复发缓解型多发性硬化的生酮饮食初步研究。
Pilot study of a ketogenic diet in relapsing-remitting MS.
机构信息
Division of Pediatric Neurology (J.N.B., D.L.-G.), Department of Neurology, University of Virginia, Charlottesville; Department of Pediatric Neurology (B.B., A.G.C.B.), University of Pennsylvania/Children's Hospital of Philadelphia; and Department of Neurology (L.G., E.L., R.C., M.D.G.), University of Virginia, Charlottesville.
出版信息
Neurol Neuroimmunol Neuroinflamm. 2019 Apr 12;6(4):e565. doi: 10.1212/NXI.0000000000000565. eCollection 2019 Jul.
OBJECTIVE
To assess the safety and tolerability of a modified Atkins diet (KD), a type of ketogenic diet (KD), in subjects with relapsing MS while exploring potential benefits of KDs in MS.
METHODS
Twenty subjects with relapsing MS enrolled into a 6-month, single-arm, open-label study of the KD. Adherence to KD was objectively monitored by daily urine ketone testing. Fatigue and depression scores and fasting adipokines were obtained at baseline and on diet. Brain MRI was obtained at baseline and 6 months. Intention to treat was used for primary data analysis, and a per-protocol approach was used for secondary analysis.
RESULTS
No subject experienced worsening disease on diet. Nineteen subjects (95%) adhered to KD for 3 months and 15 (75%) adhered for 6 months. Anthropometric improvements were noted on KD, with reductions in body mass index and total fat mass ( < 0.0001). Fatigue ( = 0.002) and depression scores ( = 0.003) were improved. Serologic leptin was significantly lower at 3 months ( < 0.0001) on diet.
CONCLUSIONS
KD is safe, feasible to study, and well tolerated in subjects with relapsing MS. KD improves fatigue and depression while also promoting weight loss and reducing serologic proinflammatory adipokines.
CLASSIFICATION OF EVIDENCE
The study is rated Class IV because of the absence of a non-KD control group.
目的
评估改良阿特金斯饮食（KD）的安全性和耐受性，KD 是一种生酮饮食（KD），适用于复发性多发性硬化症（MS）患者，同时探索 KD 在 MS 中的潜在益处。
方法
20 名复发性 MS 患者参加了为期 6 个月的单臂、开放性研究，研究 KD。通过每日尿液酮体检测客观监测 KD 的依从性。在基线和饮食时获得疲劳和抑郁评分以及空腹脂肪因子。在基线和 6 个月时获得脑 MRI。主要数据分析采用意向治疗，次要分析采用方案分析。
结果
没有患者在饮食上出现疾病恶化。19 名患者（95%）坚持 KD 治疗 3 个月，15 名患者（75%）坚持 6 个月。KD 后体重指数和总脂肪量均有改善（<0.0001）。疲劳（=0.002）和抑郁评分（=0.003）均有改善。饮食 3 个月时血清瘦素明显降低（<0.0001）。
结论
KD 在复发性 MS 患者中安全、可行且耐受良好。KD 可改善疲劳和抑郁，同时促进体重减轻和减少血清促炎脂肪因子。
证据分类
由于缺乏非 KD 对照组，该研究被评为 IV 级。
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