L‐Shaped Relationship Between Ketogenic Diet and High‐Frequency Hearing Loss

ABSTRACT Objectives The ketogenic diet (KD) is a dietary regimen characterized by high‐fat intake, strict restriction of carbohydrate consumption, and adequate protein supplementation. It is associated with various health issues. However, the correlation between hearing loss and the ketogenic diet remains unclear. This study aims to investigate the relationship between the ketogenic diet and hearing loss. Method This cross‐sectional study analyzed data from the National Health and Nutrition Examination Survey cycles conducted between 2005 and 2012. The ketogenic diet ratio (KDR) was employed to quantify the ketogenic diet. Weighted multivariate logistic regression models, restricted cubic spline regression, and trend tests were utilized to investigate the association between KD and hearing loss. Subgroup analyses were also conducted to assess the consistency of this association across various demographic subgroups. Results Weighted logistic regression analysis showed a positive correlation between continuous KDR levels and high‐frequency hearing loss (HFHL). This association remained significant after adjusting for multiple covariates. No association with KDR was found in hearing loss at other frequencies. Trend tests suggested a non‐linear relationship between KDR and HFHL. The restricted cubic spline analysis indicated an L‐shaped relationship between KDR and HFHL. In all predefined subgroups, except for Race, the association between KDR and HFHL showed robust consistency. Conclusions This study indicates a significant positive correlation between KD and HFHL among adults in the United States. When the proportion of the ketogenic diet is too high, exceeding 34.1%, individuals should be aware that there is a strong association with HFHL. Level of Evidence 3