The effect of the ketogenic diet on the developing skeleton

Area of Science:

• Pediatric Endocrinology
• Metabolic Disorders
• Skeletal Biology

Background:

• The ketogenic diet (KD) is a high-fat, low-carbohydrate diet used for refractory epilepsy.
• Limited research exists on the KD's skeletal effects in children.
• Potential for impaired bone health warrants investigation.

Purpose of the Study:

• To investigate the impact of the KD on skeletal health parameters in pediatric patients.
• To monitor bone mineral density (BMD), bone mineral apparent density (BMAD), and biochemical markers.
• To assess if mobility level influences skeletal changes during KD treatment.

Main Methods:

• Prospective, longitudinal study of 29 pediatric patients on KD for at least 6 months.
• Dual-energy X-ray absorptiometry (DXA) for BMD and BMAD measurements.
• Assessment of Vitamin D, bone turnover markers, and urinary calcium-creatinine ratios.
• Stratification by Gross Motor Functional Classification System (GMFCS) for mobility.

Main Results:

• A trend towards reduced lumbar spine BMD Z-score annually was observed.
• 68% of patients showed lower BMD Z-scores post-treatment.
• More mobile patients exhibited a greater rate of bone loss (0.28 SD/year).
• Reduced BMAD Z-scores were noted in height-adjusted data.
• Elevated urinary calcium-creatinine ratios were common, with one case of renal calculi.

Conclusions:

• The ketogenic diet may induce unfavorable skeletal changes in children.
• Bone loss appears more pronounced in ambulant pediatric patients on KD.
• Clinicians should monitor bone health and consider potential skeletal side effects during KD therapy.