■关于脑损伤后脑代谢的动物模型研究强调了酮症在减少继发性脑损伤方面的潜在益处,但是缺乏对人类的研究。
■这项研究旨在研究在亚急性期获得性脑损伤的成年患者中,添加中链甘油三酯(MCT)的6周生酮饮食干预是否可行,酮症是否可以实现和维持,严重的不良反应在多大程度上,不良反应,严重不良事件,并发生不良事件。
■将年龄≥18岁诊断为亚急性获得性脑损伤且预期住院≥6周的患者纳入干预组。未纳入干预组的患者被纳入标准护理参照组。干预措施包括添加MCT的生酮饮食,以获得β-羟基丁酸酯(BHB)的血浆浓度≥0.5mmol/L。肠内喂养的患者给予KetoCal®2.5:1LQMCT多纤维(NutriciaA/S,Allerød,Denmark),辅以Liquigen®(NutriciaA/S,Allerød,丹麦)。服用口服营养的患者给予KetoCal®2.5:1LQMCTMultiFiber补充Liquigen®,除了生酮餐。
■在13周的纳入期内,13名符合条件的患者中有12名(92%[95%CI:67%至99%])被纳入干预组,18例排除患者中的17例(94%[95%CI:74%~99%])纳入参照组.8名患者(67%)完成了为期6周的干预。从开始100%MCT生酮饮食开始,平均需要1天才能达到酮症,在获得酮症后的干预期内,它保持了97%。MCT生酮饮食无严重不良反应,在接受干预的9.5%的天数内,患者出现了认为不严重的不良反应.所有干预日患者均接受MCT生酮饮食,在从肠内喂养过渡到口服摄入的两名患者中,无与过渡相关的并发症.
■在亚急性获得性脑损伤住院的成年患者中,MCT生酮饮食干预是可行的,并且可以耐受6周。需要随机对照试验来评估MCT生酮饮食的益处和危害以及对患者康复的影响。临床试验注册:ClinicalTrials.gov,标识符[NCT04308577]。
UNASSIGNED: Research in animal models on cerebral metabolism after brain injury highlights the potential benefits of ketosis in reducing secondary brain injury, but studies in humans are lacking.
UNASSIGNED: This study aimed to examine if a 6-week ketogenic diet intervention with added medium-chain triglycerides (MCT) was feasible in adult patients with acquired brain injury in the subacute phase, whether ketosis could be achieved and maintained, and to what extent serious adverse reactions, adverse reactions, serious adverse events, and adverse events occured.
UNASSIGNED: Patients ≥18 years of age diagnosed with subacute acquired brain injury and an expectation of hospitalisation ≥6 weeks were included in the intervention group. Patients not included in the intervention group were included in a standard care reference group. The intervention consisted of a ketogenic diet supplemented with MCT to obtain a plasma concentration of β-hydroxybutyrate (BHB) ≥0.5 mmol/L. Patients who were enterally fed were given KetoCal® 2.5:1 LQ MCT Multi Fiber (Nutricia A/S, Allerød, Denmark), supplemented with Liquigen® (Nutricia A/S, Allerød, Denmark). Patients consuming oral nutrition were given KetoCal® 2.5:1 LQ MCT Multi Fiber supplemented with Liquigen®, in addition to ketogenic meals.
UNASSIGNED: During a 13-week inclusion period, 12 of 13 eligible patients (92% [95% CI: 67% to 99%]) were included in the intervention group, and 17 of 18 excluded patients (94% [95% CI: 74% to 99%]) were included in the reference group. Eight patients (67%) completed the 6-week intervention. It took a median of 1 day to achieve ketosis from starting a 100% MCT ketogenic diet, and it was maintained for 97% of the intervention period after ketosis was obtained. There were no serious adverse reactions to the MCT ketogenic diet, and patients experienced adverse reactions not considered serious in 9.5% of days with the intervention. The MCT ketogenic diet was accepted by patients on all intervention days, and in the two patients transitioning from enteral feeding to oral intake, there were no complications related to transitioning.
UNASSIGNED: Intervention with MCT ketogenic diet is feasible and tolerated for 6 weeks in hospitalised adult patients with subacute acquired brain injury. Randomised controlled trials are needed to assess the benefits and harms of the MCT ketogenic diet and the effect on patients\' recovery.Clinical trial registration: ClinicalTrials.gov, identifier [NCT04308577].