Related Experiment Video
Updated: Dec 11, 2025
Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
Published on: September 20, 2024
Longitudinal changes in insulin resistance in children with epilepsy on ketogenic diet: Prevalence and risk factors
Juhyun Kong1, Sang Ook Nam1, Ara Ko1
1Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, South Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea.
Insights
The ketogenic diet (KD) significantly increased insulin resistance (IR) in children with epilepsy. Younger age at seizure onset, antiepileptic drug initiation, and higher lipid levels were associated with increased IR, necessitating monitoring.
Area of Science:
- Pediatric Neurology
- Metabolic Disorders
- Epilepsy Management
Background:
- The ketogenic diet (KD) is an established therapy for drug-resistant epilepsy in children.
- Insulin resistance (IR) is a metabolic condition that can have long-term health implications.
- Understanding the metabolic effects of KD, particularly IR, is crucial for comprehensive patient care.
Purpose of the Study:
- To determine the incidence of insulin resistance (IR) in pediatric epilepsy patients undergoing ketogenic diet (KD) therapy.
- To identify risk factors associated with the development or exacerbation of IR in this population.
Main Methods:
- A longitudinal cohort study involving 28 children with epilepsy on KD.
- Insulin resistance was assessed using the homeostasis model assessment of insulin resistance (HOMA-IR).
- Measurements included HOMA-IR, fasting glucose, fasting insulin, and lipid profiles before and during KD treatment.
Main Results:
- A significant increase in HOMA-IR values was observed from before KD initiation to the last follow-up (median HOMA-IR increased from 1.2 to 1.8).
- Higher HOMA-IR values were associated with younger age at seizure onset, initiation of antiepileptic drugs (AEDs), and KD initiation.
- Elevated serum alanine transaminase, total cholesterol, LDL-C, and triglyceride levels were also linked to increased HOMA-IR.
Conclusions:
- The ketogenic diet is associated with an increased incidence of insulin resistance in children with epilepsy.
- Younger age at disease onset and specific metabolic markers (e.g., elevated lipids) are risk factors for IR.
- Regular monitoring of serum lipid levels, particularly in younger children, is recommended to detect potential IR exacerbation.
Introduction:
The aim of the study was to evaluate the incidence of insulin resistance (IR) and the associated risk factors in children with epilepsy on a ketogenic diet (KD).
Methods:
This longitudinal cohort study analyzed data of children with epilepsy on KD. Insulin resistance was assessed using the homeostasis model assessment of insulin resistance (HOMA-IR). The HOMA-IR value, fasting serum insulin levels, fasting glucose (FG) levels, and lipid profiles were measured before the initiation of the KD and at 6- to 12-month intervals.
Results:
A total of 28 children were enrolled. The median age at the initiation of KD was 2.7 ± 2.4 years, and the median follow-up duration was 2.1 ± 1.4 years. The median HOMA-IR (HOMA-IR-1) value before the initiation of KD was 1.2 ± 0.2, which significantly increased to 1.8 ± 0.3 at the last follow-up (HOMA-IR-2; ∆HOMA-IR = 0.6 ± 0.3, p < 0.001). The following factors were associated with patients with higher HOMA-IR-2 values (≥1.9): younger age at seizure onset (0.3 ± 0.2 years, p < 0.001), at the initiation of antiepileptic drugs (AEDs; 0.3 ± 0.3 years, p < 0.001), and at the initiation of KD (1.3 ± 0.5 years, p < 0.001) and higher serum alanine transaminase (ALT; 84.0 ± 17.8 U/L, p = 0.022), total cholesterol (TC; 245.0 ± 20.1 mg/dL, p = 0.001), low-density lipoprotein cholesterol (LDL-C, 103.0 ± 6.7 mg/dL, p = 0.003), and triglyceride (387.0 ± 28.8 mg/dL, p < 0.001) levels. Multivariate regression analysis revealed that the age at seizure onset (p = 0.002), at initiation of AEDs (p = 0.021), and at initiation of KD (p = 0.022) and serum levels of LDL-C (p = 0.012) and triglycerides (p = 0.026) were associated with a significantly high HOMA-IR-2 value.
Conclusion:
Close monitoring of serum lipids levels, especially at younger age, may aid in detecting exacerbation of IR.
More Related Videos
10:46Author Spotlight: Obtaining High-Quality CSF and Blood Samples for Epilepsy Biomarker Discovery
Published on: September 1, 2023
10:22Interictal High Frequency Oscillations Detected with Simultaneous Magnetoencephalography and Electroencephalography as Biomarker of Pediatric Epilepsy
Published on: December 6, 2016
Related Concept Videos
01:24Epilepsy and Seizures: Overview
Various factors can trigger epilepsy, including genetic factors, brain damage, metabolic causes, and unknown etiology. Diagnosis of epilepsy involves electroencephalography (EEG), which...
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
01:24Overview of Lipid Metabolism
Lipolysis: The Breakdown of Lipids:
Lipolysis is the process of breaking down lipids, particularly triglycerides, into glycerol and fatty acids. This process typically occurs in the adipose tissue and is triggered by various hormones, including glucagon and...
01:22Diabetes Mellitus: Type 2 and Gestational
01:20Pharmacokinetics in Obese Patients: Drug Metabolism and Excretion
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption