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Utility of high fat and low carbohydrate diet in suppressing myocardial FDG uptake

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

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.

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Acknowledgments

The authors acknowledge with thanks Mr. Banchha Nidhi Behera, Assistant Dietician in the department of dietetics, PGIMER, Chandigarh for helping in choosing the diet described in the paper.

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Authors and Affiliations

  1. Department of Nuclear Medicine & PET, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India

    Chidambaram Natrajan Balasubramanian Harisankar MD, Bhagwant Rai Mittal MD, DNB, Kanhaiya Lal Agrawal MBBS, Mohammed Labeeb Abrar MBBS & Anish Bhattacharya DNB

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  1. Chidambaram Natrajan Balasubramanian Harisankar MD
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  2. Bhagwant Rai Mittal MD, DNB
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  3. Kanhaiya Lal Agrawal MBBS
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  4. Mohammed Labeeb Abrar MBBS
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  5. Anish Bhattacharya DNB
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Corresponding author

Correspondence to Bhagwant Rai Mittal MD, DNB.

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No funding has been received for this work from any of the organizations.

Appendix

Appendix

LCHFPP diet consisted of 100 g of cottage cheese (paneer) cooked in 10-20 mL of cooking oil per serving.

Nutritive value of 100 g of paneer.

Energy:

265 kcal

Protein:

18.3 g

Fat:

20.8 g

Carbohydrates:

1.2 g

Minerals:

2.6 g

100 g of cooking oil contains 100 g of fat.

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Harisankar, C.N.B., Mittal, B.R., Agrawal, K.L. et al. Utility of high fat and low carbohydrate diet in suppressing myocardial FDG uptake. J. Nucl. Cardiol. 18, 926–936 (2011). https://doi.org/10.1007/s12350-011-9422-8

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  • DOI: https://doi.org/10.1007/s12350-011-9422-8

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