Ketogenic Metabolic Therapy Laboratory, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy; Laboratory of Food Education and Sport Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.
Ketogenic Metabolic Therapy Laboratory, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy; Laboratory of Food Education and Sport Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.
Nutr Res. 2024 Jun;126:67-87. doi: 10.1016/j.nutres.2024.03.009. Epub 2024 Mar 21.
Treatment adherence, defined as the degree to which the patient actively follows the plan of care, is very difficult for subjects undergoing ketogenic dietary therapies (KDTs). This is a relevant issue because adherence to dietary therapies is considered 1 of the primary determinants of the treatment's success. This paper aimed to review the literature evidence about KDT adherence according to age and diagnosis of patients. Performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method, this systematic review included clinical trials and observational studies. The risk of bias was assessed by the RoB 2.0 Cochrane tool and the quality of evidence according to the Mixed Methods Appraisal Tool system. Twenty-two articles were included, with more than half (n = 12) having average quality (2-3 stars). The studies' heterogeneity in measuring adherence and diagnosis made it difficult to compare results. Mean adherence rates were 71.5%, 66%, and 63.9% for children, adolescents, and adults, respectively. Adherence and compliance rates varied according to the follow-up period (79.7%, 66.7%, and 37.7% at 6, 24, and 36 months, respectively). The most frequent reasons for low adherence were linked to inefficacy in seizure control, adverse effects, food refusal, difficulty in preparing KDT meals or diet restrictiveness, lack of motivation, poor parental compliance, or cost of the diet. To conclude, there is a lack of standardized tools to measure adherence. Several studies highlighted the families' challenges in adhering to KDTs. These factors should be considered when creating strategies and resources on family education.
治疗依从性是指患者积极遵循治疗方案的程度，对于接受生酮饮食疗法（KDT）的患者来说非常困难。这是一个相关的问题，因为饮食疗法的依从性被认为是治疗成功的主要决定因素之一。本文旨在根据患者的年龄和诊断，综述 KDT 依从性的文献证据。本系统评价根据系统评价和荟萃分析的首选报告项目进行，包括临床试验和观察性研究。使用 RoB 2.0 Cochrane 工具评估偏倚风险，并根据混合方法评估工具系统评估证据质量。共纳入 22 篇文章，其中超过一半（n = 12）的质量为中等（2-3 星）。由于在衡量依从性和诊断方面的研究异质性，难以比较结果。儿童、青少年和成年人的平均依从率分别为 71.5%、66%和 63.9%。依从率和遵守率根据随访时间而有所不同（6、24 和 36 个月时分别为 79.7%、66.7%和 37.7%）。依从性低的最常见原因与癫痫控制效果不佳、不良反应、拒食、KDT 餐制备困难或饮食限制、缺乏动力、家长依从性差或饮食费用有关。总之，目前缺乏标准化的工具来衡量依从性。有几项研究强调了家庭在遵守 KDT 方面的挑战。在制定家庭教育策略和资源时，应考虑这些因素。
