Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Naples, Italy.
Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O.), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Naples, Italy.
Crit Rev Food Sci Nutr. 2022;62(7):1800-1821. doi: 10.1080/10408398.2020.1847030. Epub 2020 Dec 4.
Cancer cells (CCs) predominantly use aerobic glycolysis (Warburg effect) for their metabolism. This important characteristic of CCs represents a potential metabolic pathway to be targeted in the context of tumor treatment. Being this mechanism related to nutrient oxidation, dietary manipulation has been hypothesized as an important strategy during tumor treatment. Ketogenic diet (KD) is a dietary pattern characterized by high fat intake, moderate-to-low protein consumption, and very-low-carbohydrate intake (<50 g), which in cancer setting may target CCs metabolism, potentially influencing both tumor treatment and prognosis. Several mechanisms, far beyond the originally proposed inhibition of glucose/insulin signaling, can underpin the effectiveness of KD in cancer management, ranging from oxidative stress, mitochondrial metabolism, and inflammation. The role of a qualified Nutritionist is essential to reduce and manage the short and long-term complications of this dietary therapy, which must be personalized to the individual patient for the planning of tailored KD protocol in cancer patients. In the present review, we summarize the proposed antitumor mechanisms of KD, the application of KD in cancer patients with obesity and cachexia, and the preclinical and clinical evidence on KD therapy in cancer.
癌细胞（CCs）主要通过有氧糖酵解（Warburg 效应）进行代谢。CCs 的这一重要特征代表了肿瘤治疗中潜在的代谢途径靶点。由于该机制与营养氧化有关，因此饮食干预被假设为肿瘤治疗过程中的重要策略。生酮饮食（KD）是一种饮食模式，其特点是高脂肪摄入、中低蛋白消耗和非常低碳水化合物摄入（<50g），在癌症环境中可能针对 CCs 代谢，可能会影响肿瘤治疗和预后。有几种机制可以支持 KD 在癌症管理中的有效性，远远超出最初提出的抑制葡萄糖/胰岛素信号，从氧化应激、线粒体代谢和炎症等方面都有涉及。合格营养师的作用对于减少和管理这种饮食疗法的短期和长期并发症至关重要，这种饮食疗法必须针对个体患者进行个性化设计，以制定适合癌症患者的 KD 方案。在本综述中，我们总结了 KD 的抗肿瘤机制、KD 在肥胖和恶病质癌症患者中的应用以及 KD 疗法在癌症中的临床前和临床证据。
