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. 2021 Sep:89:111236.
doi: 10.1016/j.nut.2021.111236. Epub 2021 Mar 7.

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

Samir Giuseppe Sukkar  1 , Ludovica Cogorno  2 , Livia Pisciotta  3 , Andrea Pasta  3 , Antonio Vena  4 , Raffaella Gradaschi  3 , Chiara Dentone  4 , Erica Guiddo  3 , Eleonora Martino  3 , Sabrina Beltramini  5 , Lorenzo Maria Donini  6 , Luca Carmisciano  7 , Maria Pia Sormani  7 , Matteo Bassetti  4 ; GECOVID Study Group
Affiliations

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

Samir Giuseppe Sukkar et al. Nutrition. 2021 Sep.

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

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Figures

Fig 1
Fig. 1
Plan of the study.
Fig 2
Fig. 2
Kaplan–Meier estimates (between control and treatment groups) stratified by time-varying start of ketogenic diet for (A) 30-d mortality and (B) need for intensive care unit.
Fig 3
Fig. 3
Variation in interleukin-6 during ketogenic diet versus standard diet.
See this image and copyright information in PMC

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