Ketojenik Diyetin Metablolik Sendrom ve Bileşenleri Üzerine Etkisi

Yıl 2024, Cilt: 9 Sayı: 1, 25 - 40, 31.03.2024

Sena Ömür

Öz

Ketojenik diyet, genel olarak düşük karbonhidratlı, yüksek yağ ve protein içeren diyetlerdir. Günümüzde yaygın uygulama alanları arasında obezite, insülin direnci ve tip-2 diyabet yer alır. Ayrıca ağırlık yönetiminde çok düşük kalorili ketojenik diyet formlarına da başvurulmaktadır. Klasik ketojenik diyetin klinik ortamda uygulanması ve sürdürülebilirliğindeki zorluklar dolayısıyla diyetin besin kompozisyonu ve uygulanışı değiştirilerek modifiye Atkins diyeti, orta zincirli trigliserid diyeti veya düşük glisemik indeks diyeti gibi çeşitli formlara modifiye edilmiştir. Klasik ketojenik diyet beslenme ketozisi oluşturma potansiyeline rağmen kısa vadede ve uzun vadede çeşitli yan etkiler oluşturabilmektedir. Ayrıca, bağırsak mikrobiyotası üzerinde bakteri popülasyonunu etkilediği görülmüştür. Dolayısıyla ketojenik diyetin denetimli uygulanması yan etkileri önleme açısından önemsenmelidir. Metabolik sendrom tanı kriterleri çeşitli kuruluşlar tarafından güncellenmiştir ve günümüzde abdominal obezite, insülin direnci, dislipidemi (yüksek trigliserid veya düşük HDL-kolesterol) ve hipertansiyon kriterlerinden en az üçüne sahip olma durumu ile ifade edilmektedir. Bu çalışma ile ketojenik diyet müdahalesinin metabolik sendrom ve bileşenleri üzerine etkilerinin değerlendirilmesi amaçlanmıştır. Bu bağlamda, ketojenik diyetin kısa vadede ağırlık kaybı, bel çevresi ve vücut yağ oranında azalma, açlık glukoz düzeyi, insülin seviyeleri, HbA1c gibi glukoz parametrelerinde iyileşme, lipid profili üzerinde; trigliserid düzeyinde azalma, HDL-kolesterolde artma ile birlikte LDL-kolesterolü potansiyel olarak azaltma etkileri gözlemlenmiş ve kan basıncını değiştirebilme potansiyeli üzerinde durulmuştur. Gözlemlenen çalışmalardan yola çıkarak ketojenik diyetin kısa vadede obezite, tip-2 diyabet ve kardiyovasküler hastalık riski ile mücadelede etkili olabileceği ancak bu diyetlerin uzun vadeli etkinliğini kanıtlamak için daha fazla çalışma yapılması gerektiği sonucuna varılmıştır.

Anahtar Kelimeler

ketojenik diyet, metabolik sendrom, obezite, insülin direnci, dislipidemi

Teşekkür

Bu derlemenin yazımında desteklerini esirgemeyen Sayın Doç. Dr. Nihal BÜYÜKUSLU hocama teşekkür ederim.

Effect of Ketogenic Diet on Metabolic Syndrome and It’s Components

Öz

Ketogenic diets are generally low carbohydrate, high fat and protein diets. Today, common applications include obesity, insulin resistance and type-2 diabetes. In addition, very low calorie ketogenic diet forms are also used in weight management. Due to the difficulties in the implementation and sustainability of the classical ketogenic diet in the clinical setting, the nutritional composition and administration of the diet has been changed and modified into various forms such as the modified Atkins diet, medium chain triglyceride diet or low glycemic index diet. Although the classical ketogenic diet has the potential to induce nutritional ketosis, it may produce various side effects in the short term and long term. It has also been observed to affect the bacterial population on the gut microbiota. Therefore, the controlled application of the ketogenic diet should be considered in terms of preventing side effects. The diagnostic criteria for metabolic syndrome have been updated by various organizations and are currently defined as having at least three of the following criteria: abdominal obesity, insulin resistance, dyslipidemia (high triglycerides or low HDL-cholesterol) and hypertension. The aim of this study was to evaluate the effects of ketogenic diet intervention on metabolic syndrome and its components. In this context, the effects of ketogenic diet on weight loss in the short term, reduction in waist circumference and body fat percentage, improvement in glucose parameters such as fasting glucose level, insulin levels, HbA1c, on lipid profile; decrease in triglyceride level, increase in HDL-cholesterol and potentially decrease in LDL-cholesterol were observed and the potential to change blood pressure was emphasized. Based on the observed studies, it was concluded that the ketogenic diet may be effective in combating obesity, type-2 diabetes and cardiovascular disease risk in the short term, but more studies are needed to prove the long-term effectiveness of these diets.

Anahtar Kelimeler

Ketogenic diet, metabolic syndrome, obesity, insulin sensitivity, dyslipidemia

Kaynakça

• 1. Fahed G, Aoun L, Bou Zerdan M, Allam S, Bouferraa, Y, Assi HI. Metabolic syndrome: Updates on pathophysiology and management in 2021. International journal of molecular sciences. 2022;23(2):786. https://doi.org/10.3390/ijms23020786
• 2. Simmons RK, Alberti KG, Gale EA, Colagiuri S, Tuomilehto J, Qiao Q, et al. The metabolic syndrome: useful concept or clinical tool? Report of a WHO Expert Consultation. Diabetologia. 2010;53(4):600–605. https://doi.org/10.1007/s00125-009-1620-4
• 3. Arslan M, Atmaca A, Ayvaz G, Başkal N, Beyhan Z. Metabolik sendrom kılavuzu. Ankara Türkiye Endokrinol. ve Metab. Derneği. 2009.
• 4. Wheless JW. History of the ketogenic diet. Epilepsia. 2008;49(8):3–5. https://doi.org/10.1111/j.1528-1167.2008.01821.x.
• 5. Dąbek A, Wojtala M, Pirola L, Balcerczyk A. Modulation of cellular biochemistry, epigenetics and metabolomics by ketone bodies. Implications of the Ketogenic Diet in the Physiology of the Organism and Pathological States. Nutrients. 2020;12(3):788. https://doi.org/10.3390/nu12030788
• 6. Pietrzak D, Kasperek K, Rękawek P, Piątkowska-Chmiel I. The therapeutic role of ketogenic diet in neurological disorders. Nutrients. 2022;14(9):1952. https://doi.org/10.3390/nu14091952
• 7. Goswami JN, Sharma S. Current perspectives on the role of the ketogenic diet in epilepsy management. Neuropsychiatric disease and treatment. 2019;15:3273–3285. https://doi.org/10.2147/NDT.S201862
• 8. Janice L, Raymond L, Kathleen M. Krause's Food & the Nutrition Care Process 14th Edition. Elsevier Health Sciences; 2014. 122-138
• 9. Kossoff EH, Dorward JL. The modified Atkins diet. Epilepsia. 2008;49(8):37–41. https://doi.org/10.1111/j.1528-1167.2008.01831.x
• 10. Barzegar M, Afghan M, Tarmahi V, Behtari M, Rahimi Khamaneh S, Raeisi S. Ketogenic diet: overview, types, and possible anti-seizure mechanisms. Nutritional neuroscience. 2021:24(4):307–316. https://doi.org/10.1080/1028415X.2019.1627769
• 11. Liu YM, Wang HS. Medium-chain triglyceride ketogenic diet, an effective treatment for drug-resistant epilepsy and a comparison with other ketogenic diets. Biomedical journal. 2013;36(1):9–15. https://doi.org/10.4103/2319-4170.107154
• 12. Vega-López S, Venn BJ, Slavin JL. Relevance of the glycemic index and glycemic load for body weight, diabetes, and cardiovascular disease. Nutrients. 2018;10(10):1361. https://doi.org/10.3390/nu10101361
• 13. Pfeifer HH, Lyczkowski DA, Thiele EA. Low glycemic index treatment: implementation and new insights into efficacy. Epilepsia. 2008;49(8):42–45. https://doi.org/10.1111/j.1528-1167.2008.01832.x
• 14. Noakes TD, Windt J. Evidence that supports the prescription of low-carbohydrate high-fat diets: a narrative review. British journal of sports medicinem 2017;51(2):133–139. https://doi.org/10.1136/bjsports-2016-096491
• 15. Kysel P, Haluzíková D, Doležalová RP, Laňková I, Lacinová Z, Kasperová BJ et al. The influence of cyclical ketogenic reduction diet vs. nutritionally balanced reduction diet on body composition, strength, and endurance performance in healthy young males: a randomized controlled trial. Nutrients. 2020;12(9):2832. https://doi.org/10.3390/nu12092832
• 16. Dhamija R, Eckert S, Wirrell E. Ketogenic diet. The Canadian journal of neurological sciences. 2013;40(2):158–167. https://doi.org/10.1017/s0317167100013676
• 17. Olson CA, Vuong HE, Yano JM, Liang QY, Nusbaum DJ, Hsiao EY. The gut microbiota mediates the anti-seizure effects of the ketogenic diet. Cell. 2018;173(7): 1728–1741. https://doi.org/10.1016/j.cell.2018.04.027
• 18. Ma D, Wang AC, Parikh I, Green SJ, Hoffman JD, Chlipala G et al. Ketogenic diet enhances neurovascular function with altered gut microbiome in young healthy mice. Scientific reports. 2018;8(1):6670. https://doi.org/10.1038/s41598-018-25190-5
• 19. Paoli A, Mancin L, Bianco A, Thomas E, Mota JF, Piccini F. Ketogenic diet and microbiota: friends or enemies?. Genes. 2019;10(7):534. https://doi.org/10.3390/genes10070534
• 20. Beam A, Clinger E, Hao L. Effect of diet and dietary components on the composition of the gut microbiota. Nutrients. 2021. 13(8):2795. https://doi.org/10.3390/nu13082795
• 21. Gundogan K, Bayram F, Gedik V, Kaya A, Karaman A, Demir O et al. Metabolic syndrome prevalence according to ATP III and IDF criteria and related factors in Turkish adults. Archives of medical science AMS. 2013;9(2):243–253. https://doi.org/10.5114/aoms.2013.34560
• 22. Rochlani Y, Pothineni NV, Kovelamudi S, Mehta JL. Metabolic syndrome: pathophysiology, management, and modulation by natural compounds. Therapeutic advances in cardiovascular disease. 2017;11(8):215–225. https://doi.org/10.1177/1753944717711379
• 23. Saklayen MG. The global epidemic of the metabolic syndrome. Current hypertension reports. 2018;20(2):12. https://doi.org/10.1007/s11906-018-0812-z
• 24. Hyde PN, Sapper TN, Crabtree CD, LaFountain RA, Bowling ML, Buga A. et al. Dietary carbohydrate restriction improves metabolic syndrome independent of weight loss. JCI insight. 2019;4(12):e128308. https://doi.org/10.1172/jci.insight.128308
• 25. Gershuni VM, Yan SL, Medici V. Nutritional ketosis for weight management and reversal of metabolic syndrome. Current nutrition reports. 2018;7(3):97–106. https://doi.org/10.1007/s13668-018-0235-0
• 26. Kim D, Roberts C, McKenzie A, George MP. Nutritional ketosis to treat pulmonary hypertension associated with obesity and metabolic syndrome: a case report. Pulmonary circulation.2021;11(1) https://doi.org/10.1177/2045894021991426
• 27. Gibas MK, Gibas KJ. Induced and controlled dietary ketosis as a regulator of obesity and metabolic syndrome pathologies. Diabetes & metabolic syndrome 2017;11(1): S385–S390. https://doi.org/10.1016/j.dsx.2017.03.022
• 28. Engin A. The definition and prevalence of obesity and metabolic syndrome. Advances in experimental medicine and biology. 2017;960:1–17. https://doi.org/10.1007/978-3-319-48382-5_1
• 29. Türkiye Beslenme Rehberi (TÜBER) 2022 Sağlık bakanlığı, Halk Sağlığı Genel Müdürlüğü, Sağlık Bakanlığı Yayın No:1031, Ankara 2022.
• 30. Kosinski C, & Jornayvaz FR. (2017). Effects of Ketogenic Diets on Cardiovascular Risk Factors: Evidence from Animal and Human Studies. Nutrients, 9(5), 517. https://doi.org/10.3390/nu9050517
• 31. Moreno B, Crujeiras AB, Bellido D, Sajoux I, Casanueva FF. Obesity treatment by very low-calorie-ketogenic diet at two years: reduction in visceral fat and on the burden of disease. Endocrine. 2016;54(3):681–690. https://doi.org/10.1007/s12020-016-1050-2
• 32. Yancy WS, Jr Olsen MK, Guyton JR, Bakst RP, Westman EC. A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial. Annals of internal medicine. 2004;140(10):769–777. https://doi.org/10.7326/0003-4819-140-10-200405180-00006
• 33. Gomez-Arbelaez D, Bellido D, Castro AI, Ordoñez-Mayan L, Carreira J, Galban C, et al. Body Composition Changes After Very-Low-Calorie Ketogenic Diet in Obesity Evaluated by 3 Standardized Methods. The Journal of clinical endocrinology and metabolism. 2017;102(2), 488–498. https://doi.org/10.1210/jc.2016-2385
• 34. Di Rosa C, Lattanzi G, Spiezia C, Imperia E, Piccirilli S, Beato I. et al. Mediterranean diet versus very low-calorie ketogenic diet: effects of reaching 5% body weight loss on body composition in subjects with overweight and with obesity-a cohort study. International journal of environmental research and public health. 2022;19(20): 13040. https://doi.org/10.3390/ijerph192013040
• 35. LeRoith D. Beta-cell dysfunction and insulin resistance in type 2 diabetes: role of metabolic and genetic abnormalities. The American journal of medicine. 2002;113(6A):3S–11S. https://doi.org/10.1016/s0002-9343(02)01276-7
• 36. Xu H, Li X, Adams H, Kubena K, Guo S. Etiology of metabolic syndrome and dietary intervention. International journal of molecular sciences. 2018;20(1):128. https://doi.org/10.3390/ijms20010128
• 37. Locatelli CAA, & Mulvihill EE. Islet Health, Hormone Secretion, and Insulin Responsivity with Low-Carbohydrate Feeding in Diabetes. Metabolites. 2020;10(11), 455. https://doi.org/10.3390/metabo10110455
• 38. Saslow LR, Daubenmier JJ, Moskowitz JT, Kim S, Murphy EJ, Phinney SD. et al. Twelve-month outcomes of a randomized trial of a moderate-carbohydrate versus very low-carbohydrate diet in overweight adults with type 2 diabetes mellitus or prediabetes. Nutrition & Diabetes. 2017;7(12):304. https://doi.org/10.1038/s41387-017-0006-9
• 39. Michalczyk MM, Klonek G, Maszczyk A, Zajac A. The effects of a low calorie ketogenic diet on glycaemic control variables in hyperinsulinemic overweight/obese females. Nutrients. 2020;12(6):1854. https://doi.org/10.3390/nu12061854
• 40. Goday A, Bellido D, Sajoux I, Crujeiras AB, Burguera B, García-Luna PP. et al. Short-term safety, tolerability and efficacy of a very low-calorie-ketogenic diet interventional weight loss program versus hypocaloric diet in patients with type 2 diabetes mellitus. Nutrition & Diabetes. 2016;6(9):e230. https://doi.org/10.1038/nutd.2016.36
• 41. Zhou C, Wang M, Liang J, He G, & Chen N. Ketogenic diet benefits to weight loss, glycemic control, and lipid profiles in overweight patients with type 2 diabetes mellitus: a meta-Analysis of randomized controlled trails. International journal of environmental research and public health. 2022;19(16):10429. https://doi.org/10.3390/ijerph191610429
• 42. Li S, Lin G, Chen J, Chen Z, Xu F, Zhu F. et al. The effect of periodic ketogenic diet on newly diagnosed overweight or obese patients with type 2 diabetes. BMC endocrine disorders. 2022;22(1):34. https://doi.org/10.1186/s12902-022-00947-2
• 43. Gardner CD, Landry MJ, Perelman D, Petlura C, Durand LR, Aronica L. et al. Effect of a ketogenic diet versus Mediterranean diet on glycated hemoglobin in individuals with prediabetes and type 2 diabetes mellitus: The interventional Keto-Med randomized crossover trial. The American journal of clinical nutrition. 2022;116(3):640–652. https://doi.org/10.1093/ajcn/nqac154
• 44. Solomon TP, Haus JM, Kelly KR, Cook MD, Filion J, et al. A low-glycemic index diet combined with exercise reduces insulin resistance, postprandial hyperinsulinemia, and glucose-dependent insulinotropic polypeptide responses in obese, prediabetic humans. The American journal of clinical nutrition, 2010;92(6),1359–1368. https://doi.org/10.3945/ajcn.2010.29771
• 45. Bergia RE, Giacco R, Hjorth T, Biskup I, Zhu W, Costabile G, et al. Differential Glycemic Effects of Low- versus High-Glycemic Index Mediterranean-Style Eating Patterns in Adults at Risk for Type 2 Diabetes: The MEDGI-Carb Randomized Controlled Trial. Nutrients, 2022;14(3), 706. https://doi.org/10.3390/nu14030706
• 46. Kolovou GD, Anagnostopoulou KK, Cokkinos DV. Pathophysiology of dyslipidaemia in the metabolic syndrome. Postgraduate medical journal. 2005;81(956):358–366. https://doi.org/10.1136/pgmj.2004.025601
• 47. Norwitz NG, Soto-Mota A, Kaplan B, Ludwig DS, Budoff M, Kontush A, et al. The Lipid Energy Model: Reimagining Lipoprotein Function in the Context of Carbohydrate-Restricted Diets. Metabolites.2022;12(5), 460. https://doi.org/10.3390/metabo12050460
• 48. Burén J, Ericsson M, Damasceno NRT, Sjödin A. A ketogenic low-carbohydrate high-fat diet increases LDL cholesterol in healthy, young, normal-weight women: a randomized controlled feeding trial. Nutrients. 2021;13(3):814. https://doi.org/10.3390/nu13030814
• 49. Ministrini S, Calzini L, Nulli Migliola E, Ricci MA, Roscini AR, Siepi D. et al. Lysosomal acid lipase as a molecular target of the very low carbohydrate ketogenic diet in morbidly obese patients: the potential effects on liver steatosis and cardiovascular risk factors. Journal of clinical medicine. 2019;8(5):621. https://doi.org/10.3390/jcm8050621
• 50. Naveh N, Avidan Y, Zafrir B. Extreme Hypercholesterolemia Following a Ketogenic Diet: Exaggerated Response to an Increasingly Popular Diet. Cureus. 2023;15(8), e43683. https://doi.org/10.7759/cureus.43683
• 51. Tzenios N, Lewis ED, Crowley DC, Chahine M, Evans M. Examining the Efficacy of a Very-Low-Carbohydrate Ketogenic Diet on Cardiovascular Health in Adults with Mildly Elevated Low-Density Lipoprotein Cholesterol in an Open-Label Pilot Study. Metabolic syndrome and related disorders. 2022;20(2), 94–103. https://doi.org/10.1089/met.2021.0042
• 52. Guo Y, Wang X, Jia P, You Y, Cheng Y, Deng H. et al. Ketogenic diet aggravates hypertension via NF-κB-mediated endothelial dysfunction in spontaneously hypertensive rats. Life sciences. 2020;258;118124. https://doi.org/10.1016/j.lfs.2020.118124
• 53. Di Raimondo D, Buscemi S, Musiari G, Rizzo G, Pirera E, Corleo D. et al. Ketogenic diet, physical activity, and hypertension-a narrative review. Nutrients. 2021;13(8):2567. https://doi.org/10.3390/nu13082567