Bergqvist A G Christina, Schall Joan I, Stallings Virginia A, Zemel Babette S
Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Am J Clin Nutr. 2008 Dec;88(6):1678-84. doi: 10.3945/ajcn.2008.26099.
The ketogenic diet (KD) is a high-fat, low-carbohydrate, and protein diet that effectively treats intractable epilepsy (IE).
The purpose of this study was to measure the change in bone mineral content (BMC) in children with IE treated with the KD for 15 mo.
Prepubertal children >or=5 y of age with IE were eligible. A 4:1 ketogenic diet was maintained for 15 mo, and whole-body and spine BMCs were measured with dual-energy X-ray absorptiometry. Z scores were generated by comparing the children with IE with a cohort of 847 healthy children. Other measurements included demographics, anthropometry, serum 25-hydroxyvitamin D (25-OHD), intact parathyroid hormone, electrolytes, and dietary intake. All measurements were performed at baseline and at 3, 6, 12, and 15 mo. Longitudinal mixed effects models were used to analyze change in BMC over time.
Twenty-five children (9 girls, 16 boys) with IE [age (x +/- SD): 7.3 +/- 1.9 y] participated. Growth and bone health status were suboptimal as were serum 25-OHD concentrations and dietary intake of calcium and vitamin D. Whole-body and spine BMC-for-age both declined by 0.6 z score/y and whole-body and spine BMC-for-height declined 0.7 z score/y and 0.4 z score/y, respectively. Height declined 0.5 z score/y. Body mass index (BMI; in kg/m(2)) z score, age, and ambulation were positive predictors of BMC, which declined sharply over 15 mo of KD treatment.
Bone health in children with IE was poor, particularly for younger nonambulatory children with low BMI status. The KD resulted in progressive loss of BMC. The mechanism is unclear. Further studies are needed.
生酮饮食（KD）是一种高脂肪、低碳水化合物和蛋白质的饮食，可有效治疗难治性癫痫（IE）。
本研究旨在测量接受KD治疗15个月的IE患儿骨矿物质含量（BMC）的变化。
纳入≥5岁的青春期前IE患儿。维持4:1的生酮饮食15个月，采用双能X线吸收法测量全身和脊柱的BMC。通过将IE患儿与847名健康儿童队列进行比较得出Z评分。其他测量包括人口统计学、人体测量学、血清25-羟维生素D（25-OHD）、完整甲状旁腺激素、电解质和饮食摄入量。所有测量均在基线以及3、6、12和15个月时进行。采用纵向混合效应模型分析BMC随时间的变化。
25名IE患儿（9名女孩，16名男孩）[年龄（x±SD）：7.3±1.9岁]参与研究。生长和骨骼健康状况欠佳，血清25-OHD浓度以及钙和维生素D的饮食摄入量也较低。全身和脊柱的年龄别BMC均以每年0.6个Z评分的速度下降，全身和脊柱的身高别BMC分别以每年0.7个Z评分和0.4个Z评分的速度下降。身高以每年0.5个Z评分的速度下降。体重指数（BMI；单位：kg/m²）Z评分、年龄和行走能力是BMC的正向预测因素，在KD治疗的15个月期间BMC急剧下降。
IE患儿的骨骼健康状况较差，尤其是对于年龄较小、BMI较低且不能行走的患儿。KD导致BMC逐渐流失。其机制尚不清楚。需要进一步研究。
