Cappello Gianfranco, Franceschelli Antonella, Cappello Annalisa, De Luca Paolo
Department of Surgery, University of Rome La Sapienza, Rome, Italy.
J Res Med Sci. 2012 Dec;17(12):1114-8.
Ketogenic enteral nutrition (KEN) is a modification of the protein sparing modified fast in which a protein solution is introduced with a continuous infusion through a nasogastric tube over 10-days cycles. The aim of the study was to perform a retrospective analysis of the safety, compliance, weight loss and body composition changes after 3 sequential 10-days cycles of KEN therapy.
From a large number of patients who underwent KEN therapy in our department over a 5-year period, we selected 188 patients who participated in 3 KEN cycles with 10-13 days of break between them. Before and after the treatment cycles, body composition was analyzed by bioelectric impedance; a final assessment was made 10 days after the end of last cycle. During each rest period all the patients were on a low-carbohydrate, normal caloric diet.
Most patients (97%) successfully tolerated the nasogastric treatment and lost an average of 14.4 kg of body weight, 10.6 kg of fat mass and 3.4 kg of body cell mass. Adverse effects were recorded as mild gastric hypersecretion (2%) and constipation (5%). Patients continued to lose fat during the 10-day follow up period after the end of each KEN Cycle. This effect may be explained by abnormality of water distribution during the rapid weight loss inducing the observed change in fat mass.
Ten-days KEN treatment cycles can induce rapid weight loss and reduction of fat mass in obese patients. Furthermore, preservation of lean mass can be achieved by infusing 1.9 g of protein/kg of BCM.
生酮肠内营养（KEN）是蛋白质节省型改良禁食法的一种变体，即通过鼻胃管持续输注蛋白质溶液，为期10天一个周期。本研究的目的是对连续3个10天周期的KEN治疗后的安全性、依从性、体重减轻和身体成分变化进行回顾性分析。
在我们科室5年期间接受KEN治疗的大量患者中，我们选择了188例参与3个KEN周期的患者，每个周期之间间隔10 - 13天。在治疗周期前后，通过生物电阻抗分析身体成分；在最后一个周期结束后10天进行最终评估。在每个休息期，所有患者均采用低碳水化合物、正常热量饮食。
大多数患者（97%）成功耐受鼻胃管治疗，平均体重减轻14.4千克，脂肪量减轻10.6千克，身体细胞量减轻3.4千克。记录到的不良反应为轻度胃酸分泌过多（2%）和便秘（5%）。在每个KEN周期结束后的10天随访期内，患者继续减脂。这种效应可能是由于快速减重期间水分分布异常导致观察到的脂肪量变化。
为期10天的KEN治疗周期可使肥胖患者快速减重并减少脂肪量。此外，通过每千克身体细胞量输注1.9克蛋白质可实现瘦体重的保留。
