Department of Biology, College of Science, University of Bahrain, Sakhir Campus, Zallaq P.O. Box 32038, Bahrain.
Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy.
Nutrients. 2022 Apr 22;14(9):1744. doi: 10.3390/nu14091744.
Background: The classic ketogenic diet (cKD) has been used worldwide as an effective therapy for children with drug-resistant epilepsy. However, there have been no studies performed in Middle Eastern countries in order to assess the efficacy, side effects, predictors of cKD response and factors mostly associated with diet adherence. This study aims to assess the efficacy of cKD ratios of 4:1 and 3:1 and their influence on growth and biochemical parameters, particularly lipid profile and liver function tests (LFTs), and the factors most associated with diet adherence in a cohort of children with drug-resistant epilepsy in Bahrain. Methods: Baseline and follow-up data related to patients’ demographic and biochemical variables, epilepsy episodes, diet history and anthropometric measurements were retrieved for a total of 24 children treated with cKD in Bahrain. Results: After 6 months cKD initiation, 58.3% were positive responders with >50% seizure rate reduction, and 33.3% became seizure-free at 12 months. After 6 months of intervention with cKD, the level of triglycerides and albumin had a significant (p < 0.05) average increase over time of +1.47 mmol/L and 4.3 g/L, respectively. Although the median values of total cholesterol and alanine transaminase increased, respectively, following cKD initiation, the difference over time was not statistically significant. The mean z-scores for weight, height, and body mass index (or weight-for-length) did not change significantly at 12 months follow-up. cKD duration was the highest correlated variable with cKD efficacy (r = 0.76), which was followed by age at cKD initiation (r = 0.47). The cKD was discontinued by 14 patients (58.3%) during the first follow-up period (6 months), which was mainly due to inefficacy (n = 8), poor compliance (n = 3), food refusal (n = 1), achieved required efficacy (n = 1) and death (n = 1). Conclusions: cKD is an effective treatment for patients with drug-resistant epilepsy, and positive response to cKD was the main factor that increased adherence to the diet. Although long-term cKD could increase the risk of dyslipidemia and hepatic problems, it appears safe for children. Consequently, close monitoring and emphasis on healthy fats is of high priority.
背景：经典生酮饮食（cKD）已在全球范围内被用作治疗耐药性癫痫儿童的有效疗法。然而，中东国家尚未开展任何研究来评估 cKD 的疗效、副作用、反应预测因子以及与饮食依从性最相关的因素。本研究旨在评估 cKD 4:1 和 3:1 比例在巴林耐药性癫痫儿童中的疗效及其对生长和生化参数的影响，特别是血脂谱和肝功能检查（LFT），以及与饮食依从性最相关的因素。方法：从巴林接受 cKD 治疗的 24 名患儿的人口统计学和生化变量、癫痫发作、饮食史和人体测量学数据中检索出基线和随访数据。结果：cKD 起始后 6 个月，58.3%的患儿为阳性反应者，癫痫发作减少≥50%，12 个月时 33.3%的患儿无癫痫发作。cKD 干预 6 个月后，甘油三酯和白蛋白水平随时间呈显著（p < 0.05）平均增加，分别为+1.47mmol/L 和 4.3g/L。尽管 cKD 起始后总胆固醇和丙氨酸转氨酶的中位数有所增加，但随时间的差异无统计学意义。12 个月随访时，体重、身高和体重指数（或身长体重）的平均 z 评分无明显变化。cKD 持续时间与 cKD 疗效呈高度相关（r = 0.76），其次是 cKD 起始时的年龄（r = 0.47）。在第一个随访期（6 个月）期间，14 名患者（58.3%）停止了 cKD 治疗，主要原因是无效（n = 8）、依从性差（n = 3）、拒食（n = 1）、达到所需疗效（n = 1）和死亡（n = 1）。结论：cKD 是治疗耐药性癫痫患者的有效方法，对 cKD 的积极反应是增加饮食依从性的主要因素。尽管长期 cKD 可能会增加血脂异常和肝脏问题的风险，但对儿童似乎是安全的。因此，密切监测和强调健康脂肪至关重要。
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