All ETDs from UAB

Advisory Committee Chair

Barbara A Gower

Advisory Committee Members

Rebecca C Arend

Kevin R Fontaine

Lyse A Norian

Jeffery M Szychowski

Document Type

Dissertation

Date of Award

2019

Degree Name by School

Doctor of Philosophy (PhD) School of Health Professions

Abstract

Ketogenic diets (KDs) have garnered considerable research attention in recent years, having been investigated as a therapy for neurologic, metabolic, and even dermatologic diseases. Recent research has also focused on KDs as a potential intervention for cancer, with preclinical studies demonstrating profound effects such as inhibiting tumor growth, enhancing the effects of radiation and chemotherapy, and prolonging survival. However, to date few studies have been conducted in cancer patients. In order to determine if KDs might augment existing cancer treatment protocols, additional research is needed. Accordingly, the objective of this project was to conduct the first randomized, controlled trial examining the effects of a KD on body composition, metabolic health, and quality of life in women with ovarian or endometrial cancer. The first aim of this project was to determine if a KD might alter body composition and markers of metabolism toward a profile that is inhospitable to cancer proliferation. Additional aims of this project were to evaluate the safety and feasibility of a KD among cancer patients and to examine the influence of the diet on quality of life, food cravings, and hunger. To address these aims, 45 women were randomized to either a moderate protein, ketogenic diet (KD) or a high-fiber, lower-fat regimen based on recommendations from the American Cancer Society (ACS). Fasting serum samples were collected at baseline and after the 12 week diet intervention to allow for analyses of metabolic markers (e.g., glucose, insulin, C-peptide, insulin-like growth factor-1), blood lipids, and ketone bodies. Body composition was assessed via dual-energy X-ray absorptiometry (DXA) at these same time points. Diet records were collected throughout the intervention for monitoring participant adherence. Questionnaires were administered at baseline and 12 weeks to assess mental and physical function, food cravings, and appetite. Results from this project indicate that a KD reduced overall and central adiposity while maintaining lean mass, a phenotype associated with improved cancer outcomes. In addition, fasting insulin was significantly reduced in the KD participants, an alteration in metabolic environment that may hinder cancer growth. The KD did not pose a safety risk, as demonstrated by non-significant changes in blood lipids and the occurrence of only mild side effects, and KD participants demonstrated acceptable adherence. Furthermore, the KD did not have detrimental effects on quality of life and may provide benefit for physical function and fatigue in some patients.

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