Clinical efficacy of eucaloric ketogenic nutrition in the COVID-19 cytokine storm: A retrospective analysis of mortality and intensive care unit admission
Objectives: Our primary objective was to explore the effect of a eucaloric ketogenic diet (EKD) on mortality, admission to the intensive care unit, and need for non-invasive ventilation in hospitalized patients with COronaVIrus Disease 19 (COVID-19), in comparison to a eucaloric standard diet. Secon...
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| Veröffentlicht in: | Nutrition (Burbank, Los Angeles County, Calif.) Los Angeles County, Calif.), 2021-09, Vol.89, p.111236-111236, Article 111236 |
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| container_title | Nutrition (Burbank, Los Angeles County, Calif.) |
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| creator | Sukkar, Samir Giuseppe Cogorno, Ludovica Pisciotta, Livia Pasta, Andrea Vena, Antonio Gradaschi, Raffaella Dentone, Chiara Guiddo, Erica Martino, Eleonora Beltramini, Sabrina Donini, Lorenzo Maria Carmisciano, Luca Sormani, Maria Pia Bassetti, Matteo |
| description | Objectives: Our primary objective was to explore the effect of a eucaloric ketogenic diet (EKD) on mortality, admission to the intensive care unit, and need for non-invasive ventilation in hospitalized patients with COronaVIrus Disease 19 (COVID-19), in comparison to a eucaloric standard diet. Secondary objectives were verification of the safety and feasibility of the diet and its effects on inflammatory parameters, particularly interleukin-6.
Methods: The study is a retrospective analysis of 34 patients fed with an EKD in comparison to 68 patients fed with a eucaloric standard diet, selected and matched using propensity scores 1:2 to avoid the confounding effect of interfering variables. Our hypothesis was that an EKD would reduce mortality, admission to the intensive care unit, and need for non-invasive ventilation in patients with COVID-19.
Results: The preliminary multivariate analysis showed a statistically significant difference in survival (P = 0.046) and need for the intensive care unit (P = 0.049) for the EKD compared with a eucaloric standard diet. Even considering the EKD start day as a time-dependent variable, the results maintain a positive trend for application of the diet, and it is not possible to reject the null hypothesis (P < 0.05). Interleukin-6 concentrations between t0 and t7 (7 d after the beginning of the diet) in the ketogenic nutrition group show a trend that is almost significant (P = 0.062). The EKD was safe and no adverse events were observed.
Conclusions: These results show a possible therapeutic role of an EKD in the clinical management of COVID-19. Currently, a prospective controlled randomized trial is running to confirm these preliminary data.
•Nutritional therapies in COVID-19 have never been investigated before.•A eucaloric ketogenic diet is safe and feasible in patients with COVID-19.•A eucaloric ketogenic diet could reduce mortality and intensive care unit access in patients with COVID-19.•A eucaloric ketogenic diet seems to have a role in modulating inflammatory markers, particularly interleukin-6.•Further studies are necessary to clarify the role of ketogenic nutrition in COVID-19. |
| doi_str_mv | 10.1016/j.nut.2021.111236 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7937042</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0899900721000988</els_id><sourcerecordid>2565806738</sourcerecordid><originalsourceid>FETCH-LOGICAL-c479t-f3b2f26eed4f0590733f8cdce251f88fb0a439f4e944542e0711c33e7ea078e63</originalsourceid><addsrcrecordid>eNp9kc9u1DAQxi0EokvhAbggS1y4ZLFjJ45BqlQtLVSq1AtwtbzOuPU2sRfbWSmvwtPiaEsFHDiNNPObb_58CL2mZE0Jbd_v1n7K65rUdE0prVn7BK1oJ1hFa86fohXppKwkIeIEvUhpRwihspXP0QljnWyaRq7Qz83gvDN6wGBtiWbGwWKYSiZEZ_A95HALhcBlVHTZBY-dx_kO8Obm-9Wnikps5hzunQeccojjB3yOI-QY0h5MdgfA2uthTi4tymOIWQ8uzyXbF6UMPi2M0RHw5F3Guh9dSmXOS_TM6iHBq4d4ir5dXnzdfKmubz5fbc6vK8OFzJVl29rWLUDPLWkkEYzZzvQG6obarrNbojmTloPkvOE1EEGpYQwEaCI6aNkpOjvq7qftCKXR56gHtY9u1HFWQTv1d8W7O3UbDkpIJgivi8C7B4EYfkyQsioXGBgG7SFMSZVFOsGLJ8ust_-guzDF8p-FapuOtIJ1haJHypQvpgj2cRlK1OK82qlih1qcV0fnS8-bP6947PhtdQE-HgEovzw4iCoZB95A72IxSvXB_Uf-F-buwgM</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2565806738</pqid></control><display><type>article</type><title>Clinical efficacy of eucaloric ketogenic nutrition in the COVID-19 cytokine storm: A retrospective analysis of mortality and intensive care unit admission</title><source>MEDLINE</source><source>ScienceDirect Journals (5 years ago - present)</source><source>ProQuest Central UK/Ireland</source><creator>Sukkar, Samir Giuseppe ; Cogorno, Ludovica ; Pisciotta, Livia ; Pasta, Andrea ; Vena, Antonio ; Gradaschi, Raffaella ; Dentone, Chiara ; Guiddo, Erica ; Martino, Eleonora ; Beltramini, Sabrina ; Donini, Lorenzo Maria ; Carmisciano, Luca ; Sormani, Maria Pia ; Bassetti, Matteo</creator><creatorcontrib>Sukkar, Samir Giuseppe ; Cogorno, Ludovica ; Pisciotta, Livia ; Pasta, Andrea ; Vena, Antonio ; Gradaschi, Raffaella ; Dentone, Chiara ; Guiddo, Erica ; Martino, Eleonora ; Beltramini, Sabrina ; Donini, Lorenzo Maria ; Carmisciano, Luca ; Sormani, Maria Pia ; Bassetti, Matteo ; GECOVID Study Group</creatorcontrib><description>Objectives: Our primary objective was to explore the effect of a eucaloric ketogenic diet (EKD) on mortality, admission to the intensive care unit, and need for non-invasive ventilation in hospitalized patients with COronaVIrus Disease 19 (COVID-19), in comparison to a eucaloric standard diet. Secondary objectives were verification of the safety and feasibility of the diet and its effects on inflammatory parameters, particularly interleukin-6.
Methods: The study is a retrospective analysis of 34 patients fed with an EKD in comparison to 68 patients fed with a eucaloric standard diet, selected and matched using propensity scores 1:2 to avoid the confounding effect of interfering variables. Our hypothesis was that an EKD would reduce mortality, admission to the intensive care unit, and need for non-invasive ventilation in patients with COVID-19.
Results: The preliminary multivariate analysis showed a statistically significant difference in survival (P = 0.046) and need for the intensive care unit (P = 0.049) for the EKD compared with a eucaloric standard diet. Even considering the EKD start day as a time-dependent variable, the results maintain a positive trend for application of the diet, and it is not possible to reject the null hypothesis (P < 0.05). Interleukin-6 concentrations between t0 and t7 (7 d after the beginning of the diet) in the ketogenic nutrition group show a trend that is almost significant (P = 0.062). The EKD was safe and no adverse events were observed.
Conclusions: These results show a possible therapeutic role of an EKD in the clinical management of COVID-19. Currently, a prospective controlled randomized trial is running to confirm these preliminary data.
•Nutritional therapies in COVID-19 have never been investigated before.•A eucaloric ketogenic diet is safe and feasible in patients with COVID-19.•A eucaloric ketogenic diet could reduce mortality and intensive care unit access in patients with COVID-19.•A eucaloric ketogenic diet seems to have a role in modulating inflammatory markers, particularly interleukin-6.•Further studies are necessary to clarify the role of ketogenic nutrition in COVID-19.</description><identifier>ISSN: 0899-9007</identifier><identifier>EISSN: 1873-1244</identifier><identifier>DOI: 10.1016/j.nut.2021.111236</identifier><identifier>PMID: 33895559</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adverse events ; Aerobic glycolysis ; Applied Nutritional Investigation ; Blood ; Cardiovascular disease ; Clinical trials ; Comorbidity ; Coronaviruses ; COVID-19 ; Cytokine Release Syndrome ; Cytokine storm ; Cytokine storm syndrome ; Cytokines ; Dependent variables ; Diabetes ; Diet ; Genotype & phenotype ; Hematology ; High fat diet ; Hospitals ; Humans ; Hyperglycemia ; IL-6 ; Infections ; Infectious diseases ; Inflammation ; Intensive care ; Intensive Care Units ; Interleukin 6 ; Ketogenesis ; Ketogenic diet ; Laboratories ; Low carbohydrate diet ; Metabolism ; Mortality ; Multivariate analysis ; Neutrophils ; Null hypothesis ; Nutrition ; Nutrition research ; Pandemics ; Patients ; Polymerase chain reaction ; Prospective Studies ; Proteins ; Retrospective Studies ; SARS-CoV-2 ; Severe acute respiratory syndrome coronavirus 2 ; Statistical analysis ; Steroids ; Treatment Outcome ; Ventilation ; Viral diseases ; Warburg effect</subject><ispartof>Nutrition (Burbank, Los Angeles County, Calif.), 2021-09, Vol.89, p.111236-111236, Article 111236</ispartof><rights>2021 The Authors</rights><rights>Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.</rights><rights>2021. The Authors</rights><rights>2021 The Authors 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c479t-f3b2f26eed4f0590733f8cdce251f88fb0a439f4e944542e0711c33e7ea078e63</citedby><cites>FETCH-LOGICAL-c479t-f3b2f26eed4f0590733f8cdce251f88fb0a439f4e944542e0711c33e7ea078e63</cites><orcidid>0000-0002-9096-5812 ; 0000-0001-7080-9807</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2565806738?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>230,314,780,784,885,3548,27922,27923,45993,64383,64385,64387,72239</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33895559$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sukkar, Samir Giuseppe</creatorcontrib><creatorcontrib>Cogorno, Ludovica</creatorcontrib><creatorcontrib>Pisciotta, Livia</creatorcontrib><creatorcontrib>Pasta, Andrea</creatorcontrib><creatorcontrib>Vena, Antonio</creatorcontrib><creatorcontrib>Gradaschi, Raffaella</creatorcontrib><creatorcontrib>Dentone, Chiara</creatorcontrib><creatorcontrib>Guiddo, Erica</creatorcontrib><creatorcontrib>Martino, Eleonora</creatorcontrib><creatorcontrib>Beltramini, Sabrina</creatorcontrib><creatorcontrib>Donini, Lorenzo Maria</creatorcontrib><creatorcontrib>Carmisciano, Luca</creatorcontrib><creatorcontrib>Sormani, Maria Pia</creatorcontrib><creatorcontrib>Bassetti, Matteo</creatorcontrib><creatorcontrib>GECOVID Study Group</creatorcontrib><title>Clinical efficacy of eucaloric ketogenic nutrition in the COVID-19 cytokine storm: A retrospective analysis of mortality and intensive care unit admission</title><title>Nutrition (Burbank, Los Angeles County, Calif.)</title><addtitle>Nutrition</addtitle><description>Objectives: Our primary objective was to explore the effect of a eucaloric ketogenic diet (EKD) on mortality, admission to the intensive care unit, and need for non-invasive ventilation in hospitalized patients with COronaVIrus Disease 19 (COVID-19), in comparison to a eucaloric standard diet. Secondary objectives were verification of the safety and feasibility of the diet and its effects on inflammatory parameters, particularly interleukin-6.
Methods: The study is a retrospective analysis of 34 patients fed with an EKD in comparison to 68 patients fed with a eucaloric standard diet, selected and matched using propensity scores 1:2 to avoid the confounding effect of interfering variables. Our hypothesis was that an EKD would reduce mortality, admission to the intensive care unit, and need for non-invasive ventilation in patients with COVID-19.
Results: The preliminary multivariate analysis showed a statistically significant difference in survival (P = 0.046) and need for the intensive care unit (P = 0.049) for the EKD compared with a eucaloric standard diet. Even considering the EKD start day as a time-dependent variable, the results maintain a positive trend for application of the diet, and it is not possible to reject the null hypothesis (P < 0.05). Interleukin-6 concentrations between t0 and t7 (7 d after the beginning of the diet) in the ketogenic nutrition group show a trend that is almost significant (P = 0.062). The EKD was safe and no adverse events were observed.
Conclusions: These results show a possible therapeutic role of an EKD in the clinical management of COVID-19. Currently, a prospective controlled randomized trial is running to confirm these preliminary data.
•Nutritional therapies in COVID-19 have never been investigated before.•A eucaloric ketogenic diet is safe and feasible in patients with COVID-19.•A eucaloric ketogenic diet could reduce mortality and intensive care unit access in patients with COVID-19.•A eucaloric ketogenic diet seems to have a role in modulating inflammatory markers, particularly interleukin-6.•Further studies are necessary to clarify the role of ketogenic nutrition in COVID-19.</description><subject>Adverse events</subject><subject>Aerobic glycolysis</subject><subject>Applied Nutritional Investigation</subject><subject>Blood</subject><subject>Cardiovascular disease</subject><subject>Clinical trials</subject><subject>Comorbidity</subject><subject>Coronaviruses</subject><subject>COVID-19</subject><subject>Cytokine Release Syndrome</subject><subject>Cytokine storm</subject><subject>Cytokine storm syndrome</subject><subject>Cytokines</subject><subject>Dependent variables</subject><subject>Diabetes</subject><subject>Diet</subject><subject>Genotype & phenotype</subject><subject>Hematology</subject><subject>High fat diet</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hyperglycemia</subject><subject>IL-6</subject><subject>Infections</subject><subject>Infectious diseases</subject><subject>Inflammation</subject><subject>Intensive care</subject><subject>Intensive Care Units</subject><subject>Interleukin 6</subject><subject>Ketogenesis</subject><subject>Ketogenic diet</subject><subject>Laboratories</subject><subject>Low carbohydrate diet</subject><subject>Metabolism</subject><subject>Mortality</subject><subject>Multivariate analysis</subject><subject>Neutrophils</subject><subject>Null hypothesis</subject><subject>Nutrition</subject><subject>Nutrition research</subject><subject>Pandemics</subject><subject>Patients</subject><subject>Polymerase chain reaction</subject><subject>Prospective Studies</subject><subject>Proteins</subject><subject>Retrospective Studies</subject><subject>SARS-CoV-2</subject><subject>Severe acute respiratory syndrome coronavirus 2</subject><subject>Statistical analysis</subject><subject>Steroids</subject><subject>Treatment Outcome</subject><subject>Ventilation</subject><subject>Viral diseases</subject><subject>Warburg effect</subject><issn>0899-9007</issn><issn>1873-1244</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kc9u1DAQxi0EokvhAbggS1y4ZLFjJ45BqlQtLVSq1AtwtbzOuPU2sRfbWSmvwtPiaEsFHDiNNPObb_58CL2mZE0Jbd_v1n7K65rUdE0prVn7BK1oJ1hFa86fohXppKwkIeIEvUhpRwihspXP0QljnWyaRq7Qz83gvDN6wGBtiWbGwWKYSiZEZ_A95HALhcBlVHTZBY-dx_kO8Obm-9Wnikps5hzunQeccojjB3yOI-QY0h5MdgfA2uthTi4tymOIWQ8uzyXbF6UMPi2M0RHw5F3Guh9dSmXOS_TM6iHBq4d4ir5dXnzdfKmubz5fbc6vK8OFzJVl29rWLUDPLWkkEYzZzvQG6obarrNbojmTloPkvOE1EEGpYQwEaCI6aNkpOjvq7qftCKXR56gHtY9u1HFWQTv1d8W7O3UbDkpIJgivi8C7B4EYfkyQsioXGBgG7SFMSZVFOsGLJ8ust_-guzDF8p-FapuOtIJ1haJHypQvpgj2cRlK1OK82qlih1qcV0fnS8-bP6947PhtdQE-HgEovzw4iCoZB95A72IxSvXB_Uf-F-buwgM</recordid><startdate>20210901</startdate><enddate>20210901</enddate><creator>Sukkar, Samir Giuseppe</creator><creator>Cogorno, Ludovica</creator><creator>Pisciotta, Livia</creator><creator>Pasta, Andrea</creator><creator>Vena, Antonio</creator><creator>Gradaschi, Raffaella</creator><creator>Dentone, Chiara</creator><creator>Guiddo, Erica</creator><creator>Martino, Eleonora</creator><creator>Beltramini, Sabrina</creator><creator>Donini, Lorenzo Maria</creator><creator>Carmisciano, Luca</creator><creator>Sormani, Maria Pia</creator><creator>Bassetti, Matteo</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><general>The Authors. Published by Elsevier 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efficacy of eucaloric ketogenic nutrition in the COVID-19 cytokine storm: A retrospective analysis of mortality and intensive care unit admission</title><author>Sukkar, Samir Giuseppe ; Cogorno, Ludovica ; Pisciotta, Livia ; Pasta, Andrea ; Vena, Antonio ; Gradaschi, Raffaella ; Dentone, Chiara ; Guiddo, Erica ; Martino, Eleonora ; Beltramini, Sabrina ; Donini, Lorenzo Maria ; Carmisciano, Luca ; Sormani, Maria Pia ; Bassetti, Matteo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c479t-f3b2f26eed4f0590733f8cdce251f88fb0a439f4e944542e0711c33e7ea078e63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adverse events</topic><topic>Aerobic glycolysis</topic><topic>Applied Nutritional Investigation</topic><topic>Blood</topic><topic>Cardiovascular disease</topic><topic>Clinical trials</topic><topic>Comorbidity</topic><topic>Coronaviruses</topic><topic>COVID-19</topic><topic>Cytokine Release Syndrome</topic><topic>Cytokine storm</topic><topic>Cytokine storm syndrome</topic><topic>Cytokines</topic><topic>Dependent variables</topic><topic>Diabetes</topic><topic>Diet</topic><topic>Genotype & phenotype</topic><topic>Hematology</topic><topic>High fat diet</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Hyperglycemia</topic><topic>IL-6</topic><topic>Infections</topic><topic>Infectious diseases</topic><topic>Inflammation</topic><topic>Intensive care</topic><topic>Intensive Care Units</topic><topic>Interleukin 6</topic><topic>Ketogenesis</topic><topic>Ketogenic diet</topic><topic>Laboratories</topic><topic>Low carbohydrate diet</topic><topic>Metabolism</topic><topic>Mortality</topic><topic>Multivariate analysis</topic><topic>Neutrophils</topic><topic>Null hypothesis</topic><topic>Nutrition</topic><topic>Nutrition research</topic><topic>Pandemics</topic><topic>Patients</topic><topic>Polymerase chain reaction</topic><topic>Prospective Studies</topic><topic>Proteins</topic><topic>Retrospective Studies</topic><topic>SARS-CoV-2</topic><topic>Severe acute respiratory syndrome coronavirus 2</topic><topic>Statistical analysis</topic><topic>Steroids</topic><topic>Treatment Outcome</topic><topic>Ventilation</topic><topic>Viral diseases</topic><topic>Warburg effect</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sukkar, Samir Giuseppe</creatorcontrib><creatorcontrib>Cogorno, Ludovica</creatorcontrib><creatorcontrib>Pisciotta, Livia</creatorcontrib><creatorcontrib>Pasta, Andrea</creatorcontrib><creatorcontrib>Vena, Antonio</creatorcontrib><creatorcontrib>Gradaschi, Raffaella</creatorcontrib><creatorcontrib>Dentone, Chiara</creatorcontrib><creatorcontrib>Guiddo, Erica</creatorcontrib><creatorcontrib>Martino, Eleonora</creatorcontrib><creatorcontrib>Beltramini, Sabrina</creatorcontrib><creatorcontrib>Donini, Lorenzo Maria</creatorcontrib><creatorcontrib>Carmisciano, Luca</creatorcontrib><creatorcontrib>Sormani, Maria Pia</creatorcontrib><creatorcontrib>Bassetti, Matteo</creatorcontrib><creatorcontrib>GECOVID Study Group</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Career & Technical Education Database</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Toxicology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 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Database</collection><collection>Research Library</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Nutrition (Burbank, Los Angeles County, Calif.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sukkar, Samir Giuseppe</au><au>Cogorno, Ludovica</au><au>Pisciotta, Livia</au><au>Pasta, Andrea</au><au>Vena, Antonio</au><au>Gradaschi, Raffaella</au><au>Dentone, Chiara</au><au>Guiddo, Erica</au><au>Martino, Eleonora</au><au>Beltramini, Sabrina</au><au>Donini, Lorenzo Maria</au><au>Carmisciano, Luca</au><au>Sormani, Maria Pia</au><au>Bassetti, Matteo</au><aucorp>GECOVID Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical efficacy of eucaloric ketogenic nutrition in the COVID-19 cytokine storm: A retrospective analysis of mortality and intensive care unit admission</atitle><jtitle>Nutrition (Burbank, Los Angeles County, Calif.)</jtitle><addtitle>Nutrition</addtitle><date>2021-09-01</date><risdate>2021</risdate><volume>89</volume><spage>111236</spage><epage>111236</epage><pages>111236-111236</pages><artnum>111236</artnum><issn>0899-9007</issn><eissn>1873-1244</eissn><abstract>Objectives: Our primary objective was to explore the effect of a eucaloric ketogenic diet (EKD) on mortality, admission to the intensive care unit, and need for non-invasive ventilation in hospitalized patients with COronaVIrus Disease 19 (COVID-19), in comparison to a eucaloric standard diet. Secondary objectives were verification of the safety and feasibility of the diet and its effects on inflammatory parameters, particularly interleukin-6.
Methods: The study is a retrospective analysis of 34 patients fed with an EKD in comparison to 68 patients fed with a eucaloric standard diet, selected and matched using propensity scores 1:2 to avoid the confounding effect of interfering variables. Our hypothesis was that an EKD would reduce mortality, admission to the intensive care unit, and need for non-invasive ventilation in patients with COVID-19.
Results: The preliminary multivariate analysis showed a statistically significant difference in survival (P = 0.046) and need for the intensive care unit (P = 0.049) for the EKD compared with a eucaloric standard diet. Even considering the EKD start day as a time-dependent variable, the results maintain a positive trend for application of the diet, and it is not possible to reject the null hypothesis (P < 0.05). Interleukin-6 concentrations between t0 and t7 (7 d after the beginning of the diet) in the ketogenic nutrition group show a trend that is almost significant (P = 0.062). The EKD was safe and no adverse events were observed.
Conclusions: These results show a possible therapeutic role of an EKD in the clinical management of COVID-19. Currently, a prospective controlled randomized trial is running to confirm these preliminary data.
•Nutritional therapies in COVID-19 have never been investigated before.•A eucaloric ketogenic diet is safe and feasible in patients with COVID-19.•A eucaloric ketogenic diet could reduce mortality and intensive care unit access in patients with COVID-19.•A eucaloric ketogenic diet seems to have a role in modulating inflammatory markers, particularly interleukin-6.•Further studies are necessary to clarify the role of ketogenic nutrition in COVID-19.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>33895559</pmid><doi>10.1016/j.nut.2021.111236</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0002-9096-5812</orcidid><orcidid>https://orcid.org/0000-0001-7080-9807</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0899-9007 |
| ispartof | Nutrition (Burbank, Los Angeles County, Calif.), 2021-09, Vol.89, p.111236-111236, Article 111236 |
| issn | 0899-9007 1873-1244 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7937042 |
| source | MEDLINE; ScienceDirect Journals (5 years ago - present); ProQuest Central UK/Ireland |
| subjects | Adverse events Aerobic glycolysis Applied Nutritional Investigation Blood Cardiovascular disease Clinical trials Comorbidity Coronaviruses COVID-19 Cytokine Release Syndrome Cytokine storm Cytokine storm syndrome Cytokines Dependent variables Diabetes Diet Genotype & phenotype Hematology High fat diet Hospitals Humans Hyperglycemia IL-6 Infections Infectious diseases Inflammation Intensive care Intensive Care Units Interleukin 6 Ketogenesis Ketogenic diet Laboratories Low carbohydrate diet Metabolism Mortality Multivariate analysis Neutrophils Null hypothesis Nutrition Nutrition research Pandemics Patients Polymerase chain reaction Prospective Studies Proteins Retrospective Studies SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 Statistical analysis Steroids Treatment Outcome Ventilation Viral diseases Warburg effect |
| title | Clinical efficacy of eucaloric ketogenic nutrition in the COVID-19 cytokine storm: A retrospective analysis of mortality and intensive care unit admission |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-10T02%3A33%3A00IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Clinical%20efficacy%20of%20eucaloric%20ketogenic%20nutrition%20in%20the%20COVID-19%20cytokine%20storm:%20A%20retrospective%20analysis%20of%20mortality%20and%20intensive%20care%20unit%20admission&rft.jtitle=Nutrition%20(Burbank,%20Los%20Angeles%20County,%20Calif.)&rft.au=Sukkar,%20Samir%20Giuseppe&rft.aucorp=GECOVID%20Study%20Group&rft.date=2021-09-01&rft.volume=89&rft.spage=111236&rft.epage=111236&rft.pages=111236-111236&rft.artnum=111236&rft.issn=0899-9007&rft.eissn=1873-1244&rft_id=info:doi/10.1016/j.nut.2021.111236&rft_dat=%3Cproquest_pubme%3E2565806738%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2565806738&rft_id=info:pmid/33895559&rft_els_id=S0899900721000988&rfr_iscdi=true |