ABSTRACT
OBJECTIVES: This study evaluated the adequacy of micronutrient intake from the ketogenic diet (KD) with and without micronutrient supplementation according to age in Brazilian children and adolescents with refractory epilepsy undergoing KD treatment. METHODS: This study enrolled children and adolescents with refractory epilepsy who were up to 19 y of age. Nutrient intakes were monitored using 3 d food records before introducing micronutrient supplementation and 3 mo after starting KD treatment. The prevalence of micronutrient inadequacy was estimated by sex and age according to the estimated average requirement cutoff values. RESULTS: This study included 39 children and adolescents. The KD did not provide enough content of folate, calcium, and magnesium in all patients according to the dietary reference intake. Even after starting supplementation, calcium, phosphorus, and magnesium intake remained inadequate in the majority of patients. The supplementation effectively met the vitamin B12 recommendation in all age groups. CONCLUSIONS: KD treatment did not provide adequate levels of the monitored micronutrients. The supplementation improved but did not prevent the inadequacy of micronutrients such as calcium, magnesium, and phosphorus. The results highlight the importance of individual supplementation protocols and the need to monitor micronutrient intake according to age and sex.
Subject(s)
Diet, Ketogenic , Drug Resistant Epilepsy , Adolescent , Brazil , Child , Diet , Dietary Supplements , Humans , Micronutrients , Nutritional RequirementsABSTRACT
ABSTRACT Objective: To develop a graphical representation in the form of a food pyramid for a ketogenic diet for dietary treatment in children and adolescents with refractory epilepsy. Methods: The pyramid was constructed based on: the estimation of energy requirements for different age groups, macronutrient distribution, food groups, and the number of servings and respective amounts of food according to the ketogenic diet. Serving sizes were based on the calculation of energy and macronutrient requirements according to age and nutritional status. Results: The pyramid was divided into three tiers and 5 food groups (fats, proteins, type 1 vegetables, type 2 vegetables, and fruits). Four portion size lists were defined for the following age groups: 1-3 years, 4-6 years, 7-10 years, and 11-19 years. Conclusion: The ketogenic diet food pyramid can be used as nutritional guidance for patients undergoing this dietary therapy by illustrating the variety of foods that can be eaten during the treatment, optimizing adherence to the treatment, and guaranteeing beneficial effects on seizure control.
RESUMO Objetivo: Desenvolver uma representação gráfica sob a forma de pirâmide alimentar para a dieta cetogênica destinada a crianças e adolescentes com indicação de tratamento dietético da epilepsia refratária. Métodos: A construção foi baseada na estimativa da necessidade energética por faixa etária, na distribuição de macronutrientes, nos grupos alimentares, no número de porções e nas respectivas quantidades de alimentos a serem ofertados de forma a atender as recomendações da dieta cetogênica. O porcionamento dos alimentos foi feito baseado no cálculo da necessidade energética e na distribuição de macronutriente segundo a faixa etária e estado nutricional. Resultados: A pirâmide foi dividida em três estratos e em cinco grupos alimentares (gorduras, proteínas, hortaliças tipo 1, hortaliças tipo 2 e frutas). Foram elaboradas quatro listas de porcionamento para as seguintes faixas etárias 1 a 3 anos, 4 a 6 anos, 7 a 10 anos e 11 a 19 anos. Conclusão: A utilização da pirâmide alimentar da dieta cetogênica facilitará a orientação inicial dos pacientes submetidos a essa terapia nutricional, ilustrando a diversidade de alimentos que podem ser ofertados durante o tratamento e otimizando, assim, a aderência ao mesmo e a manutenção dos efeitos benéficos de controle de crises.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Diet, Ketogenic , Food and Nutrition Education , Epilepsy/diet therapyABSTRACT
OBJECTIVE: The aim of this study was to evaluate the effects of the classic ketogenic diet (KD) on low-density lipoprotein (LDL) and high-density lipoprotein (HDL) subfractions in children and adolescents with refractory epilepsy. METHODS: This prospective study recruited children and adolescents of either sex, whose epilepsy was refractory to treatment with multiple drugs. To be included, the patient had to have an indication for treatment with the KD and be treated as an outpatient. At baseline and after 3 and 6 mo of the KD, lipid profile (total cholesterol [TC], triacylglycerols [TG], LDL cholesterol [LDL-C], and HDL cholesterol [HDL-C]), apolipoproteins (apoA-I and apoB), 10 subfractions of HDL, 7 subfractions of LDL, LDL phenotype, and LDL size were analyzed using the Lipoprint system. RESULTS: The lipid profile components (TC, TG, LDL-C, HDL-C, apoA-I, and apoB) increased during the 3-mo follow-up, and remained consistent after 6 mo of treatment. Similarly, non-HDL-C, TC/HDL-C, LDL-C/HDL-C, and apoB/apoA-I ratios, representing atherogenic particles, significantly increased. In contrast, qualitative lipoprotein characteristics progressively changed during the follow-up period. Small LDL subfractions increased, and this profile was related with reduced LDL size (27.3 nm to 26.7 nm). The LDL phenotype became worse; 52.1% of the patients had a non-A phenotype after 6 mo of the KD. Small HDL subfractions decreased only after 6 mo of the KD. CONCLUSIONS: KD treatment promotes negative changes in lipoprotein size and phenotype, contributing to atherogenic risk in these patients.
