Elsevier

Nutrition

Volume 89, September 2021, 111236
Nutrition

Applied nutritional investigation
Clinical efficacy of eucaloric ketogenic nutrition in the COVID-19 cytokine storm: A retrospective analysis of mortality and intensive care unit admission

https://doi.org/10.1016/j.nut.2021.111236Get rights and content
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open access

Highlights

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    Nutritional therapies in COVID-19 have never been investigated before.

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    A eucaloric ketogenic diet is safe and feasible in patients with COVID-19.

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    A eucaloric ketogenic diet could reduce mortality and intensive care unit access in patients with COVID-19.

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    A eucaloric ketogenic diet seems to have a role in modulating inflammatory markers, particularly interleukin-6.

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    Further studies are necessary to clarify the role of ketogenic nutrition in COVID-19.

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.

Keywords

Ketogenic diet
COVID-19
Cytokine storm syndrome
IL-6
Warburg effect
Hyperglycemia
Aerobic glycolysis
SARS-CoV-2

Cited by (0)

The article was submitted to the Ligurian Ethical Committee, which approved its publication on November 24, 2020.

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GECOVID-19 Study Group: Anna Alessandrini, Marco Camera, Emanuele Delfino, Andrea De Maria, Chiara Dentone, Antonio Di Biagio, Ferdinando Dodi, Antonio Ferrazin, Giovanni Mazzarello, Malgorzata Mikulska, Laura Nicolini, Federica Toscanini, Daniele Roberto Giacobbe, Antonio Vena, Lucia Taramasso, Elisa Balletto, Federica Portunato, Eva Schenone, Nirmala Rosseti, Federico Baldi, Marco Berruti, Federica Briano, Silvia Dettori, Laura Labate, Laura Magnasco, Michele Mirabella, Rachele Pincino, Chiara Russo, Giovanni Sarteschi, Chiara Sepulcri, Stefania Tutino (Clinica di Malattie Infettive), Roberto Pontremoli, Valentina Beccati, Salvatore Casciaro, Massimo Casu, Francesco Gavaudan, Maria Ghinatti, Elisa Gualco, Giovanna Leoncini, Paola Pitto, Kassem Salam (Clinica di Medicina interna 2), Angelo Gratarola, Mattia Bixio, Annalisa Amelia, Andrea Balestra, Paola Ballarino, Nicholas Bardi, Roberto Boccafogli, Francesca Caserza, Elisa Calzolari, Marta Castelli, Elisabetta Cenni, Paolo Cortese, Giuseppe Cuttone, Sara Feltrin, Stefano Giovinazzo, Patrizia Giuntini, Letizia Natale, Davide Orsi, Matteo Pastorino, Tommaso Perazzo, Fabio Pescetelli, Federico Schenone, Maria Grazia Serra, Marco Sottano (Anestesia e Rianimazione; Emergenza Covid padiglione 64 “Fagiolone”), Roberto Tallone, Massimo Amelotti, Marie Jeanne Majabò, Massimo Merlini, Federica Perazzo (Cure intermedie), Nidal Ahamd, Paolo Barbera, Marta Bovio, Paola Campodonico, Andrea Collidà, Ombretta Cutuli, Agnese Lomeo, Francesca Fezza Nicola Gentilucci, Nadia Hussein, Emanuele Malvezzi, Laura Massobrio, Giula Motta, Laura Pastorino, Nicoletta Pollicardo, Stefano Sartini, Paola Vacca Valentina Virga (Dipartimento di Emergenza ed accettazione), Italo Porto, Giampaolo Bezante, Roberta Della Bona, Giovanni La Malfa, Alberto Valbusa, Vered Gil Ad (Clinica Malattie Cardiovascolari), Emanuela Barisione, Michele Bellotti, Aloe’ Teresita, Alessandro Blanco, Marco Grosso, Maria Grazia Piroddi (Pneumologia ad Indirizzo Interventistico), Paolo Moscatelli, Paola Ballarino, Matteo Caiti, Elisabetta Cenni, Patrizia Giuntini Ottavia Magnani (Medicine d'Urgenza), Samir Sukkar, Ludovica Cogorno, Raffaella Gradaschi, Erica Guiddo, Eleonora Martino, Livia Pisciotta (Dietetica e nutrizione clinica), Bruno Cavaliere, Rossi Cristina, Farina Francesca (Direzione delle Professioni sanitarie), Giacomo Garibotto, Pasquale Esposito (Clinica nefrologica, dialisi e trapianto), Carmen Bellezza, Emirjona Harusha, Francesca Rossi, Eleonora Arboscello, Laura Arzani, Laura De Mattei, Marzia Spadaro (Area medica critica, Pronto Soccorso), Giovanni Passalacqua, Diego Bagnasco, Fulvio Braido, Annamaria Riccio, Elena Tagliabue (Clinica Malattie Respiratorie ed Allergologia), Claudio Gustavino, Antonella Ferraiolo (Ostetricia e Ginecologia), Fiammetta Monacelli, Mona Mahmoud, Luca Tagliafico, Armando Napolitano, Maria Fiorio, Monica Pizzonia, Chiara Giannotti, Alessio Nencioni (Geriatria), Salvatore Giuffrida, Nicola Rosso (Direzione Amministrativa), Alessandra Morando, Riccardo Papalia, Donata Passerini, Gabriella Tiberio (Direzione di presidio), Giovanni Orengo, Alberto Battaglini (Gestione del rischio clinico), Silvano Ruffoni, and Sergio Caglieris.

© 2021 The Authors. Published by Elsevier Inc.