participated in the study, and data from 37 patients administered the ketogenic diet for three months were analyzed. No severe adverse events associated with the diet were observed. Total ketone bodies increased significantly, and both fasting blood sugar and insulin levels were suppressed significantly for three months after completion of the study. Five patients showed a partial response on Positron emission tomography-computed tomography (PET-CT) at three months. Three and seven patients showed complete and partial responses, respectively at one year. Median survival was 32.2 (maximum: 80.1) months, and the three-year survival rate was 44.5%. After three months on the ketogenic diet, the serum Alb, BS, and CRP (ABC) score could be used to stratify the patients into groups with significantly different survival rates (p < 0.001, log-rank test). Our ketogenic diet regimen is considered to be a promising support therapy for patients with different types of advanced cancer.
Keywords: PET-CT; cancer; ketogenic diet.
Conflict of interest statement
This study was partly performed under a joint research between the University of Osaka, Meiji Co., Ltd., and Nissin Oillio. Hagihara holds the position of Joint Research Chair in collaboration with Meiji Co., Ltd. who produced the ketogenic formula, and Nisshin Oillio produced the MCT oil. Kajimoto is a member of the Joint Research group. Other authors have no competing interests.
Figures
Figure 1
Ketogenic diet for patients with cancer. (A) Regimen of the ketogenic diet for cancer patients. The ketone ratio is calculated as: lipid/protein + carbohydrate. Daily caloric intake is 30 kcal/kg ideal body weight. Medium chain triglyceride (MCT) oil and a ketogenic formula are used for calorie supplementation. (B) Flow diagram of 37 evaluable patients from among the 55 participants.
Figure 2
Blood data of patients after the ketogenic diet. Box plots represent medians and interquartile ranges; whiskers indicate range of values that fall within 1.5 box lengths. Footnotes indicate significant differences (Wilcoxon signed-rank test; enrollment vs. 1 week and 1, 2, and 3 months. * p < 0.001, † p < 0.01, ‡ p < 0.05). BHB, β-hydroxybutyric acid; Alb, albumin; CRP, C-reactive protein.
Figure 3
(A) Glucose ketone index (GKI) and (B) the GKI after the ketogenic diet.
Figure 4
Clinical effect of the ketogenic diet for patients with cancer. Whole body maximal intensity projection images and axial fused PET/CT images before and after the ketogenic diet. (A) A 58-year-old man with colorectal cancer. (B) A 55-year-old man with lung cancer. Hot spots of 18F-FDG before (yellow arrow) and the same position after the ketogenic diet (white arrow). Physiological hot spot in the stomach (black arrow). (C) Response evaluation after the ketogenic diet. Response evaluation with PET/CT at 3 months and clinical evaluation at one year. CT imaging findings were assessed using Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. CR, complete response; NP, not performed; PD, progressive disease; PR, partial response; SD, stable disease. PET imaging findings were analyzed according to European Organization for Research and Treatment of Cancer (EORTC) criteria. CMR, complete metabolic response; PMR, partial metabolic response; SMD, stable metabolic disease; PMD, progressive metabolic disease.
Figure 5
Cumulative survival rates of patients on the ketogenic diet. (A) Continuous line shows overall survival of 37 patients. Dotted lines indicate 95% confidence intervals. (B) Patients with serum values for albumin (Alb) ≥ or < 4.0 mg/dL (_p_ < 0.001); (**C**) glucose (Glu) > or ≤ 90 mg/dL (p < 0.001) and (**D**) C-reactive protein (CRP) > or ≤ 0.5 mg/dL (p < 0.001). (E) Diagram of the ketogenic diet-ABC (KD-ABC) score calculation method. (F) KD-ABC scores significantly stratify cumulative survival rates (p < 0.001). All p values determined by log-rank tests.
References
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