Abstract
BackgroundShort periods of fasting and/or low-carbohydrate diet have been proven beneficial for decreasing the myocardial uptake of 18F-fluorodeoxyglucose (18F-FDG) and enhancing the detection of inflammatory heart diseases by 18F-FDG positron emission tomography (PET). This study aimed at determining whether this benefit is increased when a low-carbohydrate ketogenic diet is prolonged up to 7 days. MethodsWistar rats underwent serial 18F-FDG-PET imaging after an 18-hour fasting period and after 2, 4 and 7 days of a ketogenic diet (3% carbohydrate) and they were compared to rats submitted to the same protocol but with normal diet (44% carbohydrate). The 18F-FDG-PET/ketogenic protocol was also applied in rats with immune myocarditis (injection of porcine cardiac myosin). ResultsThe 7-day ketogenic diet was associated with (1) a sustained increase in circulating ketone bodies at an equivalent level to that reached after 18-hour fasting, (2) a gradual decrease in 18F-FDG uptake within normal myocardium reaching a lower level compared to fasting at the 7th day (myocardium-to-blood ratios: 1.68 ± 1.02 vs 3.25 ± 1.40, P < .05) and (3) a high 18F-FDG-PET detectability of myocarditis areas. ConclusionOne-week extension of a ketogenic diet provides a further decrease in the 18F-FDG uptake of normal myocardium and a high detectability of inflammatory areas.
Highlights
A fasting period of at least 12 hours,[1,2,3,4] as well as low-carbohydrate diet,[5,6,7,8,9,10,11,12] have been proven beneficial for decreasing the normal myocardial uptake of 18Ffluorodeoxyglucose (18F-FDG) and for enhancing the detectability of inflammatory and/or infectious heart diseases by 18F-FDG positron emission tomography (18F-FDG-PET)
The 7-day ketogenic diet was associated with (1) a sustained increase in circulating ketone bodies at an equivalent level to that reached after 18-hour fasting, (2) a gradual decrease in 18F-FDG uptake within normal myocardium reaching a lower level compared to fasting at the 7th day and (3) a high 18FFDG-PET detectability of myocarditis areas
One-week extension of a ketogenic diet provides a further decrease in the 18FFDG uptake of normal myocardium and a high detectability of inflammatory areas. (J Nucl Cardiol 2020;27:612–8.)
Summary
A fasting period of at least 12 hours,[1,2,3,4] as well as low-carbohydrate diet,[5,6,7,8,9,10,11,12] have been proven beneficial for decreasing the normal myocardial uptake of 18Ffluorodeoxyglucose (18F-FDG) and for enhancing the detectability of inflammatory and/or infectious heart diseases by 18F-FDG positron emission tomography (18F-FDG-PET). This study was aimed at determining whether a drastic ketogenic diet provides a further decrease in physiological myocardial 18F-FDG uptake and a high detectability of myocarditis by 18F-FDG-PET in rats, when this diet is prolonged up to 1 week, as compared with a standard 18-hour fasting conditioning. Such diet can be prescribed at a much longer term than fasting,[13,14,15] leading to metabolic changes that are known to progressively suppress the metabolic use of glucose, even in the brain, within at least a 3- to 5-day period.[15,16,17,18]. This study aimed at determining whether this benefit is increased when a lowcarbohydrate ketogenic diet is prolonged up to 7 days
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