title: Is ketogenic diet treatment hepatotoxic for children with intractable epilepsy?
abstract: OBJECTIVE
  Long-term ketogenic diet (KD) treatment has been shown to induce liver steatosis and gallstone formation in some in vivo and clinical studies. The aim of this retrospective study was to evaluate the hepatic side effects of KD in epileptic children.
  
  
  METHODS
  A total of 141 patients (mean age: 7.1±4.1years [2-18 years], 45.4% girls), receiving KD at least one year for intractable epilepsy due to different diagnoses (congenital brain defects, GLUT-1 deficiency, West syndrome, tuberous sclerosis, hypoxic brain injury, etc.) were included in the study. Serum triglyceride, cholesterol, aminotransferase, bilirubin, protein and albumin levels and abdominal ultrasonography were recorded before and at 1, 3, 6, and 12 months following after diet initiation.
  
  
  RESULTS
  The mean duration of KD was 15.9±4.3months. At one month of therapy, three patients had elevated alanine and aspartate aminotransferase levels. These patients were receiving ketogenic diet for Doose syndrome, idiopathic epilepsy and GLUT-1 deficiency. Hepatosteatosis was detected in three patients at 6 months of treatment. Two of these patients were treated with KD for the primary diagnosis of tuberous sclerosis and one for Landau Kleffner syndrome. Cholelithiasis was detected in two patients at 12 months of treatment. They were receiving treatment for West syndrome and hypoxic brain injury sequelae.
  
  
  CONCLUSIONS
  Long-term ketogenic diet treatment stimulates liver parenchymal injury, hepatic steatosis and gallstone formation. Patients should be monitored by screening liver enzymes and abdominal ultrasonography in order to detect these side effects.
authors.affiliation: Dokuz Eylul University, Division of Pediatric Metabolism and Nutrition, Izmir, Turkey; Dokuz Eylul University, Izmir Biomedicine and Genome Center, Izmir, Turkey. Electronic address: nur.arslan@deu.edu.tr.
authors.forename: Nur
authors.initials: N
authors.lastname: Arslan
authors.affiliation: Behçet Uz Children Hospital, Division of Pediatric Neurology, Izmir, Turkey.
authors.forename: Orkide
authors.initials: O
authors.lastname: Guzel
authors.affiliation: Dokuz Eylul University, Division of Pediatric Metabolism and Nutrition, Izmir, Turkey.
authors.forename: Engin
authors.initials: E
authors.lastname: Kose
authors.affiliation: Behçet Uz Children Hospital, Division of Pediatric Neurology, Izmir, Turkey.
authors.forename: Unsal
authors.initials: U
authors.lastname: Yılmaz
authors.affiliation: Dokuz Eylul University, Division of Pediatric Gastroenterology, Izmir, Turkey.
authors.forename: Pınar
authors.initials: P
authors.lastname: Kuyum
authors.affiliation: Dokuz Eylul University, Division of Pediatric Gastroenterology, Izmir, Turkey.
authors.forename: Betül
authors.initials: B
authors.lastname: Aksoy
authors.affiliation: Behçet Uz Children Hospital, Division of Pediatric Neurology, Izmir, Turkey.
authors.forename: Tansel
authors.initials: T
authors.lastname: Çalık
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging; D000293:Adolescent; D000886:Anthropometry; D001663:Bilirubin / Q000097:blood; D002648:Child; D002675:Child, Preschool; D002784:Cholesterol / Q000097:blood; D055423:Diet, Ketogenic / Q000379:methods*; D000069279:Drug Resistant Epilepsy / Q000097:blood / Q000150:complications / Q000178:diet therapy / Q000209:etiology; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000000981:diagnostic imaging / Q000178:diet therapy* / Q000209:etiology*; D008137:Longitudinal Studies; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D000637:Transaminases / Q000097:blood; D014280:Triglycerides / Q000097:blood; D014463:Ultrasonography
chemical_list: D014280:Triglycerides; D002784:Cholesterol; D000637:Transaminases; D001663:Bilirubin
keywords: Aminotransferase; Children; Epilepsy; Fatty liver; Gallstone; Ketogenic diet