Yasir Adil Jabbar Alabdali, Ibrahem A. Abdulzahra and  Sheereehan Abdullhussein Albyati

Department of Biology, College of Science, Al-Muthanna University, Samawah, Iraq

Received: Oct 2, 2023/ Revised: Oct 24, 2023/Accepted: Oct 25, 2023

(✉) Corresponding Author: Yasir Adil Jabbar Alabdali

 Abstract

The aim of this review is to explore the potential significance of ketogenic diets (KDs) in the treatment and prevention of coronavirus, specifically focusing on their beneficial impacts on inflammation, immune responses, and the respiratory system. The study reviewed several COVID-19 observations and findings, particularly those concerning obesity as a contributing factor. As per the study, notable obesity is linked to an elevated chance of intensive care unit (ICU) admission requiring invasive mechanical ventilation in individuals with COVID-19. Additionally, the increasing weight gain associated with a SARS-CoV-2 infection prognosis may be attributed to various factors, including prolonged systemic inflammation, susceptibility to acute respiratory infections, and the influence of the viral disease. The article ultimately concludes that ketogenic diets may play a pivotal role in managing and preventing SARS-CoV-2 by diminishing the virus’s impact on inflammatory responses, immune functionality, and respiratory system health. Furthermore, the article focuses on the link between extreme obesity and severe COVID-19 results, implying the need for weight control in high-risk patients.

Keywords:  Ketogenic Diets, COVID-19, Intensive Care Units.

References

Al-Saady, N. M., Blackmore, C. M., & Bennett, E. D. (1989). High fat, low carbohydrate, enteral feeding lowers PaCO2 and reduces the period of ventilation in artificially ventilated patients. Intensive Care Medicine, 15(5), 290–295.

https://doi.org/10.1007/bf00263863

Barrea, L., Vetrani, C., Caprio, M., Cataldi, M., Ghoch, M. E., Elce, A., Muscogiuri, G. (2022). From the Ketogenic Diet to the Mediterranean Diet: The Potential Dietary Therapy in Patients with Obesity after CoVID-19 Infection (Post CoVID Syndrome). Current Obesity Reports, 11(3), 144–165.

https://doi.org/10.1007/s13679-022-00475-z

Bowie, A. G., & Unterholzner, L. (2008). Viral evasion and subversion of pattern-recognition receptor signalling. Nature Reviews Immunology, 8(12), 911–922.

https://doi.org/10.1038/nri2436

Caprio, M., Infante, M., Moriconi, E., Armani, A., Fabbri, A., Mantovani, G., Simeoli, C. (2019). Very-low-calorie ketogenic diet (VLCKD) in the management of metabolic diseases: systematic review and consensus statement from the Italian Society of Endocrinology (SIE). Journal of Endocrinological Investigation, 42(11), 1365–1386.

https://doi.org/10.1007/s40618-019-01061-2

Chen, N., Zhou, M., Dong, X., Qu, J., Gong, F., Han, Y., . . . Zhang, L. (2020). Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet, 395(10223), 507–513.

https://doi.org/10.1016/s0140-6736(20)30211-7

El Koofy, N. M., Rady, H. I., Abdallah, S. M., Bazaraa, H. M., Rabie, W. A., & El-Ayadi, A. A. (2019). The effect of high fat dietary modification and nutritional status on the outcome of critically ill ventilated children: single-center study. Korean Journal of Pediatrics, 62(9), 344–352.

https://doi.org/10.3345/kjp.2018.06835

Elliot, J. G., Donovan, G. M., Wang, K. C., Green, F. H., James, A. L., & Noble, P. B. (2019). Fatty airways: implications for obstructive disease. European Respiratory Journal, 54(6), 1900857.

https://doi.org/10.1183/13993003.00857-2019

Forni, D., Cagliani, R., Clerici, M., & Sironi, M. (2017). Molecular Evolution of Human Coronavirus Genomes. Trends in Microbiology, 25(1), 35–48.

https://doi.org/10.1016/j.tim.2016.09.001

Foster, D. J., Ravikumar, P., Bellotto, D. J., Unger, R. H., & Hsia, C. C. W. (2010). Fatty diabetic lung: altered alveolar structure and surfactant protein expression. American Journal of Physiology-Lung Cellular and Molecular Physiology, 298(3), L392–L403.

https://doi.org/10.1152/ajplung.00041.2009

Franchi, L., & Núñez, G. (2012). Orchestrating Inflammasomes. Science, 337(6100), 1299–1300.

https://doi.org/10.1126/science.1229010

Gomez-Arbelaez, D., Crujeiras, A. B., Castro, A. I., Martinez-Olmos, M. A., Canton, A., Ordoñez-Mayan, L., Casanueva, F. F. (2018). Resting metabolic rate of obese patients under very low calorie ketogenic diet. Nutrition & Metabolism, 15(1).

https://doi.org/10.1186/s12986-018-0249-z

Guan, W. J., Ni, Z. Y., Hu, Y., Liang, W. H., Ou, C. Q., He, J. X.,  Zhong, N. S. (2020). Clinical Characteristics of Coronavirus Disease 2019 in China. New England Journal of Medicine, 382(18), 1708–1720.

https://doi.org/10.1056/nejmoa2002032

Health Commission of PRC, N. (2020). National guidelines for diagnosis and treatment of colorectal cancer 2020 in China (English version). Chinese Journal of Cancer Research, 32(4), 415–445.

https://doi.org/10.21147/j.issn.1000-9604.2020.04.01

Health Effects of Overweight and Obesity in 195 Countries over 25 Years. (2017). New England Journal of Medicine, 377(1), 13–27.

https://doi.org/10.1056/nejmoa1614362

Hearris, M. A., Hammond, K. M., Seaborne, R. A., Stocks, B., Shepherd, S. O., Philp, A., . . . Louis, J. B. (2019). Graded reductions in preexercise muscle glycogen impair exercise capacity but do not augment skeletal muscle cell signaling: implications for CHO periodization. Journal of Applied Physiology, 126(6), 1587–1597.

https://doi.org/10.1152/japplphysiol.00913.2018

Honce, R., & Schultz-Cherry, S. (2019). Impact of Obesity on Influenza A Virus Pathogenesis, Immune Response, and Evolution. Frontiers in Immunology, 10.

https://doi.org/10.3389/fimmu.2019.01071

Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., Cao, B. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet, 395(10223), 497–506.

https://doi.org/10.1016/s0140-6736(20)30183-5

Impey, S. G., Hearris, M. A., Hammond, K. M., Bartlett, J. D., Louis, J., Close, G. L., & Morton, J. P. (2018). Fuel for the Work Required: A Theoretical Framework for Carbohydrate Periodization and the Glycogen Threshold Hypothesis. Sports Medicine, 48(5), 1031–1048.

https://doi.org/10.1007/s40279-018-0867-7

Joint position statement: nutrition and athletic performance. (2001).   Scandinavian Journal of Medicine & Science in Sports, 11(3), 193–194.

https://doi.org/10.1046/j.1524-4725.2001.110310_2.x

Kalligeros, M., Shehadeh, F., Mylona, E. K., Benitez, G., Beckwith, C. G., Chan, P. A., & Mylonakis, E. (2020). Association of Obesity with Disease Severity Among Patients with Coronavirus Disease 2019. Obesity, 28(7), 1200–1204.

https://doi.org/10.1002/oby.22859

Kass, D. A., Duggal, P., & Cingolani, O. (2020). Obesity could shift severe COVID-19 disease to younger ages. The Lancet, 395(10236), 1544–1545.

https://doi.org/10.1016/s0140-6736(20)31024-2

Kossoff, E. H., Turner, Z., Adams, J., Bessone, S. K., Avallone, J., McDonald, T. J., Cervenka, M. C. (2020). Ketogenic diet therapy provision in the COVID-19 pandemic: Dual-center experience and recommendations. Epilepsy & Behavior, 111, 107181.

https://doi.org/10.1016/j.yebeh.2020.107181

Kumar, A. (2009). Critically Ill Patients With 2009 Influenza A(H1N1) Infection in Canada. JAMA, 302(17), 1872.

https://doi.org/10.1001/jama.2009.1496

Kwong, J. C., Campitelli, M. A., & Rosella, L. C. (2011). Obesity and Respiratory Hospitalizations During Influenza Seasons in Ontario, Canada: A Cohort Study. Clinical Infectious Diseases, 53(5), 413–421.

https://doi.org/10.1093/cid/cir442

Kyle, R. A., & Shampo, M. A. (1992). Wilder Penfield—Contributor to the Surgical Treatment of Epilepsy. Mayo Clinic Proceedings, 67(6), 596.

https://doi.org/10.1016/s0025-6196(12)60468-6

Li, B., Yang, J., Zhao, F., Zhi, L., Wang, X., Liu, L., Zhao, Y. (2020). Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clinical Research in Cardiology, 109(5), 531–538.

https://doi.org/10.1007/s00392-020-01626-9

Li, Q., Guan, X., Wu, P., Wang, X., Zhou, L., Tong, Y., Feng, Z. (2020). Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia. New England Journal of Medicine, 382(13), 1199–1207.

https://doi.org/10.1056/nejmoa2001316

Lim, E. L., Hollingsworth, K. G., Aribisala, B. S., Chen, M. J., Mathers, J. C., & Taylor, R. (2011). Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia, 54(10), 2506–2514.

https://doi.org/10.1007/s00125-011-2204-7

Luukkonen, P. K., Dufour, S., Lyu, K., Zhang, X. M., Hakkarainen, A., Lehtimäki, T. E.,  Yki-Järvinen, H. (2020). Effect of a ketogenic diet on hepatic steatosis and hepatic mitochondrial metabolism in nonalcoholic fatty liver disease. Proceedings of the National Academy of Sciences, 117(13), 7347–7354.

https://doi.org/10.1073/pnas.1922344117

Mancuso, P. (2010). Obesity and lung inflammation. Journal of Applied Physiology,108(3),722–728.

https://doi.org/10.1152/japplphysiol.00781.2009

Morgan, O. W., Bramley, A., Fowlkes, A., Freedman, D. S., Taylor, T. H., Gargiullo, P., Fry, A. M. (2010). Morbid Obesity as a Risk Factor for Hospitalization and Death Due to 2009 Pandemic Influenza A(H1N1) Disease. PLoS ONE, 5(3), e9694.

https://doi.org/10.1371/journal.pone.0009694

Muscogiuri, G., Pugliese, G., Barrea, L., Savastano, S., & Colao, A. (2020). Commentary: Obesity: The “Achilles heel” for COVID-19? Metabolism, 108, 154251.

https://doi.org/10.1016/j.metabol.2020.154251

Narici, M., Vito, G. D., Franchi, M., Paoli, A., Moro, T., Marcolin, G., Maganaris, C. (2020). Impact of sedentarism due to the COVID-19 home confinement on neuromuscular, cardiovascular and metabolic health: Physiological and pathophysiological implications and recommendations for physical and nutritional countermeasures. European Journal of Sport Science, 21(4), 614–635.

https://doi.org/10.1080/17461391.2020.1761076

O??BRIEN, M. J., VIGUIE, C. A., MAZZEO, R. S., & BROOKS, G. A. (1993). Carbohydrate dependence during marathon running. Medicine & Science in Sports & Exercise, 25(9), 1009???1017.

https://doi.org/10.1249/00005768-199309000-00007

Paich, H. A., Sheridan, P. A., Handy, J., Karlsson, E. A., Schultz-Cherry, S., Hudgens, M. G., Beck, M. A. (2013). Overweight and obese adult humans have a defective cellular immune response to pandemic H1N1 Influenza a virus. Obesity, 21(11), 2377–2386.

https://doi.org/10.1002/oby.20383

Paoli, A., Gorini, S., & Caprio, M. (2020). The dark side of the spoon – glucose, ketones and COVID-19: a possible role for ketogenic diet? Journal of Translational Medicine, 18(1).

https://doi.org/10.1186/s12967-020-02600-9

Paoli, A., Gorini, S., & Caprio, M. (2020). The dark side of the spoon – glucose, ketones and COVID-19: a possible role for ketogenic diet? Journal of Translational Medicine, 18(1).

https://doi.org/10.1186/s12967-020-02600-9

Paoli, A., Rubini, A., Volek, J. S., & Grimaldi, K. A. (2013). Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. European Journal of Clinical Nutrition, 67(8), 789–796.

https://doi.org/10.1038/ejcn.2013.116

Pascarella, G., Strumia, A., Piliego, C., Bruno, F., Del Buono, R., Costa, F., Agrò, F. E. (2020). COVID‐19 diagnosis and management: a comprehensive review. Journal of Internal Medicine, 288(2), 192–206.

https://doi.org/10.1111/joim.13091

Qian, Z., Travanty, E. A., Oko, L., Edeen, K., Berglund, A., Wang, J., . . . Mason, R. J. (2013). Innate Immune Response of Human Alveolar Type II Cells Infected with Severe Acute Respiratory Syndrome–Coronavirus. American Journal of Respiratory Cell and Molecular Biology, 48(6), 742–748.

https://doi.org/10.1165/rcmb.2012-0339oc

Reilly, S. M., & Saltiel, A. R. (2017). Adapting to obesity with adipose tissue inflammation. Nature Reviews Endocrinology, 13(11), 633–643.

https://doi.org/10.1038/nrendo.2017.90

Rubini, A., Bosco, G., Lodi, A., Cenci, L., Parmagnani, A., Grimaldi, K., . . . Paoli, A. (2016). Erratum to: Effects of Twenty Days of the Ketogenic Diet on Metabolic and Respiratory Parameters in Healthy Subjects. Lung, 195(1), 155–155.

https://doi.org/10.1007/s00408-016-9958-0

Simonnet, A., Chetboun, M., Poissy, J., Raverdy, V., Noulette, J., Duhamel, A., Jourdain, M. (2020). High Prevalence of Obesity in Severe Acute Respiratory Syndrome Coronavirus‐2 (SARS‐CoV‐2) Requiring Invasive Mechanical Ventilation. Obesity, 28(7), 1195–1199.

https://doi.org/10.1002/oby.22831

Soliman, S., Faris, M. E., Ratemi, Z., & Halwani, R. (2020). Switching Host Metabolism as an Approach to Dampen SARS-CoV-2 Infection. Annals of Nutrition and Metabolism, 76(5), 297–303.

https://doi.org/10.1159/000510508

South, A. M., Diz, D. I., & Chappell, M. C. (2020). COVID-19, ACE2, and the cardiovascular consequences. American Journal of Physiology-Heart and Circulatory Physiology, 318(5), H1084–H1090.

https://doi.org/10.1152/ajpheart.00217.2020

Su, S., Wong, G., Shi, W., Liu, J., Lai, A. C., Zhou, J., Gao, G. F. (2016). Epidemiology, Genetic Recombination, and Pathogenesis of Coronaviruses. Trends in Microbiology, 24(6), 490–502.

https://doi.org/10.1016/j.tim.2016.03.003

Sue, D. Y., Chung, M. M., Grosvenor, M., & Wasserman, K. (1989). Effect of Altering the Proportion of Dietary Fat and Carbohydrate on Exercise Gas Exchange in Normal Subjects. American Review of Respiratory Disease, 139(6), 1430–1434.

https://doi.org/10.1164/ajrccm/139.6.1430

Sukkar, S. G., & Bassetti, M. (2020). Induction of ketosis as a potential therapeutic option to limit hyperglycemia and prevent cytokine storm in COVID-19. Nutrition, 79–80, 110967.

https://doi.org/10.1016/j.nut.2020.110967

Tay, M. Z., Poh, C. M., Rénia, L., MacAry, P. A., & Ng, L. F. P. (2020). The trinity of COVID-19: immunity, inflammation and intervention. Nature Reviews Immunology, 20(6), 363–374.

https://doi.org/10.1038/s41577-020-0311-8

Tian, S., Hu, W., Niu, L., Liu, H., Xu, H., & Xiao, S. Y. (2020). Pulmonary Pathology of Early-Phase 2019 Novel Coronavirus (COVID-19) Pneumonia in Two Patients With Lung Cancer. Journal of Thoracic Oncology, 15(5), 700–704.

https://doi.org/10.1016/j.jtho.2020.02.010

Wang, D., Hu, B., Hu, C., Zhu, F., Liu, X., Zhang, J., Peng, Z. (2020). Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA, 323(11), 1061.

https://doi.org/10.1001/jama.2020.1585

Wang, H., Wang, Z., Dong, Y., Chang, R., Xu, C., Yu, X., Cai, Y. (2020). Phase-adjusted estimation of the number of Coronavirus Disease 2019 cases in Wuhan, China. Cell Discovery, 6(1).

https://doi.org/10.1038/s41421-020-0148-0

Wu, J. T., Leung, K., & Leung, G. M. (2020). Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study. The Lancet, 395(10225), 689–697.

https://doi.org/10.1016/s0140-6736(20)30260-9

Wu, Z., & McGoogan, J. M. (2020). Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China. JAMA, 323(13), 1239.

https://doi.org/10.1001/jama.2020.2648

Xu, X. W., Wu, X. X., Jiang, X. G., Xu, K. J., Ying, L. J., Ma, C. L., Li, L. J. (2020). Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. BMJ, m606.

https://doi.org/10.1136/bmj.m606

Xu, X. W., Wu, X. X., Jiang, X. G., Xu, K. J., Ying, L. J., Ma, C. L., Li, L. J. (2020). Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. BMJ, m606.

https://doi.org/10.1136/bmj.m606

Yang, J., Zheng, Y., Gou, X., Pu, K., Chen, Z., Guo, Q., Zhou, Y. (2020). Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. International Journal of Infectious Diseases, 94, 91–95.

https://doi.org/10.1016/j.ijid.2020.03.017

Yang, X., Yu, Y., Xu, J., Shu, H., Xia, J., Liu, H., Shang, Y. (2020). Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. The Lancet Respiratory Medicine, 8(5), 475.

https://doi.org/10.1016/s2213-2600(20)30079-5

Zhu, N., Zhang, D., Wang, W., Li, X., Yang, B., Song, J., Tan, W. (2020). A Novel Coronavirus from Patients with Pneumonia in China, 2019. New England Journal of Medicine, 382(8), 727–733.

https://doi.org/10.1056/nejmoa2001017

How to cite this article

Alabdali, Y. A. J., Abdulzahra, I. A. and Albyati, S. A. (2023). A review of ketogenic diets and their potential impact on COVID-19: Is there an interaction?.Science Archives, Vol. 4(4), 295-301.

https://doi.org/10.47587/SA.2023.4409

Licence                  Article Metadata

This work is licensed under a Creative Commons Attribution 4.0 International License.

[pdf_attachment file="1" name="View Details"]