Growth and nutritional status of pediatric patients treated with the ketogenic diet

Ketogenic diet (KD), a well-known nonpharmacologic treatment of intractable epilepsy, could adversely affect growth and nutritional status; however, such data are limited in Thailand. This study aimed to assess growth and nutritional status of Thai children treated with KD together with dietary adherence and its related factors.

The records of children treated with KD for more than 1 month between January 2009 to September 2020 were reviewed. Weight, height, and biochemical indices were retrieved at baseline, 1, 3, 6, 12, 18, and 24 months. Type of KDs, compliance and adverse effects were extracted.

Forty-eight patients (21 male) were enrolled. Median age was 3.5 years (IQR 0.9, 10.1). There was no significant decrease in weight-for-age z-score (WAZ) despite a trend toward minimal reduction in WAZ at 3 months. Median follow-up time was 13 months (IQR 7, 29.5). Height-for-age z-score (HAZ) significantly decreased at 12 months [median -1.55 (IQR -3.35, -0.43) vs baseline median -0.6 (IQR -2.07, 0.29)]. Adherence of KD in tube feeding patients was better than oral feeding. Thirty seven percent (18/48) of the patients continued the diet beyond 2 years. Early discontinuation before 6 months was mostly due to poor compliance from patients and families (6/11, 55%). Common adverse effects were GI problems (77%), dyslipidemia (64%) and hypercalciuria (29%).

Under close monitoring, KD can be administered in Thai children with minimal adverse effects on growth and nutritional status. Adherence depends on route of feeding, clinical response, and cooperation of the families.