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Kim, Park, Choi, and Park: Effects of Low-carbohydrate and High-fat Diet Supplemented with Ketogenic Drink on Cognitive Function and Physical Performance in the Elderly at High Risk for Dementia



Reduced glucose utilization in the main parts of the brain involved in memory is a major cause of Alzheimer's disease, in which ketone bodies are used as the only and effective alternative energy source of glucose. This study examined the effects of a low-carbohydrate and high-fat (LCHF) diet supplemented with a ketogenic nutrition drink on cognitive function and physical activity in the elderly at high risk for dementia.


The participants of this study were 28 healthy elderly aged 60-91 years showing a high risk factor of dementia or whose Korean Mini-Mental State Examination (K-MMSE) score was less than 24 points. Over 3 weeks, the case group was given an LCHF diet with nutrition drinks consisting of a ketone/non-ketone ratio of 1.73:1, whereas the control group consumed well-balanced nutrition drinks while maintaining a normal diet. After 3 weeks, K-MMSE, body composition, urine ketone bodies, and physical ability were all evaluated.


Urine ketone bodies of all case group subjects were positive, and K-MMSE score was significantly elevated in the case group only (p=0.021). Weight and BMI were elevated in the control group only (p<0.05). Grip strength was elevated in all subjects (p<0.01), and measurements of gait speed and one leg balance were improved only in the case group (p<0.05).


We suggest that adherence to the LCHF diet supplemented with a ketogenic drink could possibly influence cognitive and physical function in the elderly with a high risk factor for dementia. Further, we confirmed the applicability of this dietary intervention in the elderly based on its lack of any side effects or changes in nutritional status.

Figures and Tables

Table 1

Composition of nutrition drinks


1) Ketogenic ratio=Fat : Protein+Carbohydrate (g of ratio)

2) C : P : F=Carbohydrate : Protein:Fat (% of calorie)

Table 2

General characteristics of study subjects


1) Values are means ± SD

2) BMI : Body mass index

3) Significantly different at p<0.05 by Chi-square test, independent t-test. *: p<0.05, **: p<0.01, ***: p<0.001

Table 3

Personal and family disease history of risk factors for dementia


1) Other medical history included osteoporosis, stroke, parkinson's disease and hypotension.

2) Significantly different at p<0.05 by Chi-square test. **: p<0.01

3) NA : None applicable.

Table 4

Adherence to the dietary intervention for low-carbohydrate and high-fat diet


Each nutrients standard was established in accordance with the LGIT (Low Glycemic Index treatment) for dietary compliance survey. All subjects had recorded daily number of serves from each of the 8 food groups including carbohydrate, protein, oil, vegetables, fruits, nuts, dairy products, and water. The above figures are the average intake of three weeks.

1) Values are means ± SD

Table 5

Change in the Korean Mini-Mental State Examination (K-MMSE) score by each group


1) Values are means ± SD

2) Difference between baseline and 21 days

3) Significance as determined by paired t-test, Wilcoxon signed rank test (post hoc test).

4) Significant Time x Group interaction effect at p<0.05 by paired t-test.

*: p<0.05, **: p<0.01, ***: p<0.001

Table 6

Changes in anthropometry and body composition by each group


1) Values are means ± SD

2) Difference between baseline and 10 days

3) Difference between 10 days and 21 days

4) Difference between baseline and 21 days

5) Significant Time x Group interaction effect at p<0.05 by paired t-test, Wilcoxon signed rank test (post hoc test).

*: p<0.05, **: p<0.01, ***: p<0.001

6) BMI : Body mass index

Table 7

Changes in the physical fitness of daily living by each group


1) Values are means ± SD

2) Difference between baseline and 21 days

3) Significant Time x Group interaction effect at p<0.05 by paired t-test, Wilcoxon signed rank test (post hoc test).

*: p<0.05, **: p<0.01, ***: p<0.001


This research was supported by a grant from the Korea Institute of Planning and Evaluation for Technology in Food, Agriculture, Forestry, and Fisheries (IPET) (316055-3).


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Eun-Ji Kim

Jung-Sik Park

Won-Sun Choi

Yoo Kyoung Park

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