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2024 Jan 14:nuad175. doi: 10.1093/nutrit/nuad175. Online ahead of print.

The effect of a ketogenic diet on inflammation-related markers: a systematic review and meta-analysis of randomized controlled trials

Abstract
Context: Despite the important role of inflammation-related factors on the occurrence of chronic diseases, there is still conflicting evidence about the effects of the ketogenic diet (KD) on these factors.

Objective: In order to obtain a better viewpoint, this study aimed to comprehensively investigate the effects of a KD on inflammation-related markers.

Data sources: To find pertinent randomized controlled trials up to August 2023, databases including PubMed/Medline, Web of Science, Scopus, Cochrane Library, and Embase were searched.

Data extraction: This study included all randomized controlled trials investigating the effects of a KD on C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6, IL-8, and IL-10 levels. Pooled weighted mean difference (WMD) and 95% confidence intervals (CIs) were achieved by random-effects model analysis for the best estimation of outcomes.

Data analysis: Forty-four studies were included in this article. The pooled findings showed that a KD has an effect on lowering TNF-α (WMD: -0.32 pg/mL; 95% CI: -0.55, -0.09; P = 0.007) and IL-6 (WMD: -0.27 pg/mL; 95% CI: -0.52, -0.02; P = 0.036) compared with control groups. However, no significant effect was reported for others inflammation marker-related levels. The results of the subgroup analysis showed that, in trials following the KD for ≤8 weeks and in people aged ≤50 years, the reduction in TNF-α levels was significantly higher than in other groups. In addition, in people with a body mass index greater than 30 kg/m2 compared to a body mass index ≤30 kg/m2, IL-6 levels decreased to a greater extent after receiving the KD.

Conclusions: Consequently, adherence to a KD appears to improve some markers associated with inflammation, including TNF-α and IL-6.