一项随机可行性试验：中链甘油三酯补充酮饮食在帕金森病患者中的应用。
A randomized feasibility trial of medium chain triglyceride-supplemented ketogenic diet in people with Parkinson's disease.
机构信息
National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
Mid-Atlantic Permanente Medical Group, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA.
出版信息
BMC Neurol. 2024 Apr 1;24(1):106. doi: 10.1186/s12883-024-03603-5.
BACKGROUND
A ketogenic diet (KD) may benefit people with neurodegenerative disorders marked by mitochondrial depolarization/insufficiency, including Parkinson's disease (PD).
OBJECTIVE
Evaluate whether a KD supplemented by medium chain triglyceride (MCT-KD) oil is feasible and acceptable for PD patients. Furthermore, we explored the effects of MCT-KD on blood ketone levels, metabolic parameters, levodopa absorption, mobility, nonmotor symptoms, simple motor and cognitive tests, autonomic function, and resting-state electroencephalography (rsEEG).
METHODS
A one-week in-hospital, double-blind, randomized, placebo-controlled diet (MCT-KD vs. standard diet (SD)), followed by an at-home two-week open-label extension. The primary outcome was KD feasibility and acceptability. The secondary outcome was the change in Timed Up & Go (TUG) on day 7 of the diet intervention. Additional exploratory outcomes included the N-Back task, Unified Parkinson's Disease Rating Scale, Non-Motor Symptom Scale, and rsEEG connectivity.
RESULTS
A total of 15/16 subjects completed the study. The mean acceptability was 2.3/3, indicating willingness to continue the KD. Day 7 TUG time was not significantly different between the SD and KD groups. The nonmotor symptom severity score was reduced at the week 3 visit and to a greater extent in the KD group. UPDRS, 3-back, and rsEEG measures were not significantly different between groups. Blood ketosis was attained by day 4 in the KD group and to a greater extent at week 3 than in the SD group. The plasma levodopa metabolites DOPAC and dopamine both showed nonsignificant increasing trends over 3 days in the KD vs. SD groups.
CONCLUSIONS
An MCT-supplemented KD is feasible and acceptable to PD patients but requires further study to understand its effects on symptoms and disease.
TRIAL REGISTRATION
Trial Registration Number NCT04584346, registration dates were Oct 14, 2020 - Sept 13, 2022.
背景
生酮饮食（KD）可能有益于以线粒体去极化/不足为特征的神经退行性疾病患者，包括帕金森病（PD）。
目的
评估补充中链甘油三酯（MCT）的 KD（MCT-KD）是否对 PD 患者可行和可接受。此外，我们还探讨了 MCT-KD 对血酮水平、代谢参数、左旋多巴吸收、活动能力、非运动症状、简单运动和认知测试、自主功能以及静息态脑电图（rsEEG）的影响。
方法
为期一周的住院、双盲、随机、安慰剂对照饮食（MCT-KD 与标准饮食（SD）），随后进行为期两周的家庭开放标签扩展。主要结局是 KD 的可行性和可接受性。次要结局是饮食干预第 7 天的“计时起立行走”（TUG）变化。其他探索性结局包括 N-Back 任务、统一帕金森病评定量表（UPDRS）、非运动症状量表和 rsEEG 连接。
结果
共有 15/16 名受试者完成了研究。平均接受度为 2.3/3，表明愿意继续进行 KD。SD 和 KD 组之间第 7 天 TUG 时间没有显著差异。非运动症状严重程度评分在第 3 周就诊时降低，且 KD 组降低幅度更大。UPDRS、3-back 和 rsEEG 测量值在组间没有显著差异。KD 组在第 4 天达到血酮症，且在第 3 周的程度大于 SD 组。与 SD 组相比，KD 组的左旋多巴代谢物 DOPAC 和多巴胺在 3 天内均显示出非显著的增加趋势。
结论
补充 MCT 的 KD 对 PD 患者是可行和可接受的，但需要进一步研究以了解其对症状和疾病的影响。
试验注册
试验注册号 NCT04584346，注册日期为 2020 年 10 月 14 日至 2022 年 9 月 13 日。
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