{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T17:37:43Z","timestamp":1785173863006,"version":"3.55.0"},"reference-count":16,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,6,4]],"date-time":"2024-06-04T00:00:00Z","timestamp":1717459200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Human Nutrition Diet"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Lymphoedema is a chronic and progressive disease characterised by excessive accumulation of lymph in the interstitial compartment, leading to tissue swelling and fibroadipose deposition. Lymphangiogenesis is partly regulated by ketone body oxidation, and a ketogenic diet (KD) has shown therapeutic efficacy in a preclinical mouse tail lymphoedema model. Therefore, we aimed to investigate the potential therapeutic effect of a KD in patients with secondary lymphoedema.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Nine patients with unilateral stage 2 lymphoedema secondary to lymphadenectomy were included in this quasi\u2010experimental exploratory study consisting of a short run\u2010in phase to gradually induce ketosis, followed by a classic KD (CKD) and modified Atkins diet (MAD) phase during which patients consumed a CKD and MAD, respectively. Lymphatic function and oedema volume, the primary outcomes, were assessed at baseline and at the end of both the CKD and MAD phase. Secondary outcomes included health\u2010related and lymphedema\u2010specific quality of life (QoL).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seven out of nine patients completed the study protocol. Lymphatic function was improved upon consumption of both a CKD (dermal backflow score [mean\u2009\u00b1\u2009SD]: 7.29\u2009\u00b1\u20092.98 vs. 10.86\u2009\u00b1\u20092.19 at baseline;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03) and MAD (6.71\u2009\u00b1\u20092.06;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02), whereas oedema volume did not decrease during the course of the study (excess limb volume [mean\u2009\u00b1\u2009SD]: 20.13\u2009\u00b1\u200910.25% at end of CKD and 24.07\u2009\u00b1\u200917.77% at end of MAD vs. 20.79\u2009\u00b1\u200912.96% at baseline;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.99 and\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.30, respectively). No changes were observed in health\u2010related, nor lymphoedema\u2010specific QoL at the end of CKD and MAD.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The consumption of a KD improved lymphatic function and was associated with a clinically meaningful reduction in oedema volume in some patients (3\/7 at end of CKD, 2\/7 at end of MAD) with unilateral stage 2 secondary lymphoedema. These results highlight the potential of a KD to improve lymphatic function in patients with lymphoedema. However, further studies are required to substantiate our findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jhn.13330","type":"journal-article","created":{"date-parts":[[2024,6,5]],"date-time":"2024-06-05T01:40:00Z","timestamp":1717551600000},"page":"885-891","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Potential therapeutic effect of a ketogenic diet for the treatment of lymphoedema: Results of an exploratory study"],"prefix":"10.1111","volume":"37","author":[{"given":"Inge","family":"Lodewijckx","sequence":"first","affiliation":[{"name":"Department of Chronic Diseases and Metabolism, Research Group for Clinical and Experimental Endocrinology KU Leuven \u2013 University of Leuven Leuven Belgium"},{"name":"Department of Cardiovascular Sciences, Research Group for Vascular Surgery KU Leuven \u2013 University of Leuven Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christophe","family":"Matthys","sequence":"additional","affiliation":[{"name":"Department of Chronic Diseases and Metabolism, Research Group for Clinical and Experimental Endocrinology KU Leuven \u2013 University of Leuven Leuven Belgium"},{"name":"Department of Endocrinology UZ Leuven \u2013 University Hospitals Leuven Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joke","family":"Verheijen","sequence":"additional","affiliation":[{"name":"Department of Endocrinology UZ Leuven \u2013 University Hospitals Leuven Leuven Belgium"},{"name":"Center for Lymphedema UZ Leuven \u2013 University Hospitals Leuven Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raf","family":"Verscuren","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine UZ Leuven \u2013 University Hospitals Leuven Leuven Belgium"},{"name":"Department of Nuclear Medicine Regionaal Ziekenhuis Heilig Hart Tienen Tienen Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nele","family":"Devoogdt","sequence":"additional","affiliation":[{"name":"Center for Lymphedema UZ Leuven \u2013 University Hospitals Leuven Leuven Belgium"},{"name":"Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders KU Leuven \u2013 University of Leuven Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bart","family":"Van der Schueren","sequence":"additional","affiliation":[{"name":"Department of Chronic Diseases and Metabolism, Research Group for Clinical and Experimental Endocrinology KU Leuven \u2013 University of Leuven Leuven Belgium"},{"name":"Department of Endocrinology UZ Leuven \u2013 University Hospitals Leuven Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karolien","family":"Goffin","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine UZ Leuven \u2013 University Hospitals Leuven Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inge","family":"Fourneau","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, Research Group for Vascular Surgery KU Leuven \u2013 University of Leuven Leuven Belgium"},{"name":"Center for Lymphedema UZ Leuven \u2013 University Hospitals Leuven Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8491-6264","authenticated-orcid":false,"given":"Sarah","family":"Thomis","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, Research Group for Vascular Surgery KU Leuven \u2013 University of Leuven Leuven Belgium"},{"name":"Center for Lymphedema UZ Leuven \u2013 University Hospitals Leuven Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,6,4]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-med-060116-022900"},{"issue":"1","key":"e_1_2_12_3_1","first-page":"3","article-title":"The diagnosis and treatment of peripheral lymphedema: 2020 consensus document of the International Society of Lymphology","volume":"53","author":"Executive Committee of the International Society of Lymphology","year":"2020","journal-title":"Lymphology"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers12051338"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/s42255-019-0087-y"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12519-017-0053-2"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.plefa.2003.07.004"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10545-016-0011-5"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2021.702802"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu15153368"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jand.2017.02.003"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2017.12.023"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1089\/lrb.2013.0034"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCO.0000000000000596"},{"key":"e_1_2_12_15_1","first-page":"1","article-title":"The future of lymphedema: potential therapeutic targets for treatment","author":"Brown S","year":"2023","journal-title":"Curr Breast Cancer Rep"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/1559827617742108"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.22638"}],"container-title":["Journal of Human Nutrition and 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