title: Effect of classic ketogenic diet treatment on lipoprotein subfractions in children and adolescents with refractory epilepsy.
abstract: OBJECTIVE
  The aim of this study was to evaluate the effects of the classic ketogenic diet (KD) on low-density lipoprotein (LDL) and high-density lipoprotein (HDL) subfractions in children and adolescents with refractory epilepsy.
  
  
  METHODS
  This prospective study recruited children and adolescents of either sex, whose epilepsy was refractory to treatment with multiple drugs. To be included, the patient had to have an indication for treatment with the KD and be treated as an outpatient. At baseline and after 3 and 6 mo of the KD, lipid profile (total cholesterol [TC], triacylglycerols [TG], LDL cholesterol [LDL-C], and HDL cholesterol [HDL-C]), apolipoproteins (apoA-I and apoB), 10 subfractions of HDL, 7 subfractions of LDL, LDL phenotype, and LDL size were analyzed using the Lipoprint system.
  
  
  RESULTS
  The lipid profile components (TC, TG, LDL-C, HDL-C, apoA-I, and apoB) increased during the 3-mo follow-up, and remained consistent after 6 mo of treatment. Similarly, non-HDL-C, TC/HDL-C, LDL-C/HDL-C, and apoB/apoA-I ratios, representing atherogenic particles, significantly increased. In contrast, qualitative lipoprotein characteristics progressively changed during the follow-up period. Small LDL subfractions increased, and this profile was related with reduced LDL size (27.3 nm to 26.7 nm). The LDL phenotype became worse; 52.1% of the patients had a non-A phenotype after 6 mo of the KD. Small HDL subfractions decreased only after 6 mo of the KD.
  
  
  CONCLUSIONS
  KD treatment promotes negative changes in lipoprotein size and phenotype, contributing to atherogenic risk in these patients.
authors.affiliation: Postgraduate Program in Applied Human Nutrition, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Patricia
authors.initials: P
authors.lastname: Azevedo de Lima
authors.affiliation: Department of Nutrition, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Mariana
authors.initials: M
authors.lastname: Baldini Prudêncio
authors.affiliation: Children's Institute, Hospital of Clinics, School of Medicine University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Daniela Kawamoto
authors.initials: DK
authors.lastname: Murakami
authors.affiliation: Children's Institute, Hospital of Clinics, School of Medicine University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Leticia
authors.initials: L
authors.lastname: Pereira de Brito Sampaio
authors.affiliation: Experimental Physics Department, Institute of Physics, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Antônio Martins
authors.initials: AM
authors.lastname: Figueiredo Neto
authors.affiliation: Department of Nutrition, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil. Electronic address: nagila@usp.br.
authors.forename: Nágila Raquel
authors.initials: NR
authors.lastname: Teixeira Damasceno
mesh_terms: D000293:Adolescent; D017195:Adolescent Nutritional Physiological Phenomena; D050197:Atherosclerosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D015415:Biomarkers / Q000097:blood; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002664:Child Nutritional Physiological Phenomena; D004036:Diet, Atherogenic / Q000009:adverse effects; D055423:Diet, Ketogenic / Q000009:adverse effects*; D018450:Disease Progression; D000069279:Drug Resistant Epilepsy / Q000097:blood / Q000178:diet therapy* / Q000503:physiopathology; D050171:Dyslipidemias / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008075:Lipoproteins, HDL / Q000097:blood; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D011446:Prospective Studies; D012306:Risk
chemical_list: D015415:Biomarkers; D008075:Lipoproteins, HDL; D008077:Lipoproteins, LDL
keywords: Dyslipidemia; Epilepsy; Ketogenic diet; LDL size; Lipoprint; Lipoprotein subfractions