Utility of high fat and low carbohydrate diet in suppressing myocardial FDG uptake
Utility of high fat and low carbohydrate diet in suppressing myocardial FDG uptake
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DOI：
10.1007/s12350-011-9422-8
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发表时间：
2011-10-01
影响因子：
2.4
通讯作者：
Bhattacharya, Anish
中科院分区：
文献类型：
--
作者：
Harisankar, Chidambaram Natrajan Balasubramanian;Mittal, Bhagwant Rai;Bhattacharya, Anish
导论.氟脱氧葡萄糖（FDG）可以用来可视化冠状动脉粥样硬化斑块中的炎症，如果心肌FDG摄取被充分抑制。长期禁食抑制心肌FDG摄取的效果不一致。我们评估了用低碳水化合物高脂肪蛋白允许饮食（LCHFPP）持续抑制心肌FDG摄取的可行性。这是一项前瞻性研究。空腹组（空腹>12 h）50例，LCHFPP组60例。禁食组不做特殊膳食准备。LCHFPP饮食组患者在研究前一晚和研究前4小时服用LCHFPP饮食。在最大强度投影图像上直观分析心肌FDG摄取情况。采用CT图像进行定位，在相应的PET图像中评估描绘左冠状动脉可能的FDG摄取的能力，并将研究分类为“可解释”或“不可解释”。LCHFPP饮食组纳入60例患者（平均年龄47岁），禁食组纳入50例患者（平均年龄49.9岁）。这些患者中没有已知的糖尿病患者。平均血糖水平为96 mg/dL。48例患者按照方案食用LCHFPP饮食。12人仅在研究前一天晚上食用LCHFPP饮食（不合规）。饮食组依从患者的平均禁食时间为5.9 ± 0.9小时，禁食组为14.6小时。LCHFPP饮食组心肌FDG摄取完全抑制31例，轻度摄取15例，中度不均匀摄取8例，均匀强摄取6例。60例患者中有54例进行了可解释的研究。当排除不依从的患者时，84%的患者有显著的FDG摄取抑制，94%的研究被归类为可解释的。在禁食组中，16例患者观察到FDG摄取的完全心肌抑制; 8例患者为轻微抑制; 15例患者为中度不均匀抑制; 11例患者为均匀强度抑制。27例（54%）患者的研究结果可解释。在大多数使用LCHFPP饮食的患者中，心肌FDG摄取可能受到一致和显著的抑制。LCHFPP饮食，如果按照方案服用，导致一致的心肌FDG摄取抑制，以允许充分评价几乎所有患者的左冠状动脉炎症。LCHFPP饮食在抑制心肌FDG摄取方面也比长期（>12小时）禁食方案显著更有效。（J Nucl Cardiol 2011;18：926-36.）
Introduction. Fluoro-deoxy-glucose (FDG) can be used to visualize inflammation in atherosclerotic plaques in coronary arteries, if myocardial FDG uptake is adequately suppressed. Prolonged fasting for suppressing myocardial FDG uptake is inconsistent. We evaluated the feasibility to consistently suppress myocardial FDG uptake with a low carbohydrate high fat protein permitted (LCHFPP) diet.Materials and methods. This was a prospective study. 50 patients were included in fasting group (>12 hours fasting) and 60 patients were included into LCHFPP diet. Fasting group had no special dietary preparation. Patients in LCHFPP diet group were asked to consume LCHFPP diet the night before and 4 hours prior to the study. Visual analysis of myocardial FDG uptake was done on maximum intensity projection image. Using CT images for localization, the ability to delineate possible FDG uptake in the left coronary artery was assessed in the corresponding PET image and the studies were classified as "interpretable" or "Not interpretable".Results. 60 patients (mean age 47 years) from LCHFPP diet group and 50 patients (mean age 49.9 years) from fasting group were included. None of the patients were known diabetics. The mean blood glucose level was 96 mg/dL. Forty-eight patients had consumed LCHFPP diet as per protocol. Twelve had consumed LCHFPP diet only on the night before the study (non-compliant). The average duration of fasting in compliant patients was 5.9 +/- 0.9 hours in the diet group and 14.6 hours in fasting group. In LCHFPP diet group, the myocardial FDG uptake was classified as complete suppression in 31; minimal uptake in 15; moderate inhomogenous uptake in 8 and homogenous intense uptake in 6 patients. Fifty-four of the 60 patients had interpretable study. When non-compliant patients were excluded, 84% of the patients had significant FDG uptake suppression and 94% of the studies were classified as interpretable. In the fasting group, complete myocardial suppression of FDG uptake was noticed in 16; minimal in 8; moderate inhomogenous in 15; and homogenous intense in 11 patients. 27 patients (54%) had interpretable study.Conclusion. Consistent and significant myocardial FDG uptake suppression is possible in most patients using LCHFPP diet. The LCHFPP diet, if taken as per protocol, leads to consistent myocardial FDG uptake suppression to allow for adequate evaluation of the left coronary artery inflammation in nearly all the patients. LCHFPP diet is also significantly more efficacious than prolonged (>12 hours) fasting protocol in suppressing myocardial FDG uptake. (J Nucl Cardiol 2011;18:926-36.)