Impact of a ketogenic diet intervention during radiotherapy on body composition: V. Final results of the KETOCOMP study for head and neck cancer patients

Rainer J Klement, Reinhart A Sweeney, Rainer J Klement, Reinhart A Sweeney

Abstract

Purpose: Patients with head and neck cancer (HNC) are at risk of malnutrition, especially during radiochemotherapy. We aimed to study the impact of a ketogenic diet (KD) versus an unspecified standard diet (SD) on body composition and survival in HNC patients undergoing radio(chemo)therapy.

Methods: As part of a controlled clinical trial, non-metastasized HNC patients were enrolled into either a KD (N = 11) or an SD (N = 21) group between May 2015 and May 2021. Body composition was measured weekly by bioimpedance analysis and analyzed using linear mixed effects models. Overall and progression-free survival was assessed during regular follow-up.

Results: A total of 7 KD and 21 SD patients completed the study and were eligible for comparative analysis. Chemotherapy was significantly associated with declines in all body composition parameters, while the KD had opposing, yet nonsignificant effects. In patients receiving chemotherapy, average weekly reductions of body mass (BM) and skeletal muscle mass (SMM) were 0.9 kg and 0.31 kg in the KD group versus 1.2 kg and 0.57 kg in the SD group, respectively. Patients in the KD group receiving no chemotherapy achieved an average increase of 0.04 kg BM and 0.12 kg SMM per week. After a median follow-up of 42 months (range 6.7-78 months) there were no significant differences in progression-free or overall survival between the groups.

Conclusion: The KD may partially counteract the detrimental effects of radiochemotherapy on body composition in HNC patients. This should encourage further research into KDs in frail cancer patient populations and motivate their implementation as complementary therapy for selected patients.

Keywords: Bioimpedance analysis; Chemotherapy; Ketone bodies; Ketosis; Squamous cell carcinoma.

Conflict of interest statement

R.J. Klement has received an honorarium from the company vitaflo for giving a talk about the objectives and preliminary results of the KETOCOMP study. R.J. Klement and R.A. Sweeney follow a KD occasionally. No other potential conflicts of interest, in particular no financial conflicts of interest, exist. The companies providing product samples for this study had no influence on the design, data collection, or analysis, and none of the authors has any business relationship with them.

© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

Figures

Fig. 1
Fig. 1
Flowchart showing the recruitment process of the study
Fig. 2
Fig. 2
Absolute body composition changes. Notice the similarity between FFM and TBW changes as well as between SMM and ICW changes. P-values refer to a comparison of body composition changes between the KD and SD group (Wilcoxon rank sum test)
Fig. 3
Fig. 3
Survival outcomes in the KD and SD groups estimated with the Kaplan–Meier method
Fig. 4
Fig. 4
Intention-to-treat survival outcomes in the KD and SD groups estimated with the Kaplan-Meier method

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