Meer Nike, Fischer Tobias
FH Muenster-University of Applied Sciences, Department of Food, Nutrition, and Facilities, Corrensstraße 25, Muenster 48149, Germany.
J Nutr Metab. 2024 Apr 12;2024:9672969. doi: 10.1155/2024/9672969. eCollection 2024.
Pathomechanisms of dementias involve increasing damage to neuronal energy metabolism, resulting in degeneration-related insulin resistance and glucose hypometabolism. In this case, ketone bodies can provide an alternative energy source. Supplementation with medium-chain triglycerides (MCTs), which can induce ketogenesis, may alleviate brain energy deficits and improve neuronal function. This review aims to determine the effectiveness of MCT as a symptomatic treatment approach. The systematic literature search was conducted in April 2023 following the Cochrane Handbook and PRISMA guidelines. A total of 21 studies were included, comprising eight uncontrolled trials and 13 RCTs investigating the effects of MCT on Alzheimer's disease (AD) and mild cognitive impairment (MCI). A substantial increase in plasma ketone levels and brain metabolic rates was observed. Cognitive assessments showed only occasional or domain-specific performance improvements. The effects on functional abilities or psychological outcomes have been inadequately studied. Besides gastrointestinal side effects, no harmful effects were observed. However, the evidence was severely weakened by heterogeneous and poorly designed study protocols, bias, and conflicts of interest. In conclusion, the ketogenic properties of MCTs may have beneficial effects on brain metabolism in AD and MCI but do not always result in measurable clinical improvement. Current evidence is insufficient to recommend MCT as a comparable symptomatic treatment option.
痴呆症的发病机制涉及对神经元能量代谢的损害不断增加，导致与退化相关的胰岛素抵抗和葡萄糖代谢减退。在这种情况下，酮体可以提供替代能量来源。补充可诱导生酮作用的中链甘油三酯（MCTs）可能会缓解脑能量不足并改善神经元功能。本综述旨在确定MCT作为一种对症治疗方法的有效性。2023年4月按照Cochrane手册和PRISMA指南进行了系统的文献检索。共纳入21项研究，包括8项非对照试验和13项随机对照试验，这些试验研究了MCT对阿尔茨海默病（AD）和轻度认知障碍（MCI）的影响。观察到血浆酮水平和脑代谢率大幅增加。认知评估仅偶尔显示或在特定领域的表现有所改善。对功能能力或心理结果的影响研究不足。除了胃肠道副作用外，未观察到有害影响。然而，由于研究方案异质性大、设计不佳、存在偏倚和利益冲突，证据的说服力大打折扣。总之，MCT的生酮特性可能对AD和MCI的脑代谢有有益影响，但并不总是能带来可衡量的临床改善。目前的证据不足以推荐MCT作为一种等效的对症治疗选择。
