Determinants of Adherence to a Ketogenic Diet in Patients with Heart Failure with Reduced Ejection Fraction.
LP, L., B, M., GCH, G., L, T., L, F., S, M., & S, Z. (2026). Determinants of Adherence to a Ketogenic Diet in Patients with Heart Failure with Reduced Ejection Fraction.. Nutrients. https://doi.org/10.3390/nu18121857
LP L, B M, GCH G, L T, L F, S M, et al. Determinants of Adherence to a Ketogenic Diet in Patients with Heart Failure with Reduced Ejection Fraction.. Nutrients. 2026; doi: 10.3390/nu18121857
LP L, B M, GCH G, et al. Determinants of Adherence to a Ketogenic Diet in Patients with Heart Failure with Reduced Ejection Fraction.[J]. Nutrients. 2026. DOI: 10.3390/nu18121857.
@article{lp2026,
author = {Liao LP and Murphy B and Gan GCH and Thomas L and Fontana L and McKinn S and Zaman S},
title = {Determinants of Adherence to a Ketogenic Diet in Patients with Heart Failure with Reduced Ejection Fraction.},
journal = {Nutrients},
year = {2026},
doi = {10.3390/nu18121857},
note = {PMID: 42356244},
}
TY - JOUR AU - Liao LP AU - Murphy B AU - Gan GCH AU - Thomas L AU - Fontana L AU - McKinn S AU - Zaman S TI - Determinants of Adherence to a Ketogenic Diet in Patients with Heart Failure with Reduced Ejection Fraction. T2 - Nutrients PY - 2026 DO - 10.3390/nu18121857 AN - PMID:42356244 ER -
Background: Dietary interventions in heart failure (HF) remain limited, with current guidance focused largely on sodium restriction. Ketone metabolism has emerged as a potential therapeutic target in HF, with ketone supplementation shown to improve cardiac function. However, there are currently no studies investigating factors affecting adherence to a ketogenic diet (KD) in HF. Aim: To explore the factors influencing adherence to a KD in patients with HF to inform future dietary interventions. Method: This qualitative study was embedded within the KETO-HF pilot randomised controlled trial, in which participants with HF with reduced ejection fraction undertook a 4-month KD. Consenting participants were invited to complete semi-structured interviews. Interviews were audio-recorded, deidentified and transcribed verbatim. Data were analysed using thematic analysis with a mixed inductive-deductive strategy. Results: Fifteen participants were interviewed. Facilitators of adherence were: (1) personal motivation and self-regulation; (2) improved well-being; (3) interpersonal support and; (4) adaptive strategies and improved nutritional literacy. Barriers included: (1) early-phase physiological and psychological challenges; (2) social and cultural friction; (3) competing family and work demands and; (4) limited availability of suitable foods, particularly difficulty managing social situations and dining out. Conclusions: Adherence to a KD in people with HF is shaped by a combination of individual and social factors. These findings highlight the need for improved education, support, and increased food options to optimise implementation of dietary ketosis in HF.