Clinical Research, Nutricia Ltd., Trowbridge, UK.
UCL Great Ormond Street Institute of Child Health, London, UK.
Epilepsia Open. 2024 Apr;9(2):727-738. doi: 10.1002/epi4.12910. Epub 2024 Feb 27.
To investigate incorporating a ready-to-use 2.5:1 ratio liquid feed into a ketogenic diet (KD) in children and adults with drug-resistant epilepsy.
Following a three-day baseline, patients (n = 19; age: 19 years [SD 13], range: 8-46 years) followed a KD for 28 days (control period), then incorporated ≥200 mL/day of a ready-to-use liquid feed, made with a ratio of 2.5 g of fat to 1 g of protein plus carbohydrate and including medium chain triglycerides ([MCTs]; 25.6% of total fat/100 mL) for 28 days as part of their KD (intervention period). Outcome measures (control vs intervention period) included gastrointestinal (GI) tolerance, adherence to KD and intervention feed, dietary intake, blood ß-hydroxybutyrate (BHB) concentration, seizure outcomes, health-related quality of life (HRQoL), acceptability and safety.
Compared to the control period, during the intervention period, the percentage of patients reporting no GI symptoms increased (+5% [SD 5], p = 0.02); adherence to the KD prescription was similar (p = 0.92) but higher in patients (n = 5) with poor adherence (<50%) to KD during the control period (+33% [SD 26], p = 0.049); total MCT intake increased (+12.1 g/day [SD 14.0], p = 0.002), driven by increases in octanoic (C8; +8.3 g/day [SD 6.4], p < 0.001) and decanoic acid (C10; +5.4 g/day [SD 5.4], p < 0.001); KD ratio decreased (p = 0.047), driven by a nonsignificant increase in protein intake (+11 g/day [SD 44], p = 0.29); seizure outcomes were similar (p ≥ 0.63) but improved in patients (n = 6) with the worst seizure outcomes during the control period (p = 0.04); and HRQoL outcomes were similar. The intervention feed was well adhered to (96% [SD 8]) and accepted (≥88% of patients confirmed).
These findings provide an evidence-base to support the effective management of children and adults with drug-resistant epilepsy following a KD with the use of a ready-to-use, nutritionally complete, 2.5:1 ratio feed including MCTs.
This study examined the use of a ready-to-use, nutritionally complete, 2.5:1 ratio (2.5 g of fat to 1 g of protein plus carbohydrate) liquid feed, including medium chain triglycerides (MCTs), into a ketogenic diet (KD) in children and adults with drug-resistant epilepsy. The results show that the 2.5:1 ratio feed was well tolerated, adhered to, and accepted in these patients. Increases in MCT intake (particularly C8 and C10) and improvements in seizure outcomes (reduced seizure burden and intensity) and KD adherence also occurred with the 2.5:1 ratio feed in patients with the worst seizures and adherence, respectively.
研究在耐药性癫痫患儿和成人中加入即用型 2.5:1 比例的液体喂养物至生酮饮食（KD）中的效果。
在为期三天的基线期后，患者（n=19；年龄：19 岁[标准差 13]，范围：8-46 岁）遵循 KD 治疗 28 天（对照期），然后每天至少摄入 200ml 即用型液体喂养物，该喂养物的脂肪与蛋白质和碳水化合物的比例为 2.5:1，且包含中链甘油三酯（MCT；[总脂肪的 25.6%/每 100ml]），作为 KD 的一部分，持续 28 天（干预期）。主要结局（对照期与干预期）包括胃肠道（GI）耐受情况、KD 和干预喂养物的依从性、饮食摄入、血 β-羟丁酸（BHB）浓度、癫痫发作情况、健康相关生活质量（HRQoL）、可接受性和安全性。
与对照期相比，干预期报告无 GI 症状的患者比例增加（+5%[标准差 5]，p=0.02）；KD 处方的依从性相似（p=0.92），但在对照期 KD 依从性差（<50%）的患者（n=5）中更高（+33%[标准差 26]，p=0.049）；总 MCT 摄入量增加（+12.1g/天[标准差 14.0]，p=0.002），主要由辛酸（C8；+8.3g/天[标准差 6.4]，p<0.001）和癸酸（C10；+5.4g/天[标准差 5.4]，p<0.001）摄入增加所致；KD 比例降低（p=0.047），主要是由于蛋白质摄入增加（+11g/天[标准差 44]，p=0.29）；癫痫发作情况相似（p≥0.63），但在对照期癫痫发作情况最差的患者（n=6）中有所改善（p=0.04）；HRQoL 结果相似。干预喂养物的依从性良好（96%[标准差 8]）且可接受（≥88%的患者确认）。
这些发现为在 KD 中使用即用型、营养完整、2.5:1 比例（2.5g 脂肪与 1g 蛋白质加碳水化合物）的包含 MCT 的液体喂养物来有效管理耐药性癫痫患儿和成人提供了证据基础。
