Clinical Department and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium.
Curr Opin Crit Care. 2021 Aug 1;27(4):385-389. doi: 10.1097/MCC.0000000000000841.
To summarize the clinical evidence for beneficial effects of ketones, ketogenic diets and intermittent fasting in critical illness, and to review potential mechanisms behind such effects.
Recent evidence demonstrates that activation of a metabolic fasting response may be beneficial to recover from critical insults. Potential protective mechanisms are, among others, activation of ketogenesis and of damage removal by autophagy. Novel feeding strategies, including ketone supplements, ketogenic diets and intermittent fasting regimens, can activate these pathways - at least partially - in critically ill patients. Randomized controlled trials (RCTs) studying these novel feeding strategies as compared with standard care, are scarce and have not shown consistent benefit. Yet, all RCTs were small and underpowered for clinical endpoints. Moreover, in intermittent fasting studies, the duration of the fasting interval may have been too short to develop a sustained metabolic fasting response.
These findings open perspectives for the further development of fasting-mimicking diets. Ultimately, clinical benefit should be confirmed by RCTs that are adequately powered for clinically relevant, patient-centered endpoints.
总结酮体、生酮饮食和间歇性禁食在危重病中的临床益处，并综述这些效应背后的潜在机制。
最近的证据表明，激活代谢性禁食反应可能有益于从危重病打击中恢复。潜在的保护机制包括酮体生成的激活和自噬引起的损伤清除。包括酮体补充剂、生酮饮食和间歇性禁食方案在内的新的喂养策略可以在危重病患者中至少部分激活这些途径。与标准治疗相比，研究这些新的喂养策略的随机对照试验（RCT）很少，且没有显示出一致的益处。然而，所有的 RCT 都很小，对于临床终点来说没有足够的效力。此外，在间歇性禁食研究中，禁食间隔的持续时间可能太短，无法产生持续的代谢性禁食反应。
这些发现为进一步开发模拟禁食的饮食提供了前景。最终，应通过具有足够效力的针对临床相关、以患者为中心的终点的 RCT 来证实临床获益。
