Lower Ketogenic Diet Ratios for Protein Adequacy for Management of Refractory Epilepsy in Pediatric Population
Abstract number :
3.343
Submission category :
10. Dietary Therapies (Ketogenic, Atkins, etc.)
Year :
2022
Submission ID :
2203966
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:22 AM
Authors :
Robin Varughese, MD – Northwell Health; Michelle Burch, RD – RD, Division of Pediatric Neurology, Department of Pediatrics, Northwell Health Cohen Children's Medical Center; Aaqil Ali, BS – Research Coordinator, Division of Pediatric Neurology, Department of Pediatrics, Northwell Health Cohen Children's Medical Center; Shefali Karkare, MD – Division of Pediatric Neurology, Department of Pediatrics – Northwell Health Cohen Children's Medical Center; Sanjeev Kothare, MD – Division of Pediatric Neurology, Department of Pediatrics – Northwell Health Cohen Children's Medical Center
Rationale: Classic ketogenic diets (KD) consist of high-fat, low-carbohydrate and adequate protein content to achieve ketosis and lower seizure threshold. The classic KD regimen provides effective seizure reduction but reaching traditional ketogenic ratios while meeting adequate protein requirements is not always possible while staying within caloric limitations. We hypothesize that a lower ketogenic ratio for the traditional KD regimen to meet the recommended dietary allowance (RDA) for protein will not impact seizure reduction or ketosis, while providing the necessary nutrients to avoid protein deficiency and improve long-term developmental outcomes.
Methods: Inclusion criteria for this single center retrospective analysis included patients less than 18 years of age with refractory epilepsy who were on KD for at least three months. Exclusion criteria included age over 18 years, KD patients that did not achieve ketosis or lack of follow up for 3 months. The two cohorts consisted of patients utilizing the classic or modified ketogenic diet ratio (≥3:1) and patients utilizing a lower ketogenic ratio attributed to increased protein intake to meet their RDA. Baseline characteristics included epilepsy type, ketogenic diet ratios, and calculated percentage of caloric intake from protein with respect to patient’s age, height, body weight and BMI. Measured outcomes included seizure frequency prior to and after initiation of ketogenic diet obtained from self-reported seizure frequency on subsequent follow up visits or through telephonic chart notes within the outpatient electronic medical record. The Mann-Whitney U test was used for statistical analysis of between-group differences of continuous variables to evaluate statistical significance of median seizure reduction between cohorts. Chi square test was used to analyze responder rate in respective cohort.
Results: Twenty subjects, eleven subjects with lower KD ratio and nine subjects with higher KD ratio, were analyzed in this study. Median reduction of seizure frequency was 80.36% for higher ketogenic ratio and 39.29% for lower ketogenic ratio (p=0.456 on Mann-Whitney U test) with a responder rate of 45% and 33% for respective groups (p= 0.670). This demonstrates the median seizure reduction between both high and low ratio ketogenic diets were not statistically significantly different in achieving seizure reduction.
Conclusions: Lower ketogenic diet ratios with the primary variable of sufficient protein intake did not affect the seizure outcomes with respect to seizure reduction. This study further emphasizes the flexibility that may be present in ketogenic diets to improve long-term adherence while also achieving necessary dietary benchmarks.
Funding: None
Dietary Therapies (Ketogenic, Atkins, etc.)