Abstracts

The ketogenic diet (KD) is a 90% fat diet used to treat intractable epilepsy. Hypercholesterolemia or hypertriglyceridemia has been reported to occur in 32% and 36% of KD patients respectively. These abnormalities may lead to an increased risk of heart disease, pancreatitis and stroke. We report 3 children who developed elevated lipid levels while on the KD. We investigated our ability to treat hyperlipidemias in children on the KD by alternating the fat and food sources. In a retrospective chart review we evaluated our practice of treating hyperlipidemias in 3 children on the KD who developed elevated lipid levels. Prior to initiating the ketogenic diet, the children were assessed to determine if they can tolerate a daily high fat intake and their risk for hypercholesterolemia and hypertriglyceridemia. Included in this evaluation is a 3 day weighed dietary record. All meals are analyzed using Food Processor for Windows, Nutrition Analysis and Fitness Software (Version 8.22). Family history is screened for lipid and cholesterol abnormalities, early heart disease and stroke. A fasting lipid profile (cholesterol, triglycerides, HDL and LDL) is obtained before beginning the KD and repeated every 3 months while the child was treated with the KD. For this study, we concentrated on the percentage of saturated and unsaturated fats and their influence on the blood cholesterol level. Three children were identified who developed hypercholestrolemias and hypertriglyceridemias. At the initiation of the ketogenic diet, all had either normal or mildly elevated lipid profile results. The elevated lipid levels occurred after the average of 6 months of KD treatment. On average the cholesterol was 290 [plusmn] 31 mg/dl, triglyceride 329 [plusmn] 271mg/dl, and HDL 39 [plusmn] 20 mg/dl. A significantly elevated cholesterol level was an indication to reevaluate the child[apos]s food/fat intake. The average ratio saturated/unsaturated fat intake was 1.07 [plusmn] 0.12. The families were asked to increase the use of polyunsaturated fats in the form of oils and to decrease the amount of butter. Families were encouraged to include foods with less saturated fat and use lean protein sources. The follow up cholesterol was obtained and showed improvement in all 3 children. Average cholesterol 229 [plusmn] 19 mg/dl, triglycerides 192 [plusmn] 31 mg/dl, HDL 39 [plusmn] 12 mg/dl. The average ratio saturated/unsaturated fat intake was 0.58 [plusmn] 0.17. 1. To maintain healthy lipid profile levels, the keto kids need to have periodic analysis of their food intake. 2. Fasting levels of cholesterol, HDL and triglycerides should be monitored regularly. 3. When hyperlipidemias occur a change in food choices and reduction in the saturated fat content of the KD may be all that is needed to normalize the lipid levels.