Efficacy and tolerability of the ketogenic diet according to lipid:nonlipid ratios--comparison of 3:1 with 4:1 diet.
OBJECTIVE
The ketogenic diet (KD) has been considered a highly potent antiepileptic treatment for intractable childhood epilepsy. In this study, we compared the antiepileptic efficacy and diet tolerability of two different diets with lipid:nonlipid ratios of 3:1 and 4:1.


METHODS
Seventy-six patients with refractory childhood epilepsy were randomly placed into two groups and were started on KD diets with nonlipid:lipid ratios of either 3:1 or 4:1. Antiepileptic efficacy and diet tolerability were evaluated 3 months after initiating the diet. Patients showing seizure-free outcome with the 4:1 diet were changed to the 3:1 diet, and those without a seizure-free outcome on the 3:1 diet were changed to the 4:1 diet, for three more months, after which time their progress was monitored.


RESULTS
(1) Antiepileptic efficacy was higher for the 4:1 than the 3:1 diet (p < 0.05). Twenty-two (55.0%) of 40 patients on the 4:1 diet and 11 (30.5%) of 36 patients on the 3:1 diet became seizure free. Seizure reduction of over 90% was observed in 2 (5.0%) patients on the 4:1 diet, and 2 (5.6%) on the 3:1 diet. (2) Dietary tolerability was better for the 3:1 than the 4:1 diet. Gastrointestinal symptoms were observed in 5 (13.9%) patients with the 3:1 diet and 14 (35.0%) patients with the 4:1 diet (p < 0.05). (3) For seizure-free patients who started on the 4:1 diet, antiepileptic efficacy was maintained after changing to the 3:1 diet, while 10 (83.3%) of 12 patients who were not seizure free with the 3:1 diet showed increased seizure reduction after changing to the 4:1 diet. (4) Complications from the KD and laboratory data were not significantly different between the two groups.


CONCLUSIONS
The 4:1 KD showed greater antiepileptic efficacy than the 3:1 diet with higher seizure-free outcome. In most cases, seizure free outcome was maintained even after changing the ratio to 3:1. Dietary tolerability was better in the 3:1 diet than the 4:1 with less frequent gastrointestinal symptoms.
Seo
Joo Hee
JH
Department of Pediatrics, Pediatric Epilepsy Clinic, Severance Children's Hospital, Brain Research Institute, Yonsei University College of Medicine, Seodaemun Gu, Seoul, Korea.
Lee
Young Mock
YM
Lee
Joon Soo
JS
Kang
Hoon Chul
HC
Kim
Heung Dong
HD
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004041:Dietary Fats / Q000008:administration & dosage* / Q000378:metabolism / Q000627:therapeutic use; D004044:Dietary Proteins / Q000008:administration & dosage; D018572:Disease-Free Survival; D004827:Epilepsy / Q000178:diet therapy* / Q000378:metabolism*; D005260:Female; D005526:Food, Formulated / Q000009:adverse effects; D006801:Humans; D007223:Infant; D007657:Ketone Bodies / Q000096:biosynthesis*; D007662:Ketosis / Q000139:chemically induced / Q000378:metabolism; D008055:Lipids / Q000008:administration & dosage* / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D013036:Spasms, Infantile / Q000178:diet therapy / Q000378:metabolism; D016896:Treatment Outcome
D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004044:Dietary Proteins; D007657:Ketone Bodies; D008055:Lipids