Abstracts

Rationale: The ketogenic diet (KD) is a high-fat, low-carbohydrate (CHO) regimen used to treat pediatric epilepsy. Due to this shift in macronutrient distribution, dyslipidemia is a potential complication.Methods: A retrospective chart review was conducted to study the effects of the KD on lipid biomarkers in children with epilepsy who were admitted to MUSC for KD initiation (n=37; 62% male; 4.7±5.7y). Blood lipids were measured at baseline and one month after KD initiation in a subsample (n=11). Caregivers, RDN, and MD subjectively defined seizure improvement as ≥50% reduction in seizure frequency after one month on the KD.Results: Compared to baseline diets, KD initiation increased patients’ percent calories (%kcal) from fat by 48%, and decreased %kcal from CHO and protein by 45% and 3%, respectively. After 1 month on the KD, there were significant increases in children’s total cholesterol (TC, +36.3±54.8 mg/dL, p=0.05) and triglycerides (+71.8±81.1 mg/dL, p=0.015), and decreased HDL (-11.5±14.7 mg/dL, p=0.026). Overall, 73% of patients experienced seizure improvement. After controlling for gender, as well as baseline TC and weight, %kcal from PRO on the KD was a significant predictor of lower TC at 1-month follow-up (β=-16.3 mg/dL, p=0.04).Conclusions: This study suggests that although patients remained weight-stable on the isocaloric KD after one month, negative effects on lipid metabolism were observed in all children, with differential effects of each macronutrient on total cholesterol. While this study examined acute effects of the KD, further research is warranted to explore changes in lipid metabolism after long-term KD adaptation (e.g. >3 mo.).