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

Rainer J Klement, Colin E Champ, Ulrike Kämmerer, Petra S Koebrunner, Kelley Krage, Gabriele Schäfer, M Weigel, Reinhart A Sweeney, Rainer J Klement, Colin E Champ, Ulrike Kämmerer, Petra S Koebrunner, Kelley Krage, Gabriele Schäfer, M Weigel, Reinhart A Sweeney

Abstract

Background: Obesity and low muscle mass are associated with worse outcomes of breast cancer patients. We conducted a controlled trial to study the impact of a ketogenic diet (KD) based on natural foods versus an unspecified standard diet (SD) on body composition in breast cancer patients undergoing radiotherapy.

Methods: Patients with non-metastasized breast cancer were allocated to either the KD (N = 32) or the SD (N = 31) during radiotherapy. Body composition was measured weekly by bioimpedance analysis. Blood parameters and quality of life were assessed before, during, and at the end of radiotherapy.

Results: A total of 29 KD and 30 SD patients completed the study. During radiotherapy, mean and median fasting BHB concentrations in the KD group were 0.72 and 0.49 mmol/l (range 0.06-4.9) which was significantly higher than those in the SD group (p < 2.2 × 10-16). There was a very small and insignificant increase in body weight and fat mass in the SD group, as well as a decrease of fat free mass. In contrast, patients in the KD group lost body weight and fat free and skeletal muscle mass quickly after diet onset, which for the most part was related to water losses. The KD did not cause further substantial changes in fat free or skeletal muscle mass, but was associated with a gradual decrease of 0.4 kg body weight and fat mass per week (p < 0.0001). The KD significantly decreased free T3 levels by 0.06 pg/ml/week (p = 6.3 × 10-5). Global quality of life remained stable in the SD group but increased in the KD group from a score of 66.7 to 75.0 (p = 0.20).

Conclusions: In breast cancer patients undergoing curative radiotherapy, a KD based on natural foods is feasible. After initial water losses, the KD tends to reduce body weight and fat mass while preserving fat free and skeletal muscle mass.

Trial registration: ClinicalTrials.gov identifier: NCT02516501 , registered on August 06, 2015.

Keywords: Bioimpedance analysis; Diet; Ketone bodies; Nutrition.

Conflict of interest statement

All authors except for M. Weigel are occasionally on a ketogenic diet. CEC is on the advisory board at Virta Health and is a director and grant reviewer for the nonprofit Advancing Ketogenic Therapies. Besides that, there are no other potential conflicts of interest related to this publication.

Figures

Fig. 1
Fig. 1
Flowchart of patient recruitment. Reasons for dropout in the KD group were non-compliance with the dietary advice and stress
Fig. 2
Fig. 2
Individual changes in body weight, fat mass, and fat free mass in the KD (Keto) and SD (Control) groups. The lines are linear regression lines, each fitted to an individual patient’s longitudinal body composition data
Fig. 3
Fig. 3
Absolute changes in body composition for patients receiving different fractionated radiotherapy (FxRT): hypofractionation (16-19 fractions) or normofractionation (25–31 fractions)

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