Abstracts

Rationale: The ketogenic diet is an effective therapy for intractable epilepsy, despite documented associated adverse effects. Among the reported nutritional deficiencies in children treated with ketogenic diets, selenium deficiency has been described, associated with cardiomyopathy and one case of sudden death. The objective of this study is to assess the selenium status of children treated with the classic and MCT ketogenic diets in two facilities in Toronto, Canada. Methods: Fifty children, age 0.5-12.5 years (mean SD=5.07 3.27), were treated with a ketogenic diet from March 2003 to March, 2010. Twenty-three children, 14 boys, (age: mean SD=4.35 3.33) were treated with the classic diet and 27 children, 17 boys, (age: mean SD=5.61 3.21) were treated with the MCT ketogenic diet. Plasma selenium levels were collected pre-diet, and at 6 months and 12 months during diet treatment. The laboratory selenium reference range used was 1.27-2.09 umol/L. Selenium supplementation was prescribed at diet initiation if total intake did not meet the Dietary Reference Intake (DRI). Supplementation was adjusted for individual children if a single selenium level fell below the reference range on routine bi-annual testing. T-tests were performed to compare selenium levels of children treated with the MCT and Classic diets at diet initiation, and at 6 and 12 months on diet therapy. Paired t-tests were used to compare pre-diet and 6 and 12 month selenium values in each diet group. Results: Prior to diet initiation, there were 9 children in the classic diet group and 3 children in the MCT diet group with selenium levels below the recommended range. In 23 children treated with the classic ketogenic diet, mean plasma selenium prior to diet initiation was 1.37 0.34umol/L, increased to 1.66 0.61umol/L at 6 months and 1.60 0.41umol/L at 12 months. Levels were significantly higher during diet therapy (p<0.05). In 27 children treated with the MCT ketogenic diet, the mean SD plasma selenium prior to diet initiation was 1.55 0.34umol/L, remaining quite stable at 6 months, 1.57 0.35umol/L, and 12 months, 1.57 0.32umol/L. There was no significant difference between pre-diet and during diet levels in this group. There was no significant difference between the mean selenium levels in children treated with the MCT compared to the classic ketogenic diet at any time point.