Robert Mankowski, Ph.D. The University of Alabama at Birmingham Division of Gerontology, Geriatrics and Palliative Care is launching a new National Institutes of Health study that will explore whether a ketogenic diet can help preserve muscle mass and strength in older adults who are hospitalized with pneumonia. This population is vulnerable to rapid physical decline after getting sick.
“What inspired this research was a deeply personal experience involving my grandmother in Poland,” said Robert Mankowski, Ph.D., a UAB researcher and principal investigator on the study. “I learned that my 90-year-old grandmother had been hospitalized with pneumonia. As a scientist studying aging and physical function, I immediately became concerned about the consequences of prolonged bedrest and poor nutrition in an older adult.”
During her hospitalization, Mankowski’s grandmother was largely confined to her bed and received the standard of care in the hospital.
“She lost a significant amount of body weight and physical function over a very short period of time,” Mankowski said. “Seeing this happen to someone in my own family reinforced how vulnerable older adults are during acute illness and inspired me to pursue strategies that could better preserve muscle and metabolic health during hospitalization.”
Muscle loss during hospitalization is a major problem in older adults, says Mankowski. Loss of muscle mass is closely linked to a more rapid decline, including a higher fall risk, frailty, disability, nursing home placement and mortality.
The study will test whether a ketogenic diet will help support muscle preservation during illnesses like pneumonia. Researchers will directly compare a ketogenic diet, high in fat and very low in carbohydrates, with a standard hospital diet, which is typically lower in fat and higher in carbohydrates.
Mankowski and his team will evaluate whether a ketogenic diet is feasible and safe in older hospitalized pneumonia patients and “whether it shows signals of benefit for preserving muscle mass, strength and physical function.” The study aims to determine whether targeting metabolism during hospitalization can help reduce the muscle loss and functional decline that commonly occurs in older patients, which could improve recovery.
Unlike the traditional goal of a ketogenic diet, this study is not about weight loss, but the opposite. “It’s about providing adequate nutrition while potentially improving the body’s ability to maintain muscle and function during hospitalization,” he said.
The goal of the study will be to improve outcomes for older adults and their families. Further studies could potentially include larger clinical trials “designed to evaluate long-term outcomes such as physical recovery, rehospitalization risk, frailty and independence after discharge,” Mankowski said. “We are also interested in understanding the biological mechanisms involved, including how metabolism, inflammation and muscle biology interact during acute illness in older adults.”
“If the findings are promising, this research could help shift the conversation around hospital nutrition from simply providing calories to actively supporting metabolic and functional recovery.”
Other UAB collaborators include Kelly Berg, Thomas Buford, Ph.D., Davis Englund, Ph.D., Amy Goss, Ph.D., Preston Hewgley, M.D., and Peter Morris, M.D.
The study will begin in August 2026.