PMID- 30473444
OWN - NLM
STAT- MEDLINE
DCOM- 20200908
LR  - 20220409
IS  - 1532-1983 (Electronic)
IS  - 0261-5614 (Linking)
VI  - 38
IP  - 5
DP  - 2019 Oct
TI  - Treatment of malignant gliomas with ketogenic or caloric restricted diets: A 
      systematic review of preclinical and early clinical studies.
PG  - 1986-1994
LID - S0261-5614(18)32519-6 [pii]
LID - 10.1016/j.clnu.2018.10.024 [doi]
AB  - BACKGROUND & AIMS: Patients with malignant gliomas have a poor prognosis. Diets 
      that lower blood glucose, such as ketogenic or caloric restricted diets (KCRDs), 
      are hypothesized to reduce tumor growth and improve survival. In this systematic 
      review, we summarize preclinical and clinical data on KCRDs in gliomas. METHODS: 
      We searched PubMed and Embase for preclinical and clinical studies on KCRDs in 
      gliomas, and extracted data on surrogate and clinically relevant endpoints, in 
      accordance with PRISMA statement. Quality assessment of clinical studies was 
      performed with use of Cochrane Collaboration's tool. We performed Fisher's exact 
      test to examine associations between surrogate and clinically relevant endpoints. 
      RESULTS: We included 24 preclinical studies, seven clinical studies and one mixed 
      study. Both preclinical and clinical studies were highly heterogeneous. 
      Preclinically, KCRDs reduced tumor growth, but only a small majority of the 
      in vivo studies found improved survival. These effects were stronger in groups 
      with decreased blood glucose than in those with increased ketones, and also when 
      other therapies were used concomitantly. Finally, KCRDs influence multiple 
      molecular-biological pathways, including the PTEN/Akt/TSC2 and NF-kB pathway. In 
      clinical studies, KCRDs seem to be safe and feasible in glioma patients. Clinical 
      data were insufficient to draw conclusions regarding efficacy. CONCLUSIONS: KCRDs 
      have positive effects on malignant gliomas in published preclinical studies. 
      Preliminary clinical data suggest that KCRDs are safe and feasible. However, 
      because of the paucity of clinical data, the efficacy of KCRDs for improving 
      survival and quality of life of glioma patients remains to be proven in 
      prospective studies.
CI  - Copyright (c) 2018 Elsevier Ltd and European Society for Clinical Nutrition and 
      Metabolism. All rights reserved.
FAU - Noorlag, Lotte
AU  - Noorlag L
AD  - Brain Center Rudolf Magnus, Department of Neurology, University Medical Center 
      Utrecht, G03.232, PO Box 85500, 3508 GA, Utrecht, the Netherlands.
FAU - De Vos, Filip Y
AU  - De Vos FY
AD  - Department of Medical Oncology, Internal Medicine and Dermatology, University 
      Medical Center Utrecht, Utrecht, the Netherlands.
FAU - Kok, Annemieke
AU  - Kok A
AD  - Department of Dietetics, University Medical Center Utrecht, Utrecht, the 
      Netherlands.
FAU - Broekman, Marike L D
AU  - Broekman MLD
AD  - Brain Center Rudolf Magnus, Department of Neurosurgery, University Medical Center 
      Utrecht, Utrecht, the Netherlands; Department of Neurosurgery, Leiden University 
      Medical Center, Leiden, the Netherlands; Department of Neurosurgery, Haaglanden 
      Medical Center, The Hague, the Netherlands.
FAU - Seute, Tatjana
AU  - Seute T
AD  - Brain Center Rudolf Magnus, Department of Neurology, University Medical Center 
      Utrecht, G03.232, PO Box 85500, 3508 GA, Utrecht, the Netherlands.
FAU - Robe, Pierre A
AU  - Robe PA
AD  - Brain Center Rudolf Magnus, Department of Neurosurgery, University Medical Center 
      Utrecht, Utrecht, the Netherlands.
FAU - Snijders, Tom J
AU  - Snijders TJ
AD  - Brain Center Rudolf Magnus, Department of Neurology, University Medical Center 
      Utrecht, G03.232, PO Box 85500, 3508 GA, Utrecht, the Netherlands. Electronic 
      address: T.J.Snijders@umcutrecht.nl.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Systematic Review
DEP - 20181114
PL  - England
TA  - Clin Nutr
JT  - Clinical nutrition (Edinburgh, Scotland)
JID - 8309603
SB  - IM
MH  - Brain Neoplasms/*diet therapy
MH  - *Caloric Restriction
MH  - *Diet, Ketogenic
MH  - Glioma/*diet therapy
MH  - Humans
OTO - NOTNLM
OT  - Caloric restriction
OT  - Glioblastoma
OT  - Glioma
OT  - Ketogenic diet
OT  - Short-term starvation
OT  - Targeted therapy
EDAT- 2018/11/27 06:00
MHDA- 2020/09/09 06:00
CRDT- 2018/11/27 06:00
PHST- 2018/02/22 00:00 [received]
PHST- 2018/10/26 00:00 [revised]
PHST- 2018/10/30 00:00 [accepted]
PHST- 2018/11/27 06:00 [pubmed]
PHST- 2020/09/09 06:00 [medline]
PHST- 2018/11/27 06:00 [entrez]
AID - S0261-5614(18)32519-6 [pii]
AID - 10.1016/j.clnu.2018.10.024 [doi]
PST - ppublish
SO  - Clin Nutr. 2019 Oct;38(5):1986-1994. doi: 10.1016/j.clnu.2018.10.024. Epub 2018 
      Nov 14.