Is hospitalization really necessary during the introduction of the ketogenic diet?

The ketogenic diet is traditionally introduced with an initial period of fasting. This study compares the efficacy and tolerability of the introduction of a prediet (2:1 ratio of fat:protein + carbohydrates) before hospitalization with the aim at reducing the time of same and the period of fasting necessary to reach ketosis. For a minimum period of 1 year, adverse effects, metabolic profile, and linear growth were prospectively evaluated in 46 children. Twenty-three children received a prediet for a period of 10 days, and in the other 23 children, the ketogenic diet was introduced by hospitalization regimen after a fasting period. The use of the prediet led to a shorter fasting period of a mean 18.3 hours compared with the group without prediet, in which the fasting period was 41.3 hours (P = .001). At the end, there was no difference in the adverse effects between the groups. In those submitted to the prediet, a better adaptation to the diet and acceptance to the proposal of introducing the ketogenic diet were observed.