title: Efficacy of 4:1 (classic) versus 2.5:1 ketogenic ratio diets in refractory epilepsy in young children: a randomized open labeled study.
abstract: OBJECTIVE
  The ketogenic (lipid to non-lipid) ratio may play an important role in the efficacy and tolerability of ketogenic diets (KD). This study was planned to compare the efficacy and tolerability of 2.5:1 versus 4:1 lipid:non-lipid ratio KD in young children with refractory epilepsy.
  
  
  METHODS
  Children aged 6 months to 5 years with refractory epilepsy were enrolled. They were randomized to receive either a 4:1 or 2.5:1 ketogenic ratio diet, which was introduced using a non-fasting protocol. Seizure frequency, biochemical profile (liver and kidney function tests, fasting lipid profile, and spot urinary calcium-creatinine ratio), and adverse effects were recorded at three months in both groups.
  
  
  RESULTS
  Thirty eight children were enrolled, 19 in each group. At three months, 11 children (58%) in the 4:1 group and 12 (63%) in the 2.5:1 group had more than 50% reduction in seizures (p=0.78). Five children (26%) in the 4:1 group and four (21%) in 2.5:1 group became seizure free. There was no significant difference in the biochemical parameters between the two groups.
  
  
  CONCLUSIONS
  2.5:1 ratio KD is possibly as effective as 4:1 KD in controlling seizures and has fewer adverse effects.
authors.affiliation: Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India. drknvraju@yahoo.co.in
authors.forename: K N Vykunta
authors.initials: KN
authors.lastname: Raju
authors.forename: Sheffali
authors.initials: S
authors.lastname: Gulati
authors.forename: Madhulika
authors.initials: M
authors.lastname: Kabra
authors.forename: Anuja
authors.initials: A
authors.lastname: Agarwala
authors.forename: Suvasini
authors.initials: S
authors.lastname: Sharma
authors.forename: Ravindra Mohan
authors.initials: RM
authors.lastname: Pandey
authors.forename: Veena
authors.initials: V
authors.lastname: Kalra
mesh_terms: D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D055423:Diet, Ketogenic / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D004827:Epilepsy / Q000178:diet therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D050356:Lipid Metabolism; D008297:Male; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014508:Urea / Q000097:blood
chemical_list: D014508:Urea; D003404:Creatinine