Efek Diet Ketogenik pada Diabetes Melitus Tipe 2: Scoping Review
Downloads
Latar Belakang : Diabetes Melitus Tipe 2 (DMT2) merupakan penyakit metabolik yang sampai saat ini masih menjadi masalah terbesar di dunia dan Indonesia. Penatalaksanaan diet dianggap sebagai komponen penting dalam manajemen diabetes. Diet ketogenik (DK) dilaporkan memiliki efek yang baik dalam manajemen terapi pasien DMT2 dengan memperbaiki parameter glukosa darah, profil lipid maupun antropometri, namun dibutuhkan pemahaman yang tepat terkait praktik pemberiannya agar efektif untuk perbaikan parameter DMT2.
Tujuan: Artikel ini bertujuan untuk mengidentifikasi dan meninjau kembali kesenjangan dari hasil penelitian terdahulu terkait efek DK pada parameter DMT2 yaitu glukosa darah, profil lipid, dan antropometri.
Ulasan: Beberapa hasil penelitian menunjukkan DK dapat memberikan dampak positif terhadap perbaikan parameter pada pasien DMT2 (profil glukosa, profil lipid, dan indeks antropometri). Pemberian karbohidrat sebanyak 20-50 g/hari atau sekitar 5-10%, lemak 70-75% dan protein 20-15% dari total kebutuhan energi harian dapat menciptakan keadaan ketosis nutrisi. Pengaruh DK pada penderita DMT2 bergantung pada proporsi dan jenis makanan yang dikonsumsi, lama penerapan serta kepatuhan terhadap diet yang dijalankan. Komposisi DK yang tidak tepat akan menimbulkan efek samping yang membahayakan kondisi pasien.
Kesimpulan: Diet ketogenik memiliki perubahaan positif pada parameter DMT2 yaitu glukosa darah dan antropometri. Namun, efek diet ketogenik pada parameter profil lipid tidak selalu memberikan hasil yang baik. Sehingga, diperlukan pengawasan dari tenaga medis /dokter, nutrisionis dan/atau dietisien agar diperoleh pilihan bahan makanan yang baik dan sesuai dengan kondisi individual pasien DMT2.
Soelistijo S, Novida H, Rudjianto A, Soewondo P. Pengelolaan dan Pencegahan Diabetes Melitus Tipe 2 di Indonesia 2015. Pb Perkeni; 2015.
International Diabetes Federation. International Diabetes Federation (IDF) 9th Atlas.; 2019.
Kementrian Kesehatan. Riset Kesehatan Dasar.; 2018.
Kementrian Kesehatan. Profil Kesehatan Indonesia Tahun 2019.; 2019. doi:10.5005/Jp/Books/11257_5
Saeedi P, Petersohn I, Salpea P, Et al. Global and Regional Diabetes Prevalence Estimates for 2019 and Projections For 2030 And 2045: Results From The International Diabetes Federation Diabetes Atlas, 9th Edition. Diabetes Res Clin Pract. Published Online 2019. doi:10.1016/J.Diabres.2019.107843
Palacios Om, Kramer M, Maki Kc. Expert Review of Endocrinology & Metabolism Diet and Prevention of Type 2 Diabetes Mellitus : Beyond Weight Loss and Exercise. Expert Rev Endocrinol Metab. 2019;0(00):1-12. doi:10.1080/17446651.2019.1554430
Hussain T, Mathew T, Dasthi A, Asfar S, Al-Zaid N, Dashti H. Effect of Low-Calorie Versus Low-Carbohydrate Ketogenic Diet In Type 2 Diabetes. Nutrition. 2012;28(10):1016-1021. doi:10.1016/J.Nut.2012.01.016
Watanabe M, Mariani S, Gnessi L, Et al. Beneficial Effects of The Ketogenic Diet on Nonalcoholic Fatty Liver Disease : A Comprehensive Review of The Literature. Wiley Obes Rev. 2020;(March):1-11. doi:10.1111/Obr.13024
Gupta, Khandelwal, Kalra, Gupta, Dutta. Ketogenic Diet in Endocrine Disorders: Current Perspectives. J Od Postgrad Med. 2017;63(4):242-251. doi:10.4103/Jpgm.Jpgm_16_17
Joshi S. The Ketogenic Diet For Obesity And Diabetes— Enthusiasm.; 2019.
Dutta D, Ghosh S, Kalra S, Maisnam I, Sharma M. Is The Ketogenic Diet An Effective and Safe Approach To Type 2 Diabetes Management and Weight Loss? Us Endocrinol. 2020;16(1):15-22. Doi:10.17925/Use.2020.16.1.15
Landry Mj, Crimarco A, Perelman D, Et al. Adherence To Ketogenic and Mediterranean Study Diets In A Crossover Trial: The Keto–Med Randomized Trial. Nutrients. 2021;13(3):1-21. doi:10.3390/Nu13030967
Gershuni V, Yan S, Medici V. Nutritional Ketosis For Weight Management and Reversal of Metabolic Syndrome. Heal Hum Serv. 2019;7(3):97-106. doi:10.1007/S13668-018-0235-0.Nutritional
Paoli A. Ketogenic Diet For Obesity: Friend Or Foe? Int J Environ Res Public Health. Published Online 2014. doi:10.3390/Ijerph110202092
Leonard T. The Physiology Of Ketosis And The Ketogenic Diet. South African J Anaesth Analg. 2020;26(6):S94-S97. doi:10.36303/Sajaa.2020.26.6.S3.2547
Dowis L, Banga S. The Potential Health Benefits of The Ketogenic Diet : A Narrative Review. Nutrients. 2021;(Cdc).
Goday A, Bellido D, Sajoux I, Et al. Short-Term Safety, Tolerability and Efficacy Of A Very Low-Calorie-Ketogenic Diet Interventional Weight Loss Program Versus Hypocaloric Diet In Patients With Type 2 Diabetes Mellitus. Nutr Diabetes. 2016;6(9):230. doi:10.1038/Nutd.2016.36
Wong K, Raffray M, Roy-Fleming A, Blunden S, Brazeau A. The Ketogenic Diet Seen as A Normal Way of Eating by Adults With Type 1 And Type 2 Diabetes: A Qualitative Study. Can J Od Diabetes. Published Online 2020.
Partsalaki I, Karvela A, Spiliotis B. Metabolic Impact of A Ketogenic Diet Compared to A Hypocaloric Diet in Obese Children And Adolescents. J Pediatr Endocrinol Metab. 2012;25(7-8):697-704.
Yuan X, Wang J, Yang S, Et al. Effect of The Ketogenic Diet on Glycemic Control , Insulin Resistance , and Lipid Metabolism In Patients With T2dm : A Systematic Review and Meta-Analysis. Nutr Diabetes. Published Online 2020. doi:10.1038/S41387-020-00142-Z
Choi Yj, Jeon Sm, Shin S. Impact Of A Ketogenic Diet on Metabolic Parameters in Patients with Obesity or Overweight and With or Without Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials. Nutrients. 2020;12(7):1-19. doi:10.3390/Nu12072005
Azar St, Beydoun Hm, Albadri Mr. Benefits of Ketogenic Diet for Management of Type Two Diabetes : A Review. Obes Eat Disord. 2016;2(2:22):1-3. doi:10.4172/2471-8203.100022
Moreno C, Poplawski M, Mastaitis J, Mobbs C. Mechanisms By Which The Ketogenic Diet Reverses Obesity And Diabetes. Endocrinol Int J. 2017;4(6):157-163. doi:10.15406/Emij.2017.04.00107
Snorgaard O, Poulsen Gm, Andersen Hk, Astrup A. Systematic Review and Meta-Analysis of Dietary Carbohydrate Restriction In Patients With Type 2 Diabetesno Title. BMJ Open Diabetes Res Care. Published Online 2017.
Sainsbury E, Kizirian N V, Partridge S, Timothy G, Stephen C, Gibson Aa. Effect of Dietary Carbohydrate Restriction on Glycemic Control in Adults With Diabetes: A Systematic Review and Meta-Analysis. Diabetes Res Clin Pract. Published Online 2018.
Ludwig Ds. The Ketogenic Diet: Evidence for Optimism but High-Quality Research Needed. J Nutr. 2019;150(6):1354-1359. doi:10.1093/Jn/Nxz308
Tay J, Thompson Ch, Luscombe-Marsh Nd, Et al. Effects of an Energy-Restricted Low-Carbohydrate, High Unsaturated Fat/Low Saturated Fat Diet Versus A High-Carbohydrate, Low-Fat Diet In Type 2 Diabetes: A 2-Year Randomized Clinical Trial. Diabetes, Obes Metab. Published Online 2018. doi:10.1111/Dom.13164
Saslow Lr, Daubenmier Jj, Moskowitz Jt, Et al. Twelve-Month Outcomes of A Randomized Trial of A Moderate-Carbohydrate Versus Very Low-Carbohydrate Diet in Overweight Adults With Type 2 Diabetes Mellitus r Prediabetes. Nutr Diabetes. 2017;7(12). doi:10.1038/S41387-017-0006-9
Oh R, Gilani B, Uppaluri Kr. Low Carbohydrate Diet. In: Statpearls; 2021.
Walton Cm, Perry K, Hart Rh, Berry Sl, Bikman Bt. Improvement in Glycemic and Lipid Profiles in Type 2 Diabetics With a 90-Day Ketogenic Diet. J Diabetes Res. Published Online 2019. doi:10.1155/2019/8681959
Hall K, Chen K, Guo J, Lam Y, Leibel R. Energy Expenditure and Body Composition Changes After an Isocaloric Ketogenic Diet in Overweight and Obese Men: A Secondary Analysis of Energy Expenditure And Physical Activity. Biorxiv. 2016;(104):324-333. doi:10.1101/383752
Taylor R, Al-Mrabeh A, Sattar N. Personal View Understanding The Mechanisms of Reversal of Type 2 Diabetes. Lancet Diabetes Endocrinol. 2019;8587(19):1-11. doi:10.1016/S2213-8587(19)30076-2
Bueno Nb, Sofia I, Melo V De, Oliveira Sl De. Systematic Review with Meta-Analysis Very-Low-Carbohydrate Ketogenic Diet V. Low-Fat Diet For Long-Term Weight Loss : A Meta-Analysis of Randomised Controlled Trials. Br J Nutr. Published Online 2013:1178-1187. doi:10.1017/S0007114513000548
Sebille Y Van, Stansborough Rl, Wardill Hr, Bateman E, Gibson Rj, Keefe Dm. Management of Mucositis During Chemotherapy : From Pathophysiology To Pragmatic Therapeutics. Oncol Rep. Published Online 2015. doi:10.1007/S11912-015-0474-9
Peters Mdj, Godfrey Cm, Khalil H, Mcinerney P, Parker D, Soares Cb. Guidance for Conducting Systematic Scoping Reviews. Int J Evid Based Healthc. Published Online 2015. doi:10.1097/Xeb.0000000000000050
Tricco Ac, Lillie E, Zarin W, Et al. A Scoping Review on The Conduct and Reporting of Scoping Reviews. Bmc Med Res Methodol. Published Online 2016. doi:10.1186/S12874-016-0116-4
Page Mj, Mckenzie Je, Bossuyt Pm, Et al. Updating Guidance for Reporting Systematic Reviews: Development Of The Prisma 2020 Statement. J Clin Epidemiol. Published Online 2021. doi:10.1016/J.Jclinepi.2021.02.003
Amir-Behghadami M, Janati A. The Importance Of Designing And Implementing Participatory Surveillance System: An Approach as Early Detection and Prevention Of Novel Coronavirus (2019-Ncov). Data Br. Published Online 2020. doi:10.1016/J.Ajic.2020.03.013
Mayer S, Jeffreys A, Olsen M, Mcduffie J, Feinglos M, Yancy W. Two Diets With Different Hemoglobin A1c and Antiglycemic Medication Effects Despite Similar Weight Loss In Type 2 Diabetes. Diabetes Obes Metab. 2014;23(1):1-7. doi:10.1111/Dom.12191.Two
Saslow Lr, Kim S, Daubenmier Jj, Et al. A Randomized Pilot Trial Of A Moderate Carbohydrate Diet Compared to a Very Low Carbohydrate Diet in Overweight or Obese Individuals With Type 2 Diabetes Mellitus or Prediabetes. Plos One. 2014;9(4). doi:10.1371/Journal.Pone.0091027
Saslow Lr, Mason Ae, Kim S, Et al. An Online Intervention Comparing A Very Low-Carbohydrate Ketogenic Diet Aad Lifestyle Recommendations Versus A Plate Method Diet In Overweight Individuals With Type 2 Diabetes: A Randomized Controlled Trial. J Med Internet Res. Published Online 2017. doi:10.2196/Jmir.5806
Gibas Mk, Gibas Kj. Induced And Controlled Dietary Ketosis As A Regulator Of Obesity and Metabolic Syndrome Pathologies. Diabetes Metab Syndr Clin Res Rev. 2017;11:S385-S390. doi:10.1016/J.Dsx.2017.03.022
Myette-Côté É, Durrer C, Neudorf H, Et al. The Effect Of A Short-Term Low-Carbohydrate, High-Fat Diet With or Without Postmeal Walks on Glycemic Control and Inflammation In Type 2 Diabetes: A Randomized Trial. Am J Physiol - Regul Integr Comp Physiol. 2018;315(6):R1210-R1219. doi:10.1152/Ajpregu.00240.2018
Hallberg Sj, Mckenzie Al, Williams Pt, Et al. Effectiveness and Safety of A Novel Care Model for The Management of Type 2 Diabetes At 1 Year: An Open-Label, Non-Randomized, Controlled Study. Diabetes Ther. 2018;9(2):583-612. doi:10.1007/S13300-018-0373-9
Athinarayanan Sj, Adams Rn, Hallberg Sj, Et al. Long-Term Effects Of A Novel Continuous Remote Care Intervention Including Nutritional Ketosis for The Management of Type 2 Diabetes: A 2-Year Nonrandomized Clinical Trial. Front Endocrinol (Lausanne). 2019;10(Jun). doi:10.3389/Fendo.2019.00348
Ahmed Sr, Bellamkonda S, Zilbermint M, Wang J, Kalyani Rr. Effects Of The Low Carbohydrate, High Fat Diet on Glycemic Control and Body Weight in Patients With Type 2 Diabetes: Experience From A Community-Based Cohort. Bmj Open Diabetes Res Care. 2020;8(1):E000980. doi:10.1136/Bmjdrc-2019-000980
Moriconi E, Camjani E, Fabbri A, Lenzi A, Caprio M. Very-Low-Calorie Ketogenic Diet as a Safe and Valuable Tool for Long-Term Glycemic Management In Patients With Obesity And Type 2 Diabetes. Nutrients. 2021;13(758).
Al-Khalifa A, Mathew Tc, Al-Zaid Ns, Mathew E, Dashti Hm. Therapeutic Role of Low-Carbohydrate Ketogenic Diet In Diabetes. Nutrition. 2009;25(11-12):1177-1185. doi:10.1016/J.Nut.2009.04.004
Brouns F. Overweight and Diabetes Prevention: Is A Low-Carbohydrate–High-Fat Diet Recommendable? Eur J Nutr. 2018;57(4):1301-1312. doi:10.1007/S00394-018-1636-Y
Wajeed M, Uppaluri K. Ketogenic Diet - Statpearls - NCBI Bookshelf. Statpearls Publ Llc. Published Online 2019.
Zhou P, Zhang M, Wei X, Chen G, Liu C. Ketogenic Diet and Metabolic Syndrome: Progress and Perspective. Chinese J Endocrinol Metab. Published Online 2020. doi:10.3760/Cma.J.Cn311282-20200120-00037
Grabacka M, Pierzchalska M, Dean M, Reiss K. Regulation of Ketone Body Metabolism and The Role Of Pparα. Int J Mol Sci. Published Online 2016. doi:10.3390/Ijms17122093
Kirkpatrick Cf, Bolick Jp, Kris-Etherton Pm, Et al. Review of Current Evidence and Clinical Recommendations on the Effects of Low-Carbohydrate and Very-Low-Carbohydrate (Including Ketogenic) Diets For The Management Of Body Weight And Other Cardiometabolic Risk Factors: A Scientific Statement from The Nati. J Clin Lipidol. Published Online 2019. doi:10.1016/J.Jacl.2019.08.003
Goffinet L, Barrea T, Beauloye V, Lysy Pa. Blood Versus Urine Ketone Monitoring in A Pediatric Cohort of Patients With Type 1 Diabetes: A Crossover Study. Ther Adv Endocrinol Metab. Published Online 2017. doi:10.1177/2042018816681706
Kanikarla-Marie P, Jain Sk. Hyperketonemia and Ketosis Increase The Risk of Complications In Type 1 Diabetes. Free Radic Biol Med. Published Online 2016. doi:10.1016/J.Freeradbiomed.2016.03.020
Sarahdeaz Sfp, Tan A, Irfannuddin I, Murti K. Pengaruh Diet Ketogenik Terhadap Proliferasi dan Ketahanan Sel Pada Jaringan Pankreas. Jambi Med J “Jurnal Kedokteran dan Kesehatan.” 2019;7:167-178.
Sudoyo A, Setiyohadi B, Alwi I, Simadibrata M, Setiati S. Buku Ajar Ilmu Penyakit Dalam. FKUI; 2014.
Locatelli Caa, Mulvihill Ee. Islet Health, Hormone Secretion, and Insulin Responsivity with Low-Carbohydrate Feeding In Diabetes. Metabolites. Published Online 2020. doi:10.3390/Metabo10110455
Tan H, Yu K, Yu Y, An Z, Li J. Isolated Hypothalamic-Pituitary Langerhans’ Cell Histiocytosis in Female Adult: A Case Report. Med (United States). Published Online 2019. doi:10.1097/Md.0000000000013853
Rojas-Morales P, Pedraza-Chaverri J, Tapia E. Ketone Bodies, Stress Response, and Redox Homeostasis. Redox Biol. Published Online 2020. doi:10.1016/J.Redox.2019.101395
Ayuningtyas R., Gz M. The Ketogenic Diet and Its Impact on The Gut Microbiota In Diabetes Mellitus Type 2. J Gizi dan Kesehatan. 2021;13(1).
Kumar S, Behl T, Sachdeva M, Et al. Implicating The Effect Of Ketogenic Diet As A Preventive Measure To Obesity And Diabetes Mellitus. Life Sci. Published Online 2021. doi:10.1016/J.Lfs.2020.118661
Boniol M, Dragomir M, Autier P, Boyle P. Physical Activity And Change in Fasting Glucose And Hba1c: A Quantitative Meta-Analysis Of Randomized Trials. Acta Diabetol. Published Online 2017. doi:10.1007/S00592-017-1037-3
Nie R, Yuan S, Chen S, Et al. Prognostic Nutritional Index Is An Independent Prognostic Factor For Gastric Cancer Patients With Peritoneal Dissemination. Chin J Cancer. 2016;28(6):570-578. doi:10.21147/J.Issn.1000-9604.2016.06.03
Karásek D, Vaverková H. Diabetic Dyslipidemia And Microvascular Complications of Diabetes. Vnitřní Lékařství. Published Online 2018. doi:10.36290/Vnl.2018.003
Ivanova Ea, Myasoedova Va, Melnichenko Aa, Grechko A V., Orekhov An. Small Dense Low-Density Lipoprotein as Biomarker for Atherosclerotic Diseases. Oxid Med Cell Longev. Published Online 2017. doi:10.1155/2017/1273042
Summerhill Vi, Grechko A V., Yet Sf, Sobenin Ia, Orekhov An. The Atherogenic Role of Circulating Modified Lipids in Atherosclerosis. Int J Mol Sci. Published Online 2019. doi:10.3390/Ijms20143561
Laksana I, Rejeki Ps, Herawati L, Al Arif Ma, Wardhani Il. High-Fat Diet Increases Serum HDL, but not for LDL and HDL/LDL Ratio In Mice. Folia Medica Indones. Published Online 2021. doi:10.20473/Fmi.V57i2.16123
Chiu S, Williams Pt, Krauss Rm. Effects of A Very High Saturated Fat Diet on LDL Particles in Adults with Atherogenic Dyslipidemia: A Randomized Controlled Trial. Plos One. Published Online 2017. doi:10.1371/Journal.Pone.0170664
Wu H, Ballantyne Cm. Metabolic Inflammation and Insulin Resistance In Obesity. Circ Res. Published Online 2020. doi:10.1161/Circresaha.119.315896
Zand H, Morshedzadeh N, Naghashian F. Signaling Pathways Linking Inflammation to Insulin Resistance. Diabetes Metab Syndr Clin Res Rev. Published Online 2017. doi:10.1016/J.Dsx.2017.03.006
Akash Msh, Rehman K, Liaqat A. Tumor Necrosis Factor-Alpha: Role In Development of Insulin Resistance and Pathogenesis Of Type 2 Diabetes Mellitus. J Cell Biochem. Published Online 2018. doi:10.1002/Jcb.26174
Rahmawati A. Mekanisme Terjadinya Inflamasi dan Stres Oksidatif pada Obesitas. El–Hayah. Published Online 2014. doi:10.18860/Elha.V5i1.3034
Sumithran P, Prendergast La, Delbridge E, Et al. Ketosis and Appetite-Mediating Nutrients and Hormones After Weight Loss. Eur J Clin Nutr. Published Online 2013. Doi:10.1038/Ejcn.2013.90
Nymo S, Coutinho Sr, Jørgensen J, Et al. Timeline of Changes In Appetite During Weight Loss With a Ketogenic Diet. Int J Obes. Published Online 2017. Doi:10.1038/Ijo.2017.96
Copyright (c) 2022 Amerta Nutrition
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
AMERTA NUTR by Unair is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
1. The journal allows the author to hold the copyright of the article without restrictions.
2. The journal allows the author(s) to retain publishing rights without restrictions
3. The legal formal aspect of journal publication accessibility refers to Creative Commons Attribution Share-Alike (CC BY-SA).
4. The Creative Commons Attribution Share-Alike (CC BY-SA) license allows re-distribution and re-use of a licensed work on the conditions that the creator is appropriately credited and that any derivative work is made available under “the same, similar or a compatible license”. Other than the conditions mentioned above, the editorial board is not responsible for copyright violation.
