McDonald Tanya J W, Diaz-Arias Luisa, Vizthum Diane, Henry-Barron Bobbie J, Schlechter Haley, Kossoff Eric H, Cervenka Mackenzie C
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Institute for Clinical and Translational Research, Johns Hopkins University, Baltimore, MD, USA.
Nutr Neurosci. 2022 Jul;25(7):1548-1557. doi: 10.1080/1028415X.2021.1875301. Epub 2021 Jan 23.
BACKGROUND/AIMS: Ketogenic diet therapies (KDTs) offer a needed therapeutic option for patients with drug-resistant epilepsy. The current study investigated biochemical and anthropometric indices of cardiovascular disease (CVD) risk in adults with epilepsy treated with KDT over 6 months.
65 adults with epilepsy naïve to diet therapy were enrolled in a prospective longitudinal study and instructed on modified Atkins diet (MAD) use. Seizure frequency, anthropometric measures, blood levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, apolipoproteins A1 and B, and lipoprotein sub-fractions were assessed at baseline, 3 months, and 6 months.
Subsequent to study enrollment, 34 participants were lost to follow-up, elected not to start, or stopped MAD prior to study completion, leaving a total of 31 participants in the study at 6 months. Compared to baseline, participants on MAD showed significant reductions in median seizure frequency/week, weight, body mass index, waist and hip circumference, and percent body fat at 3 and 6 months. Compared to baseline, participants on MAD for 3 months showed significantly increased levels of total, small and medium LDL particles, ApoB and ApoB/A1 ratio. At 6 months, only small LDL particles and ApoB levels remained elevated and levels of ApoA1 had risen, suggesting possible compensatory adaptation over time.
This study provides evidence demonstrating the efficacy and cardiovascular safety of 6 months of MAD use by adults with epilepsy. It also highlights an index of CVD risk - small LDL particles - that should be closely monitored. ClinicalTrials.gov identifier: NCT02694094..
背景/目的：生酮饮食疗法（KDTs）为耐药性癫痫患者提供了一种必要的治疗选择。本研究调查了接受KDT治疗6个月的癫痫成人患者心血管疾病（CVD）风险的生化指标和人体测量指标。
65名未接受过饮食治疗的癫痫成人患者参加了一项前瞻性纵向研究，并接受了改良阿特金斯饮食（MAD）使用指导。在基线、3个月和6个月时评估癫痫发作频率、人体测量指标、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三酯、载脂蛋白A1和B的血液水平以及脂蛋白亚组分。
研究入组后，34名参与者失访、选择不开始或在研究完成前停止了MAD，6个月时共有31名参与者留在研究中。与基线相比，接受MAD治疗的参与者在3个月和6个月时每周癫痫发作频率中位数、体重、体重指数、腰围和臀围以及体脂百分比均显著降低。与基线相比，接受MAD治疗3个月的参与者总、中小LDL颗粒、载脂蛋白B和载脂蛋白B/载脂蛋白A1比值水平显著升高。在6个月时，只有小LDL颗粒和载脂蛋白B水平仍然升高，而载脂蛋白A1水平有所上升，这表明随着时间的推移可能会有代偿性适应。
本研究提供了证据，证明癫痫成人患者使用MAD 6个月的疗效和心血管安全性。它还强调了一个CVD风险指标——小LDL颗粒——应密切监测。ClinicalTrials.gov标识符：NCT02694094。
