University of Liverpool, Liverpool, UK.
The Walton Centre NHS Foundation Trust, Liverpool, UK.
J Hum Nutr Diet. 2019 Jun;32(3):385-390. doi: 10.1111/jhn.12637. Epub 2019 Mar 11.
Many centres across the UK and Ireland anecdotally report using a 'modified ketogenic diet' (MKD) as a treatment for refractory epilepsy. Although a MKD is within the spectrum of ketogenic diets (KDs), there is little literature reporting upon its definition, use or clinical effectiveness. We aimed to understand the core principles of MKD practice and to assess whether and how the MKD differs from other KD protocols.
An online survey, designed by a consensus group of ketogenic dietitians, was circulated to 39 KD centres across the UK and Ireland. It consisted of 35 questions regarding dietetic practice when providing MKD.
Eighteen centres completed the questionnaire: 13 paediatric, three adult and two combined centres. All dietitians based MKD 'prescriptions' on estimated total energy requirements. The average macronutrient profile was 75% fat and 5% carbohydrate, with protein ad libitum. Carbohydrate and fat targets were implemented via weighed portions (carbohydrate lists n = 18; fat lists n = 13) and 'household measures' (carbohydrate lists n = 2; fat lists n = 3). Of the centres, 94% (n = 17) adjusted macronutrients over time; these decisions were based on ketone levels and seizures in most cases (83%; n = 14). Ketogenic nutritional products available on prescription were used by 10 centres (56%) when initiating and by all centres when 'fine-tuning' the MKD.
A modified ketogenic diet in the UK and Ireland is a hybrid KD, adopting principles from other established KD protocols and defining new elements unique to the MKD. Further research into the clinical and cost-effectiveness of MKD would be of benefit.
英国和爱尔兰的许多中心都有报道称，他们采用“改良的生酮饮食”（MKD）来治疗难治性癫痫。尽管 MKD 属于生酮饮食（KDs）的范畴，但关于其定义、使用或临床效果的文献却很少。我们旨在了解 MKD 实践的核心原则，并评估 MKD 是否以及如何与其他 KD 方案有所不同。
一项由生酮饮食营养师共识小组设计的在线调查在英国和爱尔兰的 39 个 KD 中心进行了分发。它包含了 35 个关于提供 MKD 时的饮食实践的问题。
18 个中心完成了问卷：13 个儿科、3 个成人和 2 个综合中心。所有营养师都根据估计的总能量需求来制定 MKD“处方”。平均宏量营养素谱为 75%的脂肪和 5%的碳水化合物，蛋白质随意摄入。碳水化合物和脂肪目标通过称重部分（碳水化合物列表 n=18；脂肪列表 n=13）和“家庭测量”（碳水化合物列表 n=2；脂肪列表 n=3）来实施。在这些中心中，94%（n=17）随着时间的推移调整宏量营养素；这些决定主要基于酮体水平和癫痫发作（83%；n=14）。有 10 个中心（56%）在开始时使用处方上的 ketogenic 营养产品，在“微调”MKD 时所有中心都使用。
英国和爱尔兰的改良生酮饮食是一种混合 KD，采用了其他成熟 KD 方案的原则，并定义了 MKD 特有的新元素。进一步研究 MKD 的临床和成本效益将是有益的。
