• Samir Giuseppe Sukkar, Ludovica Cogorno, Livia Pisciotta, Andrea Pasta, Antonio Vena, Raffaella Gradaschi, Chiara Dentone, Erica Guiddo, Eleonora Martino, Sabrina Beltramini, Lorenzo Maria Donini, Luca Carmisciano, Maria Pia Sormani, Matteo Bassetti, and GECOVID Study Group.
• Dietetics and Clinical Nutrition Unit, IRCCS-Policlinic Hospital San Martino, Genoa, Italy. Electronic address: samir.sukkar@hsanmartino.it.
• Nutrition. 2021 Sep 1; 89: 111236111236.

ObjectivesOur primary objective was to explore the effect of a eucaloric ketogenic diet (EKD) on mortality, admission to the intensive care unit, and need for non-invasive ventilation in hospitalized patients with COronaVIrus Disease 19 (COVID-19), in comparison to a eucaloric standard diet. Secondary objectives were verification of the safety and feasibility of the diet and its effects on inflammatory parameters, particularly interleukin-6.MethodsThe study is a retrospective analysis of 34 patients fed with an EKD in comparison to 68 patients fed with a eucaloric standard diet, selected and matched using propensity scores 1:2 to avoid the confounding effect of interfering variables. Our hypothesis was that an EKD would reduce mortality, admission to the intensive care unit, and need for non-invasive ventilation in patients with COVID-19.ResultsThe preliminary multivariate analysis showed a statistically significant difference in survival (P = 0.046) and need for the intensive care unit (P = 0.049) for the EKD compared with a eucaloric standard diet. Even considering the EKD start day as a time-dependent variable, the results maintain a positive trend for application of the diet, and it is not possible to reject the null hypothesis (P < 0.05). Interleukin-6 concentrations between t0 and t7 (7 d after the beginning of the diet) in the ketogenic nutrition group show a trend that is almost significant (P = 0.062). The EKD was safe and no adverse events were observed.ConclusionsThese results show a possible therapeutic role of an EKD in the clinical management of COVID-19. Currently, a prospective controlled randomized trial is running to confirm these preliminary data.Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

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