title: Worldwide use of the ketogenic diet.
abstract: OBJECTIVE
  Over the past decade, the use of the ketogenic diet internationally has increased dramatically. The purpose of this survey was to evaluate the use of the diet worldwide.
  
  
  METHODS
  With the use of the Internet, e-mail requests for information about international ketogenic diet centers (outside the United States) were made over a 9-month period. Assistance also was obtained from the Child Neurology Society and International League Against Epilepsy. Questions included patient enrollment (total and annually), year the diet was first offered, unique cultural and religious issues in the country, community opinion, and research interests.
  
  
  RESULTS
  Successful communication was made with 73 academic centers in 41 countries outside the United States. Sixteen (39%) countries provided information from multiple centers. The median duration offering the diet was 8 years (range, 1-45 years). The average number of patients enrolled to date was 71.6 per country, with 5.4 new patients annually. Common difficulties included avoiding rice intake, tolerating higher fat-to-protein and carbohydrate ratios (e.g., 4:1), finding specific nutritional labels on foods, and handling the growing interest from large populations with limited resources. Nevertheless, cultural and religious issues were generally not limiting; physician and patient acceptance of the diet as an option is high; and most meals were similar among countries. Centers often had great pride in their programs, and international collaborative groups are forming rapidly. A website is now available with updated center information at http://www.neuro.jhmi.edu/Epilepsy/Peds/ketoworldwide.htm
  
  
  CONCLUSIONS
  Despite occasional difficulties, the ketogenic diet is being used worldwide.
authors.affiliation: The Pediatric Epilepsy Center, Department of Neurology, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-1000, USA. ekossoff@jhmi.edu
authors.forename: Eric H
authors.initials: EH
authors.lastname: Kossoff
authors.forename: Jane R
authors.initials: JR
authors.lastname: McGrogan
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D003431:Cross-Cultural Comparison; D004035:Diet Therapy / Q000706:statistics & numerical data; D004041:Dietary Fats / Q000008:administration & dosage / Q000378:metabolism / Q000627:therapeutic use*; D004827:Epilepsy / Q000178:diet therapy*; D014943:Global Health; D019538:Health Care Surveys / Q000706:statistics & numerical data*; D006801:Humans; D007255:Information Services / Q000706:statistics & numerical data; D007662:Ketosis / Q000209:etiology / Q000378:metabolism*
chemical_list: D004041:Dietary Fats