Heart failure & cardiomyopathies
Effect of ketone supplementation, a low-carbohydrate diet and a ketogenic diet on heart failure measures and outcomes: a systematic review and meta-analysis
Pooled result · Left ventricular ejection fractionResult — go to the resultMean difference 3.12% 95% CI 0.95%–5.30%Authors' conclusion
Ketone supplementation significantly improved cardiac function compared with controls, especially in people with HFrEF. More research is needed to determine how low carbohydrate and ketogenic diets affect HF outcomes.
Study context
- Population
- Humans receiving ketone supplementation, LCD and KD interventions, reporting at least one cardiac function/heart failure (HF) measure14 studies included, meta-analysis on six randomised controlled trials (RCTs)
- Comparison
- Ketone supplementation compared with controls
- Outcome
- Left ventricular ejection fraction
Methodological detailsRandomised controlled trials (RCTs) and observational studies, meta-analysis on six RCTs
- Randomised controlled trials (RCTs) and observational studies
- Meta-analysis on six RCTs
Pooled result
As reported in the abstract
Mean difference
3.12%
95% CI 0.95%–5.30%
P < 0.01
Ketone supplementationvs controls
mean difference 3.12% (95% CI 0.95%–5.30%); P < 0.01
Further pooled results
| Outcome | Mean difference (95% CI) | P value | |
|---|---|---|---|
| Left ventricular ejection fraction in HFrEF (subgroup)Greater improvement in HFrEF | 4.25% (1.99%–6.51%) | P < 0.001 | |
| Peak systolic annular velocity in HFrEF | 0.60% (0.17%–1.02%) | P < 0.01 | |
| −50510Difference (linear scale) |
| Outcome | Mean difference (L/min) (95% CI) | P value | |
|---|---|---|---|
| Cardiac output in HFrEF | 1.24 (0.24–2.24) | P < 0.05 | |
| −10123Difference, L/min (linear scale) |
Certainty of evidence
- Due to small cohorts and different treatment durations, assessment of certainty was low to high
LCD and KD studies
- Meta-analysis could not be performed on LCD or KD studies, due to low study numbers
Original publication
Effect of ketone supplementation, a low-carbohydrate diet and a ketogenic diet on heart failure measures and outcomes: a systematic review and meta-analysis. Heart. Published 16 September 2025. doi:10.
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