{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T12:26:56Z","timestamp":1783081616393,"version":"3.54.6"},"reference-count":79,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: The Ketogenic Diet (KD) has been proposed as an adjunct to standard therapy for gliomas by targeting tumor glycolysis. We systematically reviewed evidence on KD interventions in patients with glioma across multiple outcomes. Methods: Following Cochrane guidelines, we searched MEDLINE, Embase, and Cochrane Library (until 1 February 2025) for studies on humans with glioma treated with any KD versus usual care or other diets. Outcomes included overall survival (OS) and progression-free survival (PFS), quality of life (QoL), biochemical markers (glucose, ketones, glucose\u2013ketone index GKI), anthropometric measures, safety, and tolerability. All study designs were eligible. The quality of the studies was assessed with JBI tools. Data were narratively synthesized due to heterogeneity. The PROSPERO registration is CRD42024547388. Results: Twenty-three studies (306 patients) were included: two RCTs, 11 quasi-experimental studies, six case series, and four case reports. Dietary interventions included classic KD, modified KD, medium-chain triglyceride KD, and Modified Atkins Diet, sometimes combined with fasting. The overall dropout was 20.3%, mainly due to dietary restrictiveness, disease progression, adverse effects, or QoL concerns. Survival results were inconsistent: RCTs showed no significant OS\/PFS differences versus controls, although exploratory analyses suggested better outcomes with lower glucose levels. Ketosis was commonly achieved; glucose reductions were variable, and GKI was rarely reported, with target values seldom reached outside fasting periods. Weight\/BMI generally decreased modestly or remained stable; adverse events were mostly mild and tolerability was acceptable. Conclusions: Evidence for KDs in glioma patients is heterogeneous and limited. Although ketosis and safety are achievable, survival or QoL benefits remain unproven. Given the methodological challenges, the clinical complexity, and the promising potential of the Ketogenic Diet, further well-designed studies are needed to clarify its clinical utility in glioma treatment.<\/jats:p>","DOI":"10.3390\/nu18132166","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T11:39:11Z","timestamp":1783078751000},"page":"2166","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ketogenic Diet in the Treatment of Malignant Gliomas: A Systematic Review"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1400-9498","authenticated-orcid":false,"given":"Michela","family":"Persiani","sequence":"first","affiliation":[{"name":"Department of Quality of Life, University of Bologna, 40126 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7555-9659","authenticated-orcid":false,"given":"Laura","family":"Dallolio","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Neuromotor Sciences DIBINEM, University of Bologna, 40126 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1238-3777","authenticated-orcid":false,"given":"Alice","family":"Masini","sequence":"additional","affiliation":[{"name":"Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2703-9349","authenticated-orcid":false,"given":"Yari","family":"Longobucco","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of Florence, 50121 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5867-8074","authenticated-orcid":false,"given":"Simona","family":"Bertoli","sequence":"additional","affiliation":[{"name":"Department of Food, Environmental and Nutritional Sciences, University of Milan, 20122 Milan, Italy"},{"name":"Istituto Auxologico Italiano IRCCS, Obesity Unit and Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, 20145 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia","family":"Guberti","sequence":"additional","affiliation":[{"name":"Board Food and Nutrition Societ\u00e0 Italiana di Igiene e Medicina Preventiva, 40126 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9338-9147","authenticated-orcid":false,"given":"Marta","family":"Pellizzari","sequence":"additional","affiliation":[{"name":"Istituto Auxologico Italiano IRCCS, Obesity Unit and Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, 20145 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7040-6466","authenticated-orcid":false,"given":"Maria Letizia","family":"Petroni","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9478-6299","authenticated-orcid":false,"given":"Federica","family":"Valeriani","sequence":"additional","affiliation":[{"name":"Department of Movement, Human, and Health Sciences, University of Rome Foro Italico, 00135 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0504-9562","authenticated-orcid":false,"given":"Francesca","family":"Gall\u00e8","sequence":"additional","affiliation":[{"name":"Department of Medical, Movement and Wellbeing Sciences, University of Naples \u201cParthenope\u201d, 80133 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8762-9973","authenticated-orcid":false,"given":"Rossella","family":"Sacchetti","sequence":"additional","affiliation":[{"name":"Department of Education Studies \u201cGiovanni Maria Bertin\u201d, University of Bologna, 40126 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1093\/neuonc\/noab106","article-title":"The 2021 WHO Classification of Tumors of the Central Nervous System: A summary","volume":"23","author":"Louis","year":"2021","journal-title":"Neuro-Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"iv1","DOI":"10.1093\/neuonc\/noaf194","article-title":"CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2018\u20132022","volume":"27","author":"Price","year":"2025","journal-title":"Neuro-Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1007\/s13311-017-0519-x","article-title":"Glioma Subclassifications and Their Clinical Significance","volume":"14","author":"Chen","year":"2017","journal-title":"Neurotherapeutics"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.1212\/CON.0000000000000536","article-title":"2016 World Health Organization Classification of Central Nervous System Tumors","volume":"23","author":"Wen","year":"2017","journal-title":"Continuum"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.1001\/jamaoncol.2018.1977","article-title":"Association of MGMT Promoter Methylation Status with Survival Outcomes in Patients with High-Risk Glioma Treated with Radiotherapy and Temozolomide","volume":"4","author":"Bell","year":"2018","journal-title":"JAMA Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1038\/s41582-022-00679-w","article-title":"Clinical implications of the 2021 edition of the WHO classification of central nervous system tumours","volume":"18","author":"Horbinski","year":"2022","journal-title":"Nat. Rev. Neurol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1200\/JCO.21.02036","article-title":"Therapy for Diffuse Astrocytic and Oligodendroglial Tumors in Adults: ASCO-SNO Guideline","volume":"40","author":"Mohile","year":"2022","journal-title":"J. Clin. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1093\/neuonc\/nou005","article-title":"The combination of IDH1 mutations and MGMT methylation status predicts survival in glioblastoma better than either IDH1 or MGMT alone","volume":"16","author":"Molenaar","year":"2014","journal-title":"Neuro-Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"6704","DOI":"10.1038\/s41598-018-25169-2","article-title":"Concordant association validates MGMT methylation and protein expression as favorable prognostic factors in glioma patients on alkylating chemotherapy (Temozolomide)","volume":"8","author":"Pandith","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1093\/neuonc\/nos317","article-title":"IDH\/MGMT-driven molecular classification of low-grade glioma is a strong predictor for long-term survival","volume":"15","author":"Leu","year":"2013","journal-title":"Neuro-Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.semcancer.2017.12.011","article-title":"Targeting the Warburg effect for cancer treatment: Ketogenic diets for management of glioma","volume":"56","author":"Poff","year":"2019","journal-title":"Semin. Cancer Biol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.biocel.2015.01.022","article-title":"Mitochondria: The ketogenic diet\u2014A metabolism-based therapy","volume":"63","author":"Vidali","year":"2015","journal-title":"Int. J. Biochem. Cell Biol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Woolf, E.C., Syed, N., and Scheck, A.C. (2016). Tumor Metabolism, the Ketogenic Diet and \u03b2-Hydroxybutyrate: Novel Approaches to Adjuvant Brain Tumor Therapy. Front. Mol. Neurosci., 9.","DOI":"10.3389\/fnmol.2016.00122"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1007\/s11864-015-0356-2","article-title":"The Role of Glucose Modulation and Dietary Supplementation in Patients with Central Nervous System Tumors","volume":"16","author":"Strowd","year":"2015","journal-title":"Curr. Treat. Options Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.critrevonc.2017.02.016","article-title":"Role of ketogenic metabolic therapy in malignant glioma: A systematic review","volume":"112","author":"Winter","year":"2017","journal-title":"Crit. Rev. Oncol.\/Hematol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Sarga\u00e7o, B., Oliveira, P.A., Antunes, M.L., and Moreira, A.C. (2022). Effects of the Ketogenic Diet in the Treatment of Gliomas: A Systematic Review. Nutrients, 14.","DOI":"10.3390\/nu14051007"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1007\/s11060-016-2364-x","article-title":"Changes in cerebral metabolism during ketogenic diet in patients with primary brain tumors: 1H-MRS study","volume":"132","author":"Artzi","year":"2017","journal-title":"J. Neuro-Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"433","DOI":"10.3747\/co.26.4889","article-title":"Feasibility of a Modified Atkins Diet in Glioma Patients During Radiation and Its Effect on Radiation Sensitization","volume":"26","author":"Woodhouse","year":"2019","journal-title":"Curr. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1007\/s40618-019-01061-2","article-title":"Very-low-calorie ketogenic diet (VLCKD) in the management of metabolic diseases: Systematic review and consensus statement from the Italian Society of Endocrinology (SIE)","volume":"42","author":"Caprio","year":"2019","journal-title":"J. Endocrinol. Investig."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e70129","DOI":"10.1111\/jhn.70129","article-title":"Classical and Modified Ketogenic Diets for Children and Young People with Drug-Resistant Epilepsy: A Reflection of International Dietetic Practice and Best Practice Recommendations for Dietitians","volume":"38","author":"Schoeler","year":"2025","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Dal Bello, S., Valdemarin, F., Martinuzzi, D., Filippi, F., Gigli, G.L., and Valente, M. (2022). Ketogenic Diet in the Treatment of Gliomas and Glioblastomas. Nutrients, 14.","DOI":"10.3390\/nu14183851"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"63","DOI":"10.3390\/neuroglia5020005","article-title":"Ketogenic Diet in the Management of Glioblastomas: A Bibliometric Analysis","volume":"5","author":"Brotis","year":"2024","journal-title":"Neuroglia"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Strickland, M., and Stoll, E.A. (2017). Metabolic Reprogramming in Glioma. Front. Cell Dev. Biol., 5.","DOI":"10.3389\/fcell.2017.00043"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Azzalin, A., Brambilla, F., Arbustini, E., Basello, K., Speciani, A., Mauri, P., Bezzi, P., and Magrassi, L. (2020). A New Pathway Promotes Adaptation of Human Glioblastoma Cells to Glucose Starvation. Cells, 9.","DOI":"10.3390\/cells9051249"},{"key":"ref_25","first-page":"101453","article-title":"Glioblastoma Utilizes Fatty Acids and Ketone Bodies for Growth Allowing Progression during Ketogenic Diet Therapy","volume":"23","author":"Sperry","year":"2020","journal-title":"Science"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Tamas, C., Tamas, F., Kovecsi, A., Serban, G., Boeriu, C., and Balasa, A. (2023). The Role of Ketone Bodies in Treatment Individualization of Glioblastoma Patients. Brain Sci., 13.","DOI":"10.3390\/brainsci13091307"},{"key":"ref_27","unstructured":"Chandler, J., Cumpston, M., and Li, T. (2024). Cochrane Handbook for Systematic Reviews of Interventions, John Wiley & Sons."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1111\/j.1741-6787.2005.00022.x","article-title":"Outcomes and Implementation Strategies From the First U.S. Evidence-Based Practice Leadership Summit","volume":"2","author":"Melnyk","year":"2005","journal-title":"Worldviews Evid.-Based Nurs."},{"key":"ref_29","unstructured":"Joanna Briggs Institute (2020). Critical Appraisal Tools Adelaide, University of Adelaide. Available online: https:\/\/jbi.global\/critical-appraisal-tools."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"494","DOI":"10.11124\/JBIES-22-00430","article-title":"The revised JBI critical appraisal tool for the assessment of risk of bias for randomized controlled trials","volume":"21","author":"Barker","year":"2023","journal-title":"JBI Evid. Synth."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.ecns.2017.11.003","article-title":"Simulation as a Tool for Clinical Remediation: An Integrative Review","volume":"16","author":"Camp","year":"2018","journal-title":"Clin. Simul. Nurs."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1080\/07315724.1995.10718495","article-title":"Effects of a ketogenic diet on tumor metabolism and nutritional status in pediatric oncology patients: Two case reports","volume":"14","author":"Nebeling","year":"1995","journal-title":"J. Am. Coll. Nutr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"230","DOI":"10.3892\/ol.2024.14363","article-title":"Ketogenic metabolic therapy in conjunction with standard treatment for glioblastoma: A case report","volume":"27","author":"Phillips","year":"2024","journal-title":"Oncol. Lett."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1055\/s-0037-1605588","article-title":"Patient with Recurrent Glioblastoma Responding Favorably to Ketogenic Diet Combined with Intranasal Delivery of Perillyl Alcohol: A Case Report and Literature Review","volume":"36","author":"Santos","year":"2017","journal-title":"Arq. Bras. Neurocir. Braz. Neurosurg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/1743-7075-7-33","article-title":"Metabolic management of glioblastoma multiforme using standard therapy together with a restricted ketogenic diet: Case Report","volume":"7","author":"Zuccoli","year":"2010","journal-title":"Nutr. Metab."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1007\/s11060-014-1362-0","article-title":"Targeting metabolism with a ketogenic diet during the treatment of glioblastoma multiforme","volume":"117","author":"Champ","year":"2014","journal-title":"J. Neuro-Oncol."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Panhans, C.M., Gresham, G., Amaral, L.J., and Hu, J. (2020). Corrigendum: Exploring the Feasibility and Effects of a Ketogenic Diet in Patients with CNS Malignancies: A Retrospective Case Series. Front. Neurosci., 14.","DOI":"10.3389\/fnins.2020.00661"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"4496734","DOI":"10.1155\/2022\/4496734","article-title":"Feasibility and Safety of a Combined Metabolic Strategy in Glioblastoma Multiforme: A Prospective Case Series","volume":"2022","author":"Phillips","year":"2022","journal-title":"J. Oncol."},{"key":"ref_40","first-page":"e26457","article-title":"Ketogenic Metabolic Therapy for Glioma","volume":"14","author":"Smith","year":"2022","journal-title":"Cureus"},{"key":"ref_41","first-page":"e27561","article-title":"Ketogenic diet treatment in recurrent diffuse intrinsic pontine glioma in children: A safety and feasibility study","volume":"66","author":"Reddingius","year":"2018","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_42","first-page":"1","article-title":"The Effect of Ketogenic Metabolic Therapy on Recurrent High-Grade Gliomas: Case Series","volume":"4","author":"Monsalve","year":"2024","journal-title":"J. Neuro Oncol. Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1080\/01635581.2020.1779759","article-title":"Isocaloric Ketogenic Diet in Adults with High-Grade Gliomas: A Prospective Metabolic Study","volume":"73","author":"Foppiani","year":"2020","journal-title":"Nutr. Cancer"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s40170-020-00230-9","article-title":"Treatment of glioblastoma multiforme with \u201cclassic\u201d 4:1 ketogenic diet total meal replacement","volume":"8","author":"Klein","year":"2020","journal-title":"Cancer Metab."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1080\/01635581.2018.1460677","article-title":"The Modified Ketogenic Diet in Adults with Glioblastoma: An Evaluation of Feasibility and Deliverability within the National Health Service","volume":"70","author":"Marson","year":"2018","journal-title":"Nutr. Cancer"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1007\/s11060-020-03417-8","article-title":"Ketogenic diets as an adjuvant therapy for glioblastoma (KEATING): A randomized, mixed methods, feasibility study","volume":"147","author":"Marson","year":"2020","journal-title":"J. Neuro-Oncol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1007\/s11060-021-03786-8","article-title":"A Phase I clinical trial of dose-escalated metabolic therapy combined with concomitant radiation therapy in high-grade glioma","volume":"153","author":"Porper","year":"2021","journal-title":"J. Neuro-Oncol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1843","DOI":"10.3892\/ijo.2014.2382","article-title":"ERGO: A pilot study of ketogenic diet in recurrent glioblastoma","volume":"44","author":"Rieger","year":"2014","journal-title":"Int. J. Oncol."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Santos, J., Da Cruz, W.M., Sch\u00f6nthal, A., Salazar, M.D., Fontes, C.A.P., Quirico-Santos, T., and Da Fonseca, C.O. (2017). Efficacy of a ketogenic diet with concomitant intranasal perillyl alcohol as a novel strategy for the therapy of recurrent glioblastoma. Oncol. Lett.","DOI":"10.3892\/ol.2017.7362"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e953","DOI":"10.1212\/WNL.0000000000012386","article-title":"Feasibility and Biological Activity of a Ketogenic\/Intermittent-Fasting Diet in Patients with Glioma","volume":"97","author":"Schreck","year":"2021","journal-title":"Neurology"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1758835919853958","DOI":"10.1177\/1758835919853958","article-title":"Ketogenic diet treatment as adjuvant to standard treatment of glioblastoma multiforme: A feasibility and safety study","volume":"11","author":"Olieman","year":"2019","journal-title":"Ther. Adv. Med. Oncol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1016\/j.ijrobp.2020.06.021","article-title":"ERGO2: A Prospective, Randomized Trial of Calorie-Restricted Ketogenic Diet and Fasting in Addition to Reirradiation for Malignant Glioma","volume":"108","author":"Voss","year":"2020","journal-title":"Int. J. Radiat. Oncol.Biol. Phys."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1007\/s00394-021-02666-1","article-title":"Short-term fasting in glioma patients: Analysis of diet diaries and metabolic parameters of the ERGO2 trial","volume":"61","author":"Voss","year":"2021","journal-title":"Eur. J. Nutr."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"e32042","DOI":"10.1097\/MD.0000000000032042","article-title":"Clinical characteristics and prognosis of patients with glioblastoma: A review of survival analysis of 1674 patients based on SEER database","volume":"101","author":"Chen","year":"2022","journal-title":"Medicine"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Huang, B., Yu, Z., and Liang, R. (2021). Effect of long-term adjuvant temozolomide chemotherapy on primary glioblastoma patient survival. BMC Neurol., 21.","DOI":"10.1186\/s12883-021-02461-9"},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Kawauchi, D., Ohno, M., Honda-Kitahara, M., Miyakita, Y., Takahashi, M., Yanagisawa, S., Tamura, Y., Kikuchi, M., Ichimura, K., and Narita, Y. (2023). Clinical characteristics and prognosis of Glioblastoma patients with infratentorial recurrence. BMC Neurol., 23.","DOI":"10.21203\/rs.3.rs-1462235\/v1"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.5603\/RPOR.a2022.0113","article-title":"Survival and quality of life analysis in glioblastoma multiforme with adjuvant chemoradiotherapy: A retrospective study","volume":"27","author":"Mohammed","year":"2022","journal-title":"Rep. Pract. Oncol. Radiother."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Valerio, J., Borro, M., Proietti, E., Pisciotta, L., Olarinde, I.O., Gomez, M.F., and Pinzon, A.M.A. (2024). Systematic Review and Clinical Insights: The Role of the Ketogenic Diet in Managing Glioblastoma in Cancer Neuroscience. J. Pers. Med., 14.","DOI":"10.3390\/jpm14090929"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Kiryttopoulos, A., Evangeliou, A.E., Katsanika, I., Boukovinas, I., Foroglou, N., Zountsas, B., Cheva, A., Nikolopoulos, V., Zaramboukas, T., and Duraj, T. (2025). Successful application of dietary ketogenic metabolic therapy in patients with glioblastoma: A clinical study. Front. Nutr., 11.","DOI":"10.3389\/fnut.2024.1489812"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1111\/bph.13422","article-title":"The Warburg effect and drug resistance","volume":"173","author":"Bhattacharya","year":"2016","journal-title":"Br. J. Pharmacol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.canlet.2014.04.001","article-title":"The Warburg effect in tumor progression: Mitochondrial oxidative metabolism as an anti-metastasis mechanism","volume":"356","author":"Lu","year":"2015","journal-title":"Cancer Lett."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.canlet.2014.07.015","article-title":"Metabolic therapy: A new paradigm for managing malignant brain cancer","volume":"356","author":"Seyfried","year":"2015","journal-title":"Cancer Lett."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Altayyar, M., Nasser, J.A., Thomopoulos, D., and Bruneau, M. (2022). The Implication of Physiological Ketosis on The Cognitive Brain: A Narrative Review. Nutrients, 14.","DOI":"10.3390\/nu14030513"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/j.plefa.2003.08.025","article-title":"Non-invasive detection of ketosis and its application in refractory epilepsy","volume":"70","year":"2004","journal-title":"Prostaglandins Leukot. Essent. Fat. Acids"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s12986-015-0009-2","article-title":"The glucose ketone index calculator: A simple tool to monitor therapeutic efficacy for metabolic management of brain cancer","volume":"12","author":"Meidenbauer","year":"2015","journal-title":"Nutr. Metab."},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Chen, S., Su, X., Feng, Y., Li, R., Liao, M., Fan, L., Liu, J., Chen, S., Zhang, S., and Cai, J. (2023). Ketogenic Diet and Multiple Health Outcomes: An Umbrella Review of Meta-Analysis. Nutrients, 15.","DOI":"10.3390\/nu15194161"},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Yang, Y.F., Mattamel, P.B., Joseph, T., Huang, J., Chen, Q., Akinwunmi, B.O., Zhang, C.J.P., and Ming, W.K. (2021). Efficacy of Low-Carbohydrate Ketogenic Diet as an Adjuvant Cancer Therapy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients, 13.","DOI":"10.3390\/nu13051388"},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Zhang, M., Zhang, Q., Huang, S., Lu, Y., and Peng, M. (2025). Impact of ketogenic diets on cancer patient outcomes: A systematic review and meta-analysis. Front. Nutr., 12.","DOI":"10.3389\/fnut.2025.1535921"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"e04249","DOI":"10.1002\/advs.202504249","article-title":"The Interplay between the Gut and Ketogenic Diets in Health and Disease","volume":"12","author":"Mu","year":"2025","journal-title":"Adv. Sci."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1038\/s42255-024-01062-3","article-title":"The dance of gut microbes on the keto diet","volume":"6","author":"Kim","year":"2024","journal-title":"Nat. Metab."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1792","DOI":"10.1038\/s41467-025-56678-0","article-title":"Ketogenic diet suppresses colorectal cancer through the gut microbiome long chain fatty acid stearate","volume":"16","author":"Tsenkova","year":"2025","journal-title":"Nat. Commun."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"2119","DOI":"10.1016\/j.ccell.2025.09.002","article-title":"Ketogenic diet inhibits glioma progression by promoting gut microbiota-derived butyrate production","volume":"43","author":"Chen","year":"2025","journal-title":"Cancer Cell"},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Elisia, I., and Krystal, G. (2021). The Pros and Cons of Low Carbohydrate and Ketogenic Diets in the Prevention and Treatment of Cancer. Front. Nutr., 8.","DOI":"10.3389\/fnut.2021.634845"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1016\/j.cmet.2016.06.001","article-title":"Fasting, Circadian Rhythms, and Time-Restricted Feeding in Healthy Lifespan","volume":"23","author":"Longo","year":"2016","journal-title":"Cell Metab."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/S1470-2045(10)70218-7","article-title":"Definition and classification of cancer cachexia: An international consensus","volume":"12","author":"Fearon","year":"2011","journal-title":"Lancet Oncol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"100092","DOI":"10.1016\/j.esmoop.2021.100092","article-title":"Cancer cachexia in adult patients: ESMO Clinical Practice Guidelines","volume":"6","author":"Arends","year":"2021","journal-title":"ESMO Open"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1007\/s00066-024-02225-7","article-title":"Sarcopenia is associated with chemoradiotherapy discontinuation and reduced progression-free survival in glioblastoma patients","volume":"200","author":"Troschel","year":"2024","journal-title":"Strahlenther. Onkol."},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"Kelly, R., Henderson, L., and Roy, I. (2026). Does Cachexia Matter for Glioblastoma Multiforme?. Cancers, 18.","DOI":"10.3390\/cancers18020333"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"e13053","DOI":"10.1111\/obr.13053","article-title":"Scientific evidence underlying contraindications to the ketogenic diet: An update","volume":"21","author":"Watanabe","year":"2020","journal-title":"Obes. Rev."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/13\/2166\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T12:11:06Z","timestamp":1783080666000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/13\/2166"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,3]]},"references-count":79,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["nu18132166"],"URL":"https:\/\/doi.org\/10.3390\/nu18132166","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,3]]}}}