Pilot study reveals effective approach to boost adherence to Mediterranean ketogenic diet for memory concerns in older adults

A recent study published in the Nutrients Journal explored strategies for enhancing compliance with a Mediterranean ketogenic nutrition (MKN) program among older individuals.

Study: Improving Adherence to a Mediterranean Ketogenic Nutrition Program for High-Risk Older Adults: A Pilot Randomized Trial. Image Credit: AntoninaVlasova/Shutterstock.com

Background

Almost 40% of Alzheimer's disease and related dementia (ADRD) risk can be attributed to modifiable factors, indicating the importance of creating scalable strategies to address this risk. MKN shows potential as a non-pharmacologic therapy for reducing modifiable risks related to ADRD.

A modified Mediterranean ketogenic diet has been found to offer added benefits for various biomarkers linked to ADRD, along with cognitive functioning. Learning and following this nutrition type can be difficult and require careful attention to maintain a healthy approach.

About the study

In the present study, researchers developed a program to assist older adults with memory issues using MKN.

A two-arm randomized pilot trial recruited individuals from a senior health clinic, local community, and participant registry, aged between 60 and 85 years and having possible mild cognitive impairment. Approximately 109 individuals underwent a telephone screening process to assess their initial eligibility.

The study involved in-person evaluations at baseline and three months after the intervention for all participants. During the six-week program, participants monitored their ketone levels daily using at-home urinalysis test strips.

They also recorded their food and drink consumption for at least three days and provided other appropriate health and psychosocial data through weekly surveys.

Baseline and six-week blood samples were collected alongside brief neuropsychological assessments at each in-person appointment. Standardized health and psychosocial estimates of functioning were also obtained.

The MKN adherence (MKNA) program consists of seven one-hour virtual group meetings over six weeks via a secure HIPAA-compliant Zoom platform. A clinical psychologist headed the meetings along with a nurse practitioner who specializes in functional medicine. They provided nutritional and psycho-educational training.

Half of each session was focused on nutrition and diet content, while the other half was dedicated to motivational interviewing strategies and behavior change techniques (MI-BCT) components.

Individualized gram recommendations were given to participants every week, taking into account their sex, age, body mass index (BMI), and activity level. The participants received personalized recommendations weekly, gradually altering their ketogenic ratio from 50% to 70% fat and 25% to 5% net carbohydrate intake.

The MKN education (MKNE) arm participants received uniform nutrition education, a workbook, monitoring, and MKN guidance.

Results

The sample had a mean age of 72.91, and 81% of the participants identified as women. Participants showed possible mild cognitive impairment at the screening, with a median score of 25.91 on the Montreal Cognitive Assessment (MoCA) and 4.24 on the Memory Complaint scale.

However, their scores on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)-form A total score and delayed memory index at baseline were within the average range. The trial included 53% of the screened participants.

Almost 79% of the group identified as white, 16% reported being Black or African American, and 5% were "other." The MKNA arm had higher retention rates, with 83% of participants completing the program and 89.6% meeting the study.

In comparison, the MKNE arm had lower rates, with 72% completing the program and 82.7% completing the study.

Approximately 65% of participants rated the service as "excellent," while 32.6% rated it as "good," and only 2.3% rated it as "fair." Additionally, 60% of both cohorts reported being "very satisfied" with the service.

Although the MKNA arm tended to rate service quality and satisfaction higher than the MKNE group, there were no statistically significant differences between the two groups. Participants found both the MKNA and MKNE programs highly acceptable, although they seemed to prefer the MKNA program.

On average, participants reported adhering to MKN for half of the days during the six-week program based on their weekly self-reported adherence. Almost 47% of the participants reported adhering to the protocol for more than half of the days in both arms. The MKNA group had better adherence over six weeks than the MKNE group.

Moreover, the MKNA group reported more days with higher urine ketone levels than the MKNE group, but the difference did not have statistical significance.

The RBANS total scale score and the Delayed Memory Index score showed a significant improvement from baseline to six weeks for cognition in both arms.

No notable alterations were observed in hemoglobin A1C (HbA1C), total cholesterol, or blood glucose levels during the six weeks compared to the baseline.

There was a significant decrease in systolic blood pressure from baseline to six weeks and a significant decrease in BMI from baseline to six weeks. Notably, no significant differences were found between groups on clinical outcomes when comparing change scores from baseline to six weeks.

Conclusion

The MKNA program was found to be feasible and highly acceptable in a pilot clinical trial. MKNA was found to have short-term benefits for BMI, cognition, and systolic blood pressure.

Higher retention and improved participant engagement in the trial were observed in association with the MI-BCT components. MI-BCT strategies were found to increase adherence to MKN. The pilot study revealed that the program and protocol require further investigation.

Future studies should focus on extending the program beyond six sessions, increasing diversity through new recruitment strategies, and detecting higher-risk participants.

Written by

Bhavana Kunkalikar

Bhavana Kunkalikar is a medical writer based in Goa, India. Her academic background is in Pharmaceutical sciences and she holds a Bachelor's degree in Pharmacy. Her educational background allowed her to foster an interest in anatomical and physiological sciences. Her college project work based on ‘The manifestations and causes of sickle cell anemia’ formed the stepping stone to a life-long fascination with human pathophysiology.