Abstract
The ketogenic diet (KD) is a restrictive therapeutic diet, distinguished by being hyperlipidic, normoproteic, and hypoglucidic. This diet simulates biochemical changes related to fasting periods to achieve systemic ketosis. The metabolic particularities of glioma tumors motivated the rise in investigations and nutritional strategies, such as KD, to modulate the glycemic response as a treatment. This systematic review followed the PRISMA recommendations and was published in PROSPERO, with the identification CRD42021264173. The databases used were EMBASE, PubMed/Medline, Scopus, and Web of Science, and the studies were analyzed using the web-based application Rayyan. To analyze the risk of bias, Cochrane RevMan 5 software was used. For the analysis and treatment of statistical data, Microsoft® Excel® was used. A total of nine original articles were included. Data on survival, symptomology, and quality of life were collected. Mean overall survival was 15.9 months. Constipation and fatigue were the most reported symptoms. In 44.4% of the studies, an improvement in the quality of life was found. The KD is supported by most published studies as an effective therapy in the treatment of malignant gliomas due to its positive effects on patient survival. It was not possible to conclude the effectiveness of KD on quality of life.
Highlights
The ketogenic diet (KD) is a restrictive therapeutic diet distinguished by being high-fat, normoproteic, and hypoglucidic, and is considered a non-pharmacological therapeutic method [1–3]
In the studies included in this review, we found that different results were described, with survival values between 32 weeks and 25.4 months
Some limitations were found in the quality of the analyzed data, including the sample size in the studies, the different types of gliomas, and the absence of a control group in most studies
Summary
The ketogenic diet (KD) is a restrictive therapeutic diet distinguished by being high-fat, normoproteic, and hypoglucidic, and is considered a non-pharmacological therapeutic method [1–3]. The four major types of KD are the Classic Ketogenic Diet (CKD), the Ketogenic Diet with Medium-Chain Triglycerides (MCT), the Modified Atkins Diet (MAD), and the Low Glycemic Index Diet (LGID). The classical type is classified by a ratio of 3:1 to 4:1, that is, 3 to 4 grams of lipids for every 1 gram of carbohydrate and protein [4,5]. The utilization of MCT as an energy source is due to the greater production of ketone bodies compared to long-chain fatty acids. The KD provides a high amount of lipids (60–90% of total energy value (TEV)), a low carbohydrate content (4–19% TEV), and is adequate in protein, minerals, and vitamins [6,7]
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