Effect of the modified Atkins diet on NLRP3, caspase-1, IL-1β, and IL-10 in patients with tetralogy of Fallot undergoing open-heart surgery: A randomized controlled trial

Authors

  • Piprim B. Yanuarso Department of Child and Health, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; Department of Child and Health, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia https://orcid.org/0009-0009-3387-3346
  • Mulyadi M. Djer Department of Child and Health, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; Department of Child and Health, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Aryono Hendarto Department of Child and Health, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; Department of Child and Health, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia https://orcid.org/0000-0002-7714-8332
  • Antonius H. Pudjiadi Department of Child and Health, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; Department of Child and Health, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia https://orcid.org/0000-0002-5675-195X
  • Lisnawati Rachmadi Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; Department of Anatomical Pathology, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia https://orcid.org/0000-0002-5307-3671
  • Heri Wibowo Integrated Laboratory for Diagnostic and Research Center, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia https://orcid.org/0000-0001-7708-5135
  • Najib Advani Department of Child and Health, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; Department of Child and Health, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia https://orcid.org/0000-0002-9331-3174
  • Indah K. Murni Department of Child and Health, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia; Department of Child and Health, Dr. Sardjito Hospital, Yogyakarta, Indonesia https://orcid.org/0000-0001-9174-8425
  • Aria Kekalih Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; Department of Community Medicine, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia https://orcid.org/0000-0001-7811-097X
  • Rubiana Sukardi Integrated Cardiac Center, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia https://orcid.org/0000-0001-5405-8599
  • Ismail Dilawar Department of Cardiothoracic Surgery, Jakarta Heart Center Hospital, Jakarta, Indonesia https://orcid.org/0000-0002-1915-1349
  • Dhama S. Susanti Integrated Cardiac Center, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia https://orcid.org/0009-0005-4977-4335
  • Novianti Supriatna Master Program in Biomedical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia https://orcid.org/0009-0002-6598-3901

DOI:

https://doi.org/10.52225/narra.v5i1.2138

Keywords:

Ketogenic diet, modified Atkins diet, tetralogy of Fallot, NLRP3, cytokines

Abstract

Cardiopulmonary bypass in tetralogy of Fallot (TOF) corrective surgery induces hyperinflammation by activating NLRP3, caspase-1, and interleukin-1β (IL-1β), subsequently triggering an interleukin-10 (IL-10) response. Despite its known metabolic and anti-inflammatory effects, the impact of the modified Atkins diet (MAD) in pediatric cardiac surgery remains unexplored, with no studies on its use in TOF patients undergoing open-heart surgery. The aim of this study was to assess the effect of MAD on the expression of NLRP3, caspase-1, IL-1β, and IL-10, in TOF patients undergoing open-heart surgery. A double-arm, randomized-controlled trial was conducted with 44 TOF patients. The treatment group (n=22) received the MAD, a low-carbohydrate, high-fat regimen with unrestricted fat and protein intake for at least 14 days preoperatively, while the control group (n=22) followed a standard diet without carbohydrate restriction. Blood plasma and infundibulum heart tissues were collected for analysis. Whole blood samples were collected using a winged infusion needle before the intervention, an Abbocath infusion needle after 14 days of intervention, and a syringe without a needle connected to an arterial line in patients undergoing open-heart surgery at 6, 24, and 48 hours post-surgical correction. Infundibulum heart tissues were collected during the open-heart surgery. This study demonstrated significant differences in NLRP3 protein expression (p=0.015), caspase-1 protein expression (p=0.001), and IL-10 levels between before intervention and 6-, 24-, and 48-hours post-surgery in the MAD group compared to the control group. In contrast, no significant differences in IL-10 levels were observed in the control group between before intervention and 48 hours post-surgery (p=0.654). In conclusion, MAD may modulate perioperative inflammation in TOF patients undergoing open-heart surgery by downregulating NLRP3 and caspase-1 expression while sustaining IL-10 levels. Despite reduced NLRP3 and caspase-1 expression, unchanged IL-1β levels indicate alternative regulatory mechanisms.

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How to Cite

Yanuarso, P. B., Djer, M. M., Hendarto, A., Pudjiadi, A. H., Rachmadi, L., Wibowo, H. ., Advani, N., Murni, I. K., Kekalih, A., Sukardi, R., Dilawar, I., Susanti, D. S., & Supriatna, N. (2025). Effect of the modified Atkins diet on NLRP3, caspase-1, IL-1β, and IL-10 in patients with tetralogy of Fallot undergoing open-heart surgery: A randomized controlled trial. Narra J, 5(1), e2138. https://doi.org/10.52225/narra.v5i1.2138

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