title: Linear growth of children on a ketogenic diet: does the protein-to-energy ratio matter?
abstract: Ketogenic diet is a structured effective treatment for children with intractable epilepsy. Several reports have indicated poor linear growth in children on the diet but the mechanism of poor growth has not been elucidated. We aimed to explore whether the protein to energy ratio plays a role in linear growth of children on ketogenic diet. Data regarding growth and nutrition were, retrospectively, collected from the clinical histories of 35 children who were treated with ketogenic diet for at least 6 months between 2002 and 2010. Patients were stratified into groups according to periods of satisfactory or poor linear growth. Poor linear growth was associated with protein or caloric intake of <80% recommended daily intake, and with a protein-to-energy ratio consistently ≤1.4 g protein/100 kcal even when protein and caloric intakes were adequate. We recommend a protein-to-energy ratio of 1.5 g protein/100 kcal be prescribed to prevent growth retardation.
authors.affiliation: Metabolic Genetics, Victorian Clinical Genetics Services and Royal Children's Hospital, Melbourne, Victoria, Australia Department of Nutrition and Dietetics, Royal Children's Hospital, Melbourne, Victoria, Australia judy.nation@vcgs.org.au.
authors.forename: Judy
authors.initials: J
authors.lastname: Nation
authors.affiliation: Metabolic Genetics, Victorian Clinical Genetics Services and Royal Children's Hospital, Melbourne, Victoria, Australia Department of Nutrition and Dietetics, Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Maureen
authors.initials: M
authors.lastname: Humphrey
authors.affiliation: Children's Neuroscience Centre, Royal Children's Hospital, Melbourne, Victoria, Australia Department of Paediatrics, University of Melbourne, Victoria, Australia Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: MacKay
authors.affiliation: Metabolic Genetics, Victorian Clinical Genetics Services and Royal Children's Hospital, Melbourne, Victoria, Australia Department of Paediatrics, University of Melbourne, Victoria, Australia Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
authors.forename: Avihu
authors.initials: A
authors.lastname: Boneh
mesh_terms: D000293:Adolescent; D000886:Anthropometry; D002648:Child; D002657:Child Development / Q000502:physiology; D002675:Child, Preschool; D055423:Diet, Ketogenic / Q000009:adverse effects / Q000379:methods*; D004044:Dietary Proteins / Q000008:administration & dosage*; D002149:Energy Intake / Q000502:physiology; D004827:Epilepsy / Q000178:diet therapy / Q000503:physiopathology; D005260:Female; D006801:Humans; D007223:Infant; D016014:Linear Models; D008297:Male; D012189:Retrospective Studies
chemical_list: D004044:Dietary Proteins
keywords: caloric intake; feeding; growth patterns; ketogenic diet; protein