Evidence map›Paper›PMID 34233941›Full record

Trial reportNeurology2021

Feasibility and Biological Activity of a Ketogenic/Intermittent-Fasting Diet in Patients With Glioma.

Karisa C Schreck, Fang-Chi Hsu, Adam Berrington, Bobbie Henry-Barron, Diane Vizthum, Lindsay Blair, Eric H Kossoff, Linda Easter, Christopher T Whitlow, Peter B Barker and 3 more

Registry-linked trialOpen access · greenAbstract readClinical Trial, Phase II
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Neurology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02286167 (The Feasibility and Biologic Effect of a Modified Atkins-based Intermittent Fasting Diet in Patients With Glioblastoma), which is not on this map. Cited by 39 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
39citing papers in PubMed, 4 pooled it
4.3field-weighted citation impact, top 5% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02286167 nacompletednot on this map

The Feasibility and Biologic Effect of a Modified Atkins-based Intermittent Fasting Diet in Patients With Glioblastoma (GBM)

TypeinterventionalSponsorWake Forest University Health SciencesRan2014 to 2019Enrolled25ConditionsGlioblastoma MultiformeArmsDiet modification
3 · Its place in the literature

Who cites it

39 citing papers in PubMed, 4 syntheses or guidelines pooled it, 62 citations in OpenAlex.

  1. Pooled it
  2. Efficacy and safety of ketogenic diet in glioblastoma: an updated systematic review and meta-analysis.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 1 institution in 3 countries.

Karisa C SchreckFrom the Departments of Neurology (K.C.S., J.O.B., L.B., E.H.K., M.C.C., R.E.S.), Oncology (K.C.S., J.O.B.), Neurosurgery (K.C.S., J.O.B.), and Radiology (A.B., P.B.B.) and Institute for Clinical and Translational Research (B.H.-B., D.V.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Biostatistics and Data Science (F.-C.H., C.T.W.), Clinical Research Unit (L.E.), Department of Radiology (C.T.W.), Department of Biomedical Engineering (C.T.W.), Clinical and Translational Science Institute (C.T.W.), Department of Neurology (R.E.S.), and Department of Oncology (R.E.S.), Wake Forest School of Medicine, Winston-Salem, NC; and Sir Peter Mansfield Imaging Centre (A.B.), School of Physics and Astronomy, University of Nottingham, UK.ORCID 0000-0001-7181-3269
Fang-Chi HsuFrom the Departments of Neurology (K.C.S., J.O.B., L.B., E.H.K., M.C.C., R.E.S.), Oncology (K.C.S., J.O.B.), Neurosurgery (K.C.S., J.O.B.), and Radiology (A.B., P.B.B.) and Institute for Clinical and Translational Research (B.H.-B., D.V.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Biostatistics and Data Science (F.-C.H., C.T.W.), Clinical Research Unit (L.E.), Department of Radiology (C.T.W.), Department of Biomedical Engineering (C.T.W.), Clinical and Translational Science Institute (C.T.W.), Department of Neurology (R.E.S.), and Department of Oncology (R.E.S.), Wake Forest School of Medicine, Winston-Salem, NC; and Sir Peter Mansfield Imaging Centre (A.B.), School of Physics and Astronomy, University of Nottingham, UK.
Adam BerringtonFrom the Departments of Neurology (K.C.S., J.O.B., L.B., E.H.K., M.C.C., R.E.S.), Oncology (K.C.S., J.O.B.), Neurosurgery (K.C.S., J.O.B.), and Radiology (A.B., P.B.B.) and Institute for Clinical and Translational Research (B.H.-B., D.V.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Biostatistics and Data Science (F.-C.H., C.T.W.), Clinical Research Unit (L.E.), Department of Radiology (C.T.W.), Department of Biomedical Engineering (C.T.W.), Clinical and Translational Science Institute (C.T.W.), Department of Neurology (R.E.S.), and Department of Oncology (R.E.S.), Wake Forest School of Medicine, Winston-Salem, NC; and Sir Peter Mansfield Imaging Centre (A.B.), School of Physics and Astronomy, University of Nottingham, UK.ORCID 0000-0002-1207-8193
Bobbie Henry-BarronFrom the Departments of Neurology (K.C.S., J.O.B., L.B., E.H.K., M.C.C., R.E.S.), Oncology (K.C.S., J.O.B.), Neurosurgery (K.C.S., J.O.B.), and Radiology (A.B., P.B.B.) and Institute for Clinical and Translational Research (B.H.-B., D.V.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Biostatistics and Data Science (F.-C.H., C.T.W.), Clinical Research Unit (L.E.), Department of Radiology (C.T.W.), Department of Biomedical Engineering (C.T.W.), Clinical and Translational Science Institute (C.T.W.), Department of Neurology (R.E.S.), and Department of Oncology (R.E.S.), Wake Forest School of Medicine, Winston-Salem, NC; and Sir Peter Mansfield Imaging Centre (A.B.), School of Physics and Astronomy, University of Nottingham, UK.ORCID 0000-0001-5390-794X
Diane VizthumFrom the Departments of Neurology (K.C.S., J.O.B., L.B., E.H.K., M.C.C., R.E.S.), Oncology (K.C.S., J.O.B.), Neurosurgery (K.C.S., J.O.B.), and Radiology (A.B., P.B.B.) and Institute for Clinical and Translational Research (B.H.-B., D.V.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Biostatistics and Data Science (F.-C.H., C.T.W.), Clinical Research Unit (L.E.), Department of Radiology (C.T.W.), Department of Biomedical Engineering (C.T.W.), Clinical and Translational Science Institute (C.T.W.), Department of Neurology (R.E.S.), and Department of Oncology (R.E.S.), Wake Forest School of Medicine, Winston-Salem, NC; and Sir Peter Mansfield Imaging Centre (A.B.), School of Physics and Astronomy, University of Nottingham, UK.
Lindsay BlairFrom the Departments of Neurology (K.C.S., J.O.B., L.B., E.H.K., M.C.C., R.E.S.), Oncology (K.C.S., J.O.B.), Neurosurgery (K.C.S., J.O.B.), and Radiology (A.B., P.B.B.) and Institute for Clinical and Translational Research (B.H.-B., D.V.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Biostatistics and Data Science (F.-C.H., C.T.W.), Clinical Research Unit (L.E.), Department of Radiology (C.T.W.), Department of Biomedical Engineering (C.T.W.), Clinical and Translational Science Institute (C.T.W.), Department of Neurology (R.E.S.), and Department of Oncology (R.E.S.), Wake Forest School of Medicine, Winston-Salem, NC; and Sir Peter Mansfield Imaging Centre (A.B.), School of Physics and Astronomy, University of Nottingham, UK.
Eric H KossoffFrom the Departments of Neurology (K.C.S., J.O.B., L.B., E.H.K., M.C.C., R.E.S.), Oncology (K.C.S., J.O.B.), Neurosurgery (K.C.S., J.O.B.), and Radiology (A.B., P.B.B.) and Institute for Clinical and Translational Research (B.H.-B., D.V.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Biostatistics and Data Science (F.-C.H., C.T.W.), Clinical Research Unit (L.E.), Department of Radiology (C.T.W.), Department of Biomedical Engineering (C.T.W.), Clinical and Translational Science Institute (C.T.W.), Department of Neurology (R.E.S.), and Department of Oncology (R.E.S.), Wake Forest School of Medicine, Winston-Salem, NC; and Sir Peter Mansfield Imaging Centre (A.B.), School of Physics and Astronomy, University of Nottingham, UK.ORCID 0000-0002-5260-5314
Linda EasterFrom the Departments of Neurology (K.C.S., J.O.B., L.B., E.H.K., M.C.C., R.E.S.), Oncology (K.C.S., J.O.B.), Neurosurgery (K.C.S., J.O.B.), and Radiology (A.B., P.B.B.) and Institute for Clinical and Translational Research (B.H.-B., D.V.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Biostatistics and Data Science (F.-C.H., C.T.W.), Clinical Research Unit (L.E.), Department of Radiology (C.T.W.), Department of Biomedical Engineering (C.T.W.), Clinical and Translational Science Institute (C.T.W.), Department of Neurology (R.E.S.), and Department of Oncology (R.E.S.), Wake Forest School of Medicine, Winston-Salem, NC; and Sir Peter Mansfield Imaging Centre (A.B.), School of Physics and Astronomy, University of Nottingham, UK.
Christopher T WhitlowFrom the Departments of Neurology (K.C.S., J.O.B., L.B., E.H.K., M.C.C., R.E.S.), Oncology (K.C.S., J.O.B.), Neurosurgery (K.C.S., J.O.B.), and Radiology (A.B., P.B.B.) and Institute for Clinical and Translational Research (B.H.-B., D.V.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Biostatistics and Data Science (F.-C.H., C.T.W.), Clinical Research Unit (L.E.), Department of Radiology (C.T.W.), Department of Biomedical Engineering (C.T.W.), Clinical and Translational Science Institute (C.T.W.), Department of Neurology (R.E.S.), and Department of Oncology (R.E.S.), Wake Forest School of Medicine, Winston-Salem, NC; and Sir Peter Mansfield Imaging Centre (A.B.), School of Physics and Astronomy, University of Nottingham, UK.ORCID 0000-0003-2392-8293
Peter B BarkerFrom the Departments of Neurology (K.C.S., J.O.B., L.B., E.H.K., M.C.C., R.E.S.), Oncology (K.C.S., J.O.B.), Neurosurgery (K.C.S., J.O.B.), and Radiology (A.B., P.B.B.) and Institute for Clinical and Translational Research (B.H.-B., D.V.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Biostatistics and Data Science (F.-C.H., C.T.W.), Clinical Research Unit (L.E.), Department of Radiology (C.T.W.), Department of Biomedical Engineering (C.T.W.), Clinical and Translational Science Institute (C.T.W.), Department of Neurology (R.E.S.), and Department of Oncology (R.E.S.), Wake Forest School of Medicine, Winston-Salem, NC; and Sir Peter Mansfield Imaging Centre (A.B.), School of Physics and Astronomy, University of Nottingham, UK.
Mackenzie C CervenkaFrom the Departments of Neurology (K.C.S., J.O.B., L.B., E.H.K., M.C.C., R.E.S.), Oncology (K.C.S., J.O.B.), Neurosurgery (K.C.S., J.O.B.), and Radiology (A.B., P.B.B.) and Institute for Clinical and Translational Research (B.H.-B., D.V.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Biostatistics and Data Science (F.-C.H., C.T.W.), Clinical Research Unit (L.E.), Department of Radiology (C.T.W.), Department of Biomedical Engineering (C.T.W.), Clinical and Translational Science Institute (C.T.W.), Department of Neurology (R.E.S.), and Department of Oncology (R.E.S.), Wake Forest School of Medicine, Winston-Salem, NC; and Sir Peter Mansfield Imaging Centre (A.B.), School of Physics and Astronomy, University of Nottingham, UK.ORCID 0000-0002-4760-857X
Jaishri O BlakeleyFrom the Departments of Neurology (K.C.S., J.O.B., L.B., E.H.K., M.C.C., R.E.S.), Oncology (K.C.S., J.O.B.), Neurosurgery (K.C.S., J.O.B.), and Radiology (A.B., P.B.B.) and Institute for Clinical and Translational Research (B.H.-B., D.V.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Biostatistics and Data Science (F.-C.H., C.T.W.), Clinical Research Unit (L.E.), Department of Radiology (C.T.W.), Department of Biomedical Engineering (C.T.W.), Clinical and Translational Science Institute (C.T.W.), Department of Neurology (R.E.S.), and Department of Oncology (R.E.S.), Wake Forest School of Medicine, Winston-Salem, NC; and Sir Peter Mansfield Imaging Centre (A.B.), School of Physics and Astronomy, University of Nottingham, UK.ORCID 0000-0002-1049-0993
Roy E StrowdFrom the Departments of Neurology (K.C.S., J.O.B., L.B., E.H.K., M.C.C., R.E.S.), Oncology (K.C.S., J.O.B.), Neurosurgery (K.C.S., J.O.B.), and Radiology (A.B., P.B.B.) and Institute for Clinical and Translational Research (B.H.-B., D.V.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Biostatistics and Data Science (F.-C.H., C.T.W.), Clinical Research Unit (L.E.), Department of Radiology (C.T.W.), Department of Biomedical Engineering (C.T.W.), Clinical and Translational Science Institute (C.T.W.), Department of Neurology (R.E.S.), and Department of Oncology (R.E.S.), Wake Forest School of Medicine, Winston-Salem, NC; and Sir Peter Mansfield Imaging Centre (A.B.), School of Physics and Astronomy, University of Nottingham, UK. rstrowd@wakehealth.edu.ORCID 0000-0001-6651-5267
University of Nottingham · GB

Funding

QAQC Johns Hopkins Institute for Clinical and Translational ResearchUL1TR003098 · NCATS · JOHNS HOPKINS UNIVERSITY · PI FORD, DANIEL ERNEST · 2019 to 2023
$57.7M
Tumor Tissue CoreP30CA012197 · NCI · WAKE FOREST UNIVERSITY HEALTH SCIENCES · PI Ruben A. Mesa · 1985 to 2026
$55.4M
Wake Forest Clinical and Translational Science AwardUL1TR001420 · NCATS · WAKE FOREST UNIVERSITY HEALTH SCIENCES · PI ARD, JAMY D, FOLEY, KRISTIE L · 2015 to 2023
$32.3M
Wake Forest Clinical and Translational Science AwardKL2TR001421 · NCATS · WAKE FOREST UNIVERSITY HEALTH SCIENCES · PI MILLER, DAVID P · 2015 to 2023
$5.8M
NCATS NIH HHS KL2 TR001421NCATS NIH HHS UL1 TR001420NCATS NIH HHS UL1 TR003098NCI NIH HHS P30 CA012197
6 · The paper itself

Abstract

objectiveTo examine the feasibility, safety, systemic biological activity, and cerebral activity of a ketogenic dietary intervention in patients with glioma.

methodsTwenty-five patients with biopsy-confirmed World Health Organization grade 2 to 4 astrocytoma with stable disease after adjuvant chemotherapy were enrolled in an 8-week Glioma Atkins-Based Diet (GLAD). GLAD consisted of 2 fasting days (calories <20% calculated estimated needs) interleaved between 5 modified Atkins diet days (net carbohydrates ≤20 g/d) each week. The primary outcome was dietary adherence by food records. Markers of systemic and cerebral activity included weekly urine ketones, serum insulin, glucose, hemoglobin A1c, insulin-like growth factor-1, and magnetic resonance spectroscopy at baseline and week 8.

resultsTwenty-one patients (84%) completed the study. Eighty percent of patients reached ≥40 mg/dL urine acetoacetate during the study. Forty-eight percent of patients were adherent by food record. The diet was well tolerated, with two grade 3 adverse events (neutropenia, seizure). Measures of systemic activity, including hemoglobin A1c, insulin, and fat body mass, decreased significantly, while lean body mass increased. Magnetic resonance spectroscopy demonstrated increased ketone concentrations (β-hydroxybutyrate [bHB] and acetone) in both lesional and contralateral brain compared to baseline. Average ketonuria correlated with cerebral ketones in lesional (tumor) and contralateral brain (bHB

conclusionThe GLAD dietary intervention, while demanding, produced meaningful ketonuria and significant systemic and cerebral metabolic changes in participants. Ketonuria in participants correlated with cerebral ketone concentration and appears to be a better indicator of systemic activity than patient-reported food records. TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov Identifier: NCT02286167.

Indexed as

AdultAgedBrainBrain NeoplasmsDiet, High-Protein Low-CarbohydrateDiet, KetogenicFastingFeasibility StudiesFemaleGliomaHumansKetosisMaleMiddle Aged

Identifiers

PMID34233941
PMCPMC8589278
OpenAlexW3181952999

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.