General Health

An open-label, randomized controlled trial to assess a ketogenic diet in critically ill patients with sepsis

Sepsis is a deadly immune response condition that remains highly fatal despite advanced care. The current standard of carbohydrate-rich feeding in critically ill patients may potentially worsen immune activation and tissue damage.

A recent study aimed to determine if ketogenic enteral feeding could achieve stable ketosis in critically ill sepsis patients and to evaluate its feasibility, safety, and immunological effects compared to standard enteral feeding.

This single-center randomized controlled trial involved 40 critically ill adults with sepsis who received enteral feeding for 7 to 14 days.

Findings:

→ Primary outcome: Patients on the ketogenic diet (KD) achieved stable ketosis with significantly higher β-hydroxybutyrate levels than the control group (mean difference of 1.4 mmol/L).

→ Safety: No major adverse events or harmful metabolic side effects were found in the KD group.

→ Insulin dependency: None of the KD patients needed insulin after day 4, compared to 35-60% of the control group.

→ Clinical outcomes: The KD group had more days without ventilation, vasopressors, or dialysis, and had a shorter ICU stay. However, there was no difference in 30-day survival rates.

→ Immunological impact: KD patients experienced reduced immune dysregulation, with lower T-cell activation gene expression and decreased pro-inflammatory cytokine levels.

This trial found that ketogenic enteral feeding safely induces stable ketosis in critically ill sepsis patients, showing potential clinical and immunological benefits. Larger trials are needed to further explore the impact of ketogenic diets on sepsis-related organ dysfunction.