Ketogenic diet in relapsing multiple sclerosis: Patient perceptions, post-trial diet adherence & outcomes.

Autor: Wetmore E; Dept of Neurology, University of Virginia, Charlottesville, VA, USA; School of Medicine, Medical University of South Carolina, Charleston, SC, USA., Lehner-Gulotta D; Dept of Neurology, University of Virginia, Charlottesville, VA, USA; Division of Child Neurology, Dept. of Neurology, University of Virginia, Charlottesville, VA, USA., Florenzo B; School of Medicine, University of Virginia, Charlottesville, VA, USA., Banwell B; Division of Child Neurology, Children's Hospital of Philadelphia, Dept. of Neurology and Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA., Bergqvist AGC; Division of Child Neurology, Children's Hospital of Philadelphia, Dept. of Neurology and Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA., Coleman R; Dept of Neurology, University of Virginia, Charlottesville, VA, USA., Conaway M; Dept of Public Health Sciences, University of Virginia, Charlottesville, VA, USA., Goldman MD; Dept of Neurology, Virginia Commonwealth University, Richmond, VA, USA., Brenton JN; Dept of Neurology, University of Virginia, Charlottesville, VA, USA; Division of Child Neurology, Dept. of Neurology, University of Virginia, Charlottesville, VA, USA. Electronic address: jnb8h@uvahealth.org.
Jazyk: angličtina
Zdroj: Clinical nutrition (Edinburgh, Scotland) [Clin Nutr] 2023 Aug; Vol. 42 (8), pp. 1427-1435. Date of Electronic Publication: 2023 Jul 04.
DOI: 10.1016/j.clnu.2023.06.029
Abstrakt: Background: Ketogenic diets (KDs) are safe and tolerable in people with multiple sclerosis (MS). While many patient-reported and clinical benefits are noted, the sustainability of these diets outside of a clinical trial is unknown.
Aims: Evaluate patient perceptions of the KD following intervention, determine the degree of adherence to KDs post-trial, and examine what factors increase the likelihood of KD continuation following the structured diet intervention trial.
Methods: Sixty-five subjects with relapsing MS previously enrolled into a 6-month prospective, intention-to-treat KD intervention. Following the 6-month trial, subjects were asked to return for a 3-month post-study follow-up, at which time patient reported outcomes, dietary recall, clinical outcome measures, and laboratory values were repeated. In addition, subjects completed a survey to evaluate sustained and attenuated benefits following completion of the intervention phase of the trial.
Results: Fifty-two subjects (81%) returned for the 3-month post-KD intervention visit. Twenty-one percent reported continued adherence to a strict KD and an additional 37% reported adhering to a liberalized, less restrictive form of the KD. Those subjects with greater reductions in body mass index (BMI) and fatigue at 6-months on-diet were more likely to continue on KD following trial completion. Using intention-to-treat analysis, patient-reported and clinical outcomes at 3-months post-trial remained significantly improved from baseline (pre-KD), though the degree of improvement was slightly attenuated relative to outcomes at 6-months on KD. Regardless of diet type following the KD intervention, dietary patterns shifted toward greater protein and polyunsaturated fats and less carbohydrate/added sugar consumption.
Conclusions: Following the 6-month KD intervention study, the majority of subjects elected to continue on KD, though many pursued a more liberal limit for carbohydrate restriction. Those who experienced a greater reduction in BMI or fatigue were more likely to continue with strict KD. The 6-month KD intervention induced persistent changes to dietary habits in the months following study completion.
Trial Registration Information: Registered on Clinicaltrials.gov under registration number NCT03718247, posted on Oct 24, 2018. First patient enrollment date: Nov 1, 2018. Link: https://clinicaltrials.gov/ct2/show/NCT03718247?term=NCT03718247&draw=2&rank=1.
Competing Interests: Conflict of interest E. Wetmore reports no disclosures relevant to the manuscript. D. Lehner-Gulotta is a consultant for Functional Formularies. B. Florenzo has no disclosures relevant to the manuscript. B. Banwell serves as a consultant to Novartis, Roche, UCB, Teva Neuroscience, Biogen, and Sanofi. AGC Bergqvist serves as a paid speaker for Nutricia North America. R. Coleman reports no disclosures relevant to the manuscript. M. Conaway reports no disclosures relevant to the manuscript. M.D. Goldman has served on the DSMB for Anokion SMC and Immunic. She has received consulting fees from Adamas Pharmaceuticals, Biogen IDEC, Brainstorm Cell Therapeutics Ltd, EMD Serono, Genetec, Greenwich Biosciences, Horizons, Immunic, Merck, Novartis, Sanofi Genzyme, and Vebrilio. J.N. Brenton has served as a consultant to Cycle Pharmaceuticals. JNB's research is funded by the NIH and the National Institute of Neurological Disorders and Stroke (grant number: K23NS116225) and by the iTHRIV Scholars Program through the National Center for Advancing Translational Sciences of the NIH under award numbers UL1TR003015 and KL2TR003016.
(Copyright © 2023 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)
Databáze: MEDLINE
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