Liu Yuping, Qu Xiaolong, Liu Dingsheng, Yang Dongming
Department of Nutrition, Gongli Hospital of Shanghai Pudong New Area, Shanghai, China.
Department of Cardiovascular Medicine, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Nutr Cancer. 2025 Jul 10:1-11. doi: 10.1080/01635581.2025.2497095.
Ketogenic diet (KD) has increasingly been applied in anti-cancer therapy in recent years; however, its effect on cancer development risk remains controversial. We examined the association between dietary ketogenic ratio (DKR) and cancer incidence using cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2001 and 2018. Dietary intake information was collected a detailed 24-h dietary recall survey, and DKR values were calculated using a specialized formula. Multivariate logistic regression analysis was performed to evaluate the correlation between DKR and tumor occurrence, with restricted cubic splines (RCS) utilized to assess potential nonlinear relationships. Furthermore, a two-stage linear regression analysis was carried out to determine the inflection point. Furthermore, subgroup analyses were conducted stratified by demographic variables, including age, gender, race, body mass index (BMI), smoking status, and diabetes mellitus. A significant association was observed between DKR and cancer risk in multivariate logistic regression models fully adjusted for all potential confounding factors (OR, 1.58; 95%CI: 1.08, 1.54; = 0.049). Moreover, individuals in the highest quartile of DKR exhibited a significantly increased risk for all cancers compared to those in the lowest quartile (Q4: OR, 1.29; 95%CI: 1.08, 1.34; = 0.005). The RCS analysis revealed a non-linear relationship between DKR and cancer risk ( < 0.001, P for nonlinear trend = 0.003), with a turning point identified at 0.44 units on the scale used in this study. Piecewise regression analysis based on this threshold indicated that DKR values below 0.44 (DKR < 0.44) were significantly associated with an increased risk for all cancers within the context of this investigation (OR, 1.08; 95%CI: 1.04, 1.12; < 0.001), while no significant correlation was observed for DKR values above this threshold (DKR ≥ 0.44) (OR, 1.01; 95%CI: 0.95, 1.07; = 0.77). Furthermore, the findings from the subgroup analyses were consistent with the overall results. Therefore, we conclude that a KD might elevate the risk for all cancers, and further studies are warranted to validate this hypothesis.
近年来，生酮饮食（KD）在抗癌治疗中的应用越来越广泛；然而，其对癌症发生风险的影响仍存在争议。我们利用2001年至2018年期间进行的美国国家健康与营养检查调查（NHANES）的横断面数据，研究了饮食生酮比（DKR）与癌症发病率之间的关联。通过详细的24小时饮食回顾调查收集饮食摄入信息，并使用专门公式计算DKR值。进行多变量逻辑回归分析以评估DKR与肿瘤发生之间的相关性，并使用受限立方样条（RCS）评估潜在的非线性关系。此外，进行两阶段线性回归分析以确定拐点。此外，还按年龄、性别、种族、体重指数（BMI）、吸烟状况和糖尿病等人口统计学变量进行了亚组分析。在对所有潜在混杂因素进行完全调整的多变量逻辑回归模型中，观察到DKR与癌症风险之间存在显著关联（OR，1.58；95%CI：1.08，1.54；P = 0.049）。此外，与最低四分位数的个体相比，DKR最高四分位数的个体患所有癌症的风险显著增加（Q4：OR，1.29；95%CI：1.08，1.34；P = 0.005）。RCS分析显示DKR与癌症风险之间存在非线性关系（P < 0.001，非线性趋势P = 0.003），在本研究使用的量表上，转折点为0.44单位。基于此阈值的分段回归分析表明，在本研究范围内，DKR值低于0.44（DKR < 0.44）与所有癌症风险增加显著相关（OR，1.08；95%CI：1.04，1.12；P < 0.001），而高于此阈值的DKR值（DKR ≥ 0.44）未观察到显著相关性（OR，1.01；95%CI：0.95，1.07；P = 0.77）。此外，亚组分析的结果与总体结果一致。因此，我们得出结论，生酮饮食可能会增加患所有癌症的风险，需要进一步研究来验证这一假设。
