Abstract：
BACKGROUND: Lymphoedema is a chronic and progressive disease characterised by excessive accumulation of lymph in the interstitial compartment, leading to tissue swelling and fibroadipose deposition. Lymphangiogenesis is partly regulated by ketone body oxidation, and a ketogenic diet (KD) has shown therapeutic efficacy in a preclinical mouse tail lymphoedema model. Therefore, we aimed to investigate the potential therapeutic effect of a KD in patients with secondary lymphoedema.
METHODS: Nine patients with unilateral stage 2 lymphoedema secondary to lymphadenectomy were included in this quasi-experimental exploratory study consisting of a short run-in phase to gradually induce ketosis, followed by a classic KD (CKD) and modified Atkins diet (MAD) phase during which patients consumed a CKD and MAD, respectively. Lymphatic function and oedema volume, the primary outcomes, were assessed at baseline and at the end of both the CKD and MAD phase. Secondary outcomes included health-related and lymphedema-specific quality of life (QoL).
RESULTS: Seven out of nine patients completed the study protocol. Lymphatic function was improved upon consumption of both a CKD (dermal backflow score [mean ± SD]: 7.29 ± 2.98 vs. 10.86 ± 2.19 at baseline; p = 0.03) and MAD (6.71 ± 2.06; p = 0.02), whereas oedema volume did not decrease during the course of the study (excess limb volume [mean ± SD]: 20.13 ± 10.25% at end of CKD and 24.07 ± 17.77% at end of MAD vs. 20.79 ± 12.96% at baseline; p > 0.99 and p > 0.30, respectively). No changes were observed in health-related, nor lymphoedema-specific QoL at the end of CKD and MAD.
CONCLUSIONS: The consumption of a KD improved lymphatic function and was associated with a clinically meaningful reduction in oedema volume in some patients (3/7 at end of CKD, 2/7 at end of MAD) with unilateral stage 2 secondary lymphoedema. These results highlight the potential of a KD to improve lymphatic function in patients with lymphoedema. However, further studies are required to substantiate our findings.
METHODS: Nine patients with unilateral stage 2 lymphoedema secondary to lymphadenectomy were included in this quasi-experimental exploratory study consisting of a short run-in phase to gradually induce ketosis, followed by a classic KD (CKD) and modified Atkins diet (MAD) phase during which patients consumed a CKD and MAD, respectively. Lymphatic function and oedema volume, the primary outcomes, were assessed at baseline and at the end of both the CKD and MAD phase. Secondary outcomes included health-related and lymphedema-specific quality of life (QoL).
RESULTS: Seven out of nine patients completed the study protocol. Lymphatic function was improved upon consumption of both a CKD (dermal backflow score [mean ± SD]: 7.29 ± 2.98 vs. 10.86 ± 2.19 at baseline; p = 0.03) and MAD (6.71 ± 2.06; p = 0.02), whereas oedema volume did not decrease during the course of the study (excess limb volume [mean ± SD]: 20.13 ± 10.25% at end of CKD and 24.07 ± 17.77% at end of MAD vs. 20.79 ± 12.96% at baseline; p > 0.99 and p > 0.30, respectively). No changes were observed in health-related, nor lymphoedema-specific QoL at the end of CKD and MAD.
CONCLUSIONS: The consumption of a KD improved lymphatic function and was associated with a clinically meaningful reduction in oedema volume in some patients (3/7 at end of CKD, 2/7 at end of MAD) with unilateral stage 2 secondary lymphoedema. These results highlight the potential of a KD to improve lymphatic function in patients with lymphoedema. However, further studies are required to substantiate our findings.
摘要：
背景：淋巴水肿是一种慢性和进行性疾病，其特征是淋巴在间质室过度积聚，导致组织肿胀和纤维脂肪沉积。淋巴管生成部分受酮体氧化调节，生酮饮食（KD）在临床前小鼠尾部淋巴水肿模型中显示出治疗功效。因此,我们旨在研究KD对继发性淋巴水肿患者的潜在治疗效果.
方法：本准实验性探索性研究包括9例继发于淋巴结清扫术的单侧2期淋巴水肿患者，包括一个短暂的磨合期以逐渐诱发酮症，随后是经典的KD（CKD）和改良的阿特金斯饮食（MAD）阶段，在此期间患者消耗CKD和MAD，分别。淋巴功能和水肿体积，主要结果，在基线和CKD和MAD阶段结束时进行评估。次要结果包括健康相关和淋巴水肿特异性生活质量（QoL）。
结果：9名患者中有7名完成了研究方案。同时服用CKD后，淋巴功能均得到改善（皮肤回流评分[平均值±SD]：7.29±2.98vs.基线时10.86±2.19；p=0.03）和MAD（6.71±2.06；p=0.02），而水肿体积在研究过程中没有减少（多余的肢体体积[平均值±SD]：CKD结束时20.13±10.25％，MAD结束时24.07±17.77％与基线时为20.79±12.96％；分别为p>0.99和p>0.30）。没有观察到与健康相关的变化，在CKD和MAD结束时也没有淋巴水肿特异性QoL。
结论：在某些患者中，KD的消耗可改善淋巴功能，并与有临床意义的水肿体积减少有关（CKD结束时的3/7，MAD结束时的2/7）伴有单侧2期继发性淋巴水肿。这些结果突出了KD改善淋巴水肿患者淋巴功能的潜力。然而,我们需要进一步的研究来证实我们的发现.
方法：本准实验性探索性研究包括9例继发于淋巴结清扫术的单侧2期淋巴水肿患者，包括一个短暂的磨合期以逐渐诱发酮症，随后是经典的KD（CKD）和改良的阿特金斯饮食（MAD）阶段，在此期间患者消耗CKD和MAD，分别。淋巴功能和水肿体积，主要结果，在基线和CKD和MAD阶段结束时进行评估。次要结果包括健康相关和淋巴水肿特异性生活质量（QoL）。
结果：9名患者中有7名完成了研究方案。同时服用CKD后，淋巴功能均得到改善（皮肤回流评分[平均值±SD]：7.29±2.98vs.基线时10.86±2.19；p=0.03）和MAD（6.71±2.06；p=0.02），而水肿体积在研究过程中没有减少（多余的肢体体积[平均值±SD]：CKD结束时20.13±10.25％，MAD结束时24.07±17.77％与基线时为20.79±12.96％；分别为p>0.99和p>0.30）。没有观察到与健康相关的变化，在CKD和MAD结束时也没有淋巴水肿特异性QoL。
结论：在某些患者中，KD的消耗可改善淋巴功能，并与有临床意义的水肿体积减少有关（CKD结束时的3/7，MAD结束时的2/7）伴有单侧2期继发性淋巴水肿。这些结果突出了KD改善淋巴水肿患者淋巴功能的潜力。然而,我们需要进一步的研究来证实我们的发现.
