A ketogenic diet exerts beneficial effects on body composition of cancer patients during radiotherapy: An interim analysis of the KETOCOMP study

Abstract

Background and aim Ketogenic diets (KDs) have gained interest as a complementary treatment for cancer patients. Here we present first results of our ongoing KETOCOMP study (NCT02516501) concerning body composition changes among rectal, breast and head & neck cancer (HNC) patients who consumed a KD during curative radiotherapy (RT). Experimental procedure Sixty-one patients eating a non-ketogenic diet were compared to 20 patients on a KD supplemented with 10 g essential amino acids on RT days. Body composition was measured prior to and weekly during RT using 8-electrode bioimpedance analysis. Longitudinal body composition data were analyzed using linear mixed effects models. Results and conclusion Patients on the KD exhibited nutritional ketosis, defined as serum β-hydroxybutyrate levels ≥0.5 mmol/l, in a median of 69.0% of blood measurements (range 0–100%) performed in our clinic. In rectal and breast cancer patients, KD was significantly associated with a loss of 0.5 and 0.4 kg fat mass per week (p = 0.00089 and 8.49 × 10 −5 , respectively), with no significant changes in fat free and skeletal muscle mass. In HNC patients, concurrent chemotherapy was the strongest predictor of body weight, fat free and skeletal muscle mass loss during RT, while consuming a KD was significantly associated with a gain in these measures. These preliminary results confirm prior reports indicating that KDs are safe to consume during standard-of-care therapy. They also provide an important first indication that KDs with ample amino acid intake could improve body composition during RT in curative cancer patients.

Impact of a ketogenic diet intervention during radiotherapy on body composition: III—final results of the KETOCOMP study for breast cancer patients

“…The KD induced weight loss, primarily by reducing ICW and FM. These results are in line with, and thus confirm, our interim analysis that already revealed these effects [24].…”

“…This study has been approved by the ethics committee of the Bavarian Medical Association (Landesaerztekammer Bayern) and registered under ClinicalTrials.gov identifier NCT02516501. In a first interim analysis, we have reported favorable effects on body composition of seven breast cancer, eight rectal cancer, and five head and neck cancer patients following a KD during radiotherapy compared to control patients on a standard diet (SD) [ 24 ]. Here, we report the final results of the KETOCOMP study for the subgroup of breast cancer patients.…”

Addressing the controversial role of ketogenic diets in cancer treatment

“…We now have some evidence for beneficial effects of a KD on body composition in gynecological cancers [19,21], pancreatic cancer [23] and head and neck cancer patients [21]. We also have some evidence for synergistic effects between KDs and other therapies, in accordance with predictions from animal studies [2].…”

“…However, more recently higher-quality clinical studies have been published. Table 1 gives an overview of the controlled clinical trials published to date and their endpoints [17][18][19][20][21][22].…”

“…Finally, a randomized controlled trial in breast cancer patients receiving neoadjuvant chemotherapy found that a KD resulted in significantly longer overall survival compared to a control diet over a follow-up period of 30 months [22]. As a drawback, only some of these controlled studies have also been randomized, patient numbers were [18] 2018 HGG 17 15 Intranasal perillyl alcohol Yes Yes No Cohen [19] 2018 Ovarian, endometrial cancer 25 20 Chemotherapy (24% of the patients) No No Yes Furukawa [20] 2018 Rectal cancer 7 13 Chemotherapy No Yes No Klement [21] 2019 Breast, rectal, HNC 20 61 Radiotherapy ± chemotherapy No No Yes Khodabakhshi [22] 2019 Breast cancer 30 30 Chemotherapy Yes No Yes small, diets were not well described and ketosis not reached by all patients [6]. Some studies have also provided disappointing results.…”