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Zaghloul MS, Elizondo-Benedetto S, Zayed MA. Impact of ketogenic diet on cardiovascular disease. Nutr Rev 2023:nuad152. [PMID: 38109885 DOI: 10.1093/nutrit/nuad152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVES A comprehensive review of the current literature was conducted to summarize the potential therapeutic and management roles of ketogenic diet (KD) for cardiovascular disease (CVD). BACKGROUND Consensus has not been reached on the optimal diet for individuals with cardiovascular risk factors. KDs are characterized by high-fat, low-carbohydrate, and appropriate protein content, and have gained popularity in recent years in the management of various conditions, including cardiovascular and metabolic diseases. METHODS Original research, systematic reviews, and meta-analyses available in the PubMed, Web of Science, and Google Scholar databases were reviewed. RESULTS The current body of preclinical and clinical evidence on the efficacy of KD in the management of CVD remains limited. Specific applications of KD seem to suggest a positive impact on management of CVD. However, conflicting results and a lack of precise molecular and biochemical mechanisms of action provide ample opportunity for future investigation. CONCLUSION More multidisciplinary studies are needed to determine the true clinical benefit of KD in the management of CVD and so justify its expanded clinical use.
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Affiliation(s)
- Mohamed S Zaghloul
- Department of Surgery, Section of Vascular Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Santiago Elizondo-Benedetto
- Department of Surgery, Section of Vascular Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Mohamed A Zayed
- Department of Surgery, Section of Vascular Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Division of Molecular Cell Biology, Washington University School of Medicine, St. Louis, MO, USA
- McKelvey School of Engineering, Department of Biomedical Engineering, Washington University, St. Louis, MO, USA
- Department of Surgery, Veterans Affairs St. Louis Health Care System, St. Louis, MO, USA
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Santangelo A, Corsello A, Spolidoro GCI, Trovato CM, Agostoni C, Orsini A, Milani GP, Peroni DG. The Influence of Ketogenic Diet on Gut Microbiota: Potential Benefits, Risks and Indications. Nutrients 2023; 15:3680. [PMID: 37686712 PMCID: PMC10489661 DOI: 10.3390/nu15173680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/10/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
The ketogenic diet (KD) restricts carbohydrate consumption, leading to an increase in ketone bodies, such as acetoacetate, β-hydroxybutyrate, and acetone, which are utilized as energy substrates. This dietary approach impacts several biochemical processes, resulting in improved clinical management of various disorders, particularly in childhood. However, the exact mechanisms underlying the efficacy of KD remain unclear. Interestingly, KD may also impact the gut microbiota, which plays a pivotal role in metabolism, nutrition, and the development of the immune and nervous systems. KD has gained popularity for its potential benefits in weight loss, blood sugar control, and certain neurological conditions. This narrative review sums up KD-related studies published over 30 years. While short-term studies have provided valuable insights into the effects of KD on the gut microbiota, persistent uncertainties surround its long-term efficacy and potential for inducing dysbiosis. The significant influence of KD on epigenetic mechanisms, intracellular pathways, and gut microbial composition underscores its potential as a therapeutic choice. However, a judicious consideration of the potential risks associated with the strict adherence to a low-carbohydrate, high-fat, and high-protein regimen over prolonged periods is imperative. As KDs gain popularity among the adolescent and young adult demographic for weight management, it becomes imperative to undertake additional research to comprehensively assess their impact on nutritional status and gut microbiota, ensuring a holistic and sustainable approach to medical nutrition.
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Affiliation(s)
- Andrea Santangelo
- Department of Pediatrics, Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy; (A.S.); (A.O.); (D.G.P.)
| | - Antonio Corsello
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy; (G.C.I.S.); (C.A.); (G.P.M.)
| | - Giulia Carla Immacolata Spolidoro
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy; (G.C.I.S.); (C.A.); (G.P.M.)
| | - Chiara Maria Trovato
- Hepatology Gastroenterology and Nutrition Unit, Bambino Gesù Children Hospital, 00165 Rome, Italy;
| | - Carlo Agostoni
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy; (G.C.I.S.); (C.A.); (G.P.M.)
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Alessandro Orsini
- Department of Pediatrics, Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy; (A.S.); (A.O.); (D.G.P.)
| | - Gregorio Paolo Milani
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy; (G.C.I.S.); (C.A.); (G.P.M.)
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Diego Giampietro Peroni
- Department of Pediatrics, Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy; (A.S.); (A.O.); (D.G.P.)
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3
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Capra ME, Monopoli D, Decarolis NM, Giudice A, Stanyevic B, Esposito S, Biasucci G. Dietary Models and Cardiovascular Risk Prevention in Pediatric Patients. Nutrients 2023; 15:3664. [PMID: 37630854 PMCID: PMC10458109 DOI: 10.3390/nu15163664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/08/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Nutritional intervention is worldwide recognized as a first step treatment for subjects with increased cardiovascular risk and it is of utmost importance especially for children and adolescents. Currently scientific evidence supports the role of dietary patterns instead of simple single nutrients or foods in cardiovascular risk prevention. Indeed, the American Heart Association dietary guidelines have expanded beyond nutrients to dietary pattern, that comprise not only single food items but also behavioral or cultural habits of specific populations. The aim of our narrative review is to analyze the most frequently adopted dietary patterns in children and adolescents and to evaluate their effect on cardiovascular risk factors and in cardiovascular risk prevention. Literature review showed that children cannot be considered as little adults: nutritional intervention must always grant adequate growth and neurodevelopment before reaching the proposed goals, therefore dietary patterns considered heart-healthy for adult subjects might not be suitable for pediatric patients. Mediterranean diet, DASH diet, Nordic diet and some plant-based diets seem to be the most promising dietary patterns in terms of cardiovascular health in the developmental age, even if further studies are needed to better standardize and analyze their effect on growing up individuals.
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Affiliation(s)
- Maria Elena Capra
- Pediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (M.E.C.); (G.B.)
- Società Italiana di Nutrizione Pediatrica, 20126 Milan, Italy
| | - Delia Monopoli
- Pediatric Clinic, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy; (D.M.); (N.M.D.); (A.G.); (B.S.)
| | - Nicola Mattia Decarolis
- Pediatric Clinic, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy; (D.M.); (N.M.D.); (A.G.); (B.S.)
| | - Antonella Giudice
- Pediatric Clinic, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy; (D.M.); (N.M.D.); (A.G.); (B.S.)
| | - Brigida Stanyevic
- Pediatric Clinic, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy; (D.M.); (N.M.D.); (A.G.); (B.S.)
| | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy; (D.M.); (N.M.D.); (A.G.); (B.S.)
| | - Giacomo Biasucci
- Pediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (M.E.C.); (G.B.)
- Società Italiana di Nutrizione Pediatrica, 20126 Milan, Italy
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
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4
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Edwards S, Foster M, Ahmed SF, Lucas-Herald AK. Preventative interventions that target cardiovascular dysfunction in children and young people: a systematic review of their effectiveness and an investigation of sexual dimorphism. J Hum Hypertens 2023; 37:726-734. [PMID: 36463360 PMCID: PMC10403341 DOI: 10.1038/s41371-022-00780-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 12/07/2022]
Abstract
Given that cardiovascular diseases remain a primary cause of mortality and morbidity, there is a need to consider preventative strategies to improve vascular function from early in life. The aims of this study were therefore to investigate which interventions may improve endothelial function, intima media thickness and arterial stiffness in children and young people and to assess whether these interventions differ in boys and girls. A systematic literature search of Science Direct, Pubmed, Google Scholar and the Cochrane Library by two independent reviewers was performed to source articles. Inclusion criteria were any studies including any child ≤18 years of age receiving an intervention, which measured vascular function other than blood pressure. Exclusion criteria were studies assessing children with chronic medical conditions. A total of 72 studies were identified, which met the inclusion criteria. A measurable change in outcome was more likely to be reported in studies investigating endothelial function (p = 0.03). Interventions which improved vascular function included physical activity and dietary programmes. Under 10% of studies considered sex differences. In conclusion, school-based physical activity interventions are most likely to result in improvements in vascular function. Endothelial function may be the first variable of vascular function to change secondary to an intervention. Standardisation of reporting of differences between the sexes is essential to be able to ensure interventions are equally effective for boys and girls.
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Affiliation(s)
- Sophie Edwards
- Developmental Endocrinology Research Group, University of Glasgow, Royal Hospital for Children, Glasgow, UK
| | - Murray Foster
- Developmental Endocrinology Research Group, University of Glasgow, Royal Hospital for Children, Glasgow, UK
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, University of Glasgow, Royal Hospital for Children, Glasgow, UK
| | - Angela K Lucas-Herald
- Developmental Endocrinology Research Group, University of Glasgow, Royal Hospital for Children, Glasgow, UK.
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Ferraris C, Guglielmetti M, Neri LDCL, Allehdan S, Mohsin Albasara JM, Fareed Alawadhi HH, Trentani C, Perna S, Tagliabue A. A Review of Ketogenic Dietary Therapies for Epilepsy and Neurological Diseases: A Proposal to Implement an Adapted Model to Include Healthy Mediterranean Products. Foods 2023; 12:foods12091743. [PMID: 37174282 PMCID: PMC10178865 DOI: 10.3390/foods12091743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
Based on the growing evidence of the therapeutic role of high-fat ketogenic dietary therapies (KDTs) for neurological diseases and on the protective effect of the Mediterranean diet (MD), it could be important to delineate a Mediterranean version of KDTs in order to maintain a high ketogenic ratio, and thus avoid side effects, especially in patients requiring long-term treatment. This narrative review aims to explore the existing literature on this topic and to elaborate recommendations for a Mediterranean version of the KDTs. It presents practical suggestions based on MD principles, which consist of key elements for the selection of foods (both from quantitative and qualitative prospective), and indications of the relative proportions and consumption frequency of the main food groups that constitute the Mediterranean version of the KDTs. We suggest the adoption of a Mediterranean version of ketogenic diets in order to benefit from the multiple protective effects of the MD. This translates to: (i) a preferential use of olive oil and vegetable fat sources in general; (ii) the limitation of foods rich in saturated fatty acids; (iii) the encouragement of high biological value protein sources; (iv) inserting fruit and vegetables at every meal possible, varying their choices according to seasonality.
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Affiliation(s)
- Cinzia Ferraris
- Ketogenic Metabolic Therapy Laboratory, Department of Public Health, Experimental and Forensics Medicine, University of Pavia, 27100 Pavia, Italy
- Laboratory of Food Education and Sport Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Monica Guglielmetti
- Ketogenic Metabolic Therapy Laboratory, Department of Public Health, Experimental and Forensics Medicine, University of Pavia, 27100 Pavia, Italy
- Laboratory of Food Education and Sport Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Lenycia de Cassya Lopes Neri
- Ketogenic Metabolic Therapy Laboratory, Department of Public Health, Experimental and Forensics Medicine, University of Pavia, 27100 Pavia, Italy
| | - Sabika Allehdan
- Department of Biology, College of Science, University of Bahrain, Sakhir P.O. Box 32038, Bahrain
| | | | | | - Claudia Trentani
- Ketogenic Metabolic Therapy Laboratory, Department of Public Health, Experimental and Forensics Medicine, University of Pavia, 27100 Pavia, Italy
| | - Simone Perna
- Division of Human Nutrition, Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, 20122 Milano, Italy
| | - Anna Tagliabue
- Ketogenic Metabolic Therapy Laboratory, Department of Public Health, Experimental and Forensics Medicine, University of Pavia, 27100 Pavia, Italy
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6
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Schmidt T, Harmon DM, Kludtke E, Mickow A, Simha V, Kopecky S. Dramatic elevation of LDL cholesterol from ketogenic-dieting: A Case Series. Am J Prev Cardiol 2023; 14:100495. [PMID: 37096158 PMCID: PMC10121782 DOI: 10.1016/j.ajpc.2023.100495] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/24/2023] [Accepted: 04/01/2023] [Indexed: 04/08/2023] Open
Abstract
High-fat, low carb dieting, also known as the "ketogenic diet," has increased in popularity as a rapid weight-loss tool. Previous studies describe a modest elevation in cholesterol in the average keto-diet participant without specific cardiovascular impact. We hypothesize that patients with a genetic predisposition to cholesterol metabolism dysregulation may have a disproportionate elevation in cholesterol in response to ketogenic dieting.
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7
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A Review of the Multi-Systemic Complications of a Ketogenic Diet in Children and Infants with Epilepsy. CHILDREN 2022; 9:children9091372. [PMID: 36138681 PMCID: PMC9498174 DOI: 10.3390/children9091372] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/08/2022] [Accepted: 09/08/2022] [Indexed: 11/23/2022]
Abstract
Ketogenic diets (KDs) are highly effective in the treatment of epilepsy. However, numerous complications have been reported. During the initiation phase of the diet, common side effects include vomiting, hypoglycemia, metabolic acidosis and refusal of the diet. While on the diet, the side effects involve the following systems: gastrointestinal, hepatic, cardiovascular, renal, dermatological, hematologic and bone. Many of the common side effects can be tackled easily with careful monitoring including blood counts, liver enzymes, renal function tests, urinalysis, vitamin levels, mineral levels, lipid profiles, and serum carnitine levels. Some rare and serious side effects reported in the literature include pancreatitis, protein-losing enteropathy, prolonged QT interval, cardiomyopathy and changes in the basal ganglia. These serious complications may need more advanced work-up and immediate cessation of the diet. With appropriate monitoring and close follow-up to minimize adverse effects, KDs can be effective for patients with intractable epilepsy.
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8
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Tahreem A, Rakha A, Rabail R, Nazir A, Socol CT, Maerescu CM, Aadil RM. Fad Diets: Facts and Fiction. Front Nutr 2022; 9:960922. [PMID: 35866077 PMCID: PMC9294402 DOI: 10.3389/fnut.2022.960922] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 06/20/2022] [Indexed: 12/11/2022] Open
Abstract
The global prevalence of obesity is alarmingly high and is impacting both developed and underdeveloped countries, beyond the borders of ethnicity, sex, and age. On the other hand, the global interest in dieting has increased, and people are obsessed with certain fad diets, assuming them as a magic bullet for their long-term problems. A fad diet is a popular dietary pattern known to be a quick fix for obesity. These diets are quite appealing due to the proposed claims, but the lack of scientific evidence is a big question mark. Such diets are often marketed with specific claims that defy the basic principles of biochemistry and nutritional adequacy. These diets may have protective effects against obesity and certain chronic diseases like cardiovascular diseases, metabolic syndrome, and certain cancers. Limited evidence exists to support the proposed claims; rather certain studies suggest the negative health consequences of long-term adherence to such dietary patterns. Many fad diets have emerged in the previous few decades. This review article will explore the current evidence related to the health impacts of some most popular diets: Atkins diet, ketogenic diet, Paleolithic diet, Mediterranean diet, vegetarian diet, intermittent fasting and detox diet.
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Affiliation(s)
- Aaiza Tahreem
- National Institute of Food Science and Technology, University of Agriculture, Faisalabad, Pakistan
| | - Allah Rakha
- National Institute of Food Science and Technology, University of Agriculture, Faisalabad, Pakistan
- *Correspondence: Allah Rakha,
| | - Roshina Rabail
- National Institute of Food Science and Technology, University of Agriculture, Faisalabad, Pakistan
| | - Aqsa Nazir
- National Institute of Food Science and Technology, University of Agriculture, Faisalabad, Pakistan
| | | | | | - Rana Muhammad Aadil
- National Institute of Food Science and Technology, University of Agriculture, Faisalabad, Pakistan
- Rana Muhammad Aadil,
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9
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Carroll JH, Martin-McGill KJ, Cross JH, Hickson M, Williams E, Aldridge V, Collinson A. Core outcome set development for childhood epilepsy treated with ketogenic diet therapy: Results of a scoping review and parent interviews. Seizure 2022; 99:54-67. [PMID: 35598573 DOI: 10.1016/j.seizure.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/23/2022] [Accepted: 05/10/2022] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Clinical trials on childhood epilepsy treated with ketogenic diet (KD) use a wide range of outcomes, however, patients and decision-makers often do not perceive the outcomes used as the most important. We sought parental opinion on outcomes of importance and compared these to outcomes reported in published research. METHODS Ethical approval (London-Surrey-REC19/LO/1680). A scoping review identified outcomes reported in previous studies of childhood epilepsy and KD. Parents were recruited from nine KD centres (UK), charities and social media (international), then interviewed (Jan-April 2020) to explore priority outcomes. Content analysis identified all outcomes in transcripts. Parent identified outcomes were compared with those in the scoping review. Outcomes were collated and grouped into domains according to the COMET Taxonomy. RESULTS Of 2663 articles;147 met inclusion criteria. 921 verbatim outcomes were sorted into 90 discrete outcomes, reduced to 70 in consultation with the study advisory group, then classified into 21 domains. Parents (n = 21) identified 39 outcomes as important from the scoping review and seven new outcomes. They prioritised both physiological and functional outcomes in contrast to past studies, which prioritised physiological outcomes. CONCLUSION Little consistency exists in the outcomes used in childhood epilepsy and KD research. Those traditionally used do not adequately reflect parents' important outcomes for their child. Clinical trials should consider the broader priorities of parents when choosing outcomes, in particular, functional outcomes. Identified outcomes will inform an international two-round Delphi-study with parent, professional and researcher participants to develop a core outcome set for this clinical area (COMET registration #1116).
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Affiliation(s)
| | | | - J Helen Cross
- Developmental Neurosciences, UCL, NIHR BRC Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Mary Hickson
- Faculty of Health, University of Plymouth, Devon, United Kingdom
| | - Emma Williams
- Matthew's Friends, Lingfield, Surrey, United Kingdom
| | - Val Aldridge
- Matthew's Friends, Lingfield, Surrey, United Kingdom
| | - Avril Collinson
- Faculty of Health, University of Plymouth, Devon, United Kingdom
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Pickel L, Iliuta IA, Scholey J, Pei Y, Sung HK. Dietary Interventions in Autosomal Dominant Polycystic Kidney Disease. Adv Nutr 2022; 13:652-666. [PMID: 34755831 PMCID: PMC8970828 DOI: 10.1093/advances/nmab131] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/12/2021] [Accepted: 11/02/2021] [Indexed: 12/22/2022] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is characterized by the progressive growth of renal cysts, leading to the loss of functional nephrons. Recommendations for individuals with ADPKD to maintain a healthy diet and lifestyle are largely similar to those for the general population. However, recent evidence from preclinical models suggests that more tightly specified dietary regimens, including caloric restriction, intermittent fasting, and ketogenic diets, hold promise to slow disease progression, and the results of ongoing human clinical trials are eagerly awaited. These dietary interventions directly influence nutrient signaling and substrate availability in the cystic kidney, while also conferring systemic metabolic benefits. The present review focuses on the importance of local and systemic metabolism in ADPKD and summarizes current evidence for dietary interventions to slow disease progression and improve quality of life.
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Affiliation(s)
- Lauren Pickel
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ioan-Andrei Iliuta
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - James Scholey
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - York Pei
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Hoon-Ki Sung
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
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11
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Yılmaz Ü, Edizer S, Köse M, Akışin Z, Güzin Y, Pekuz S, Kırkgöz HH, Yavuz M, Ünalp A. The effect of ketogenic diet on serum lipid concentrations in children with medication resistant epilepsy. Seizure 2021; 91:99-107. [PMID: 34147890 DOI: 10.1016/j.seizure.2021.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/26/2021] [Accepted: 06/06/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Ketogenic diet (KD) is a valuable treatment option for patients with medication-resistant epilepsy. It is associated with a number of side effects. However limited data are available for the long-term effects of KD on serum lipid levels. PURPOSE The aim of this study was to investigate the long-term effects of KD on serum lipid concentrations in children with medication-resistant epilepsy in daily clinical practice. METHOD A total of 73 children (40 girls) aged 3 to 193 months (median, 53 months) with medication-resistant epilepsy who received a KD treatment for at least 12 months between 2014 and 2019 years were enrolled in the study. All children were started on a KD with 3:1 ratio which was then adjusted between 2:1 to 4:1 after the onset of KD as clinically necessary. Serum total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride concentrations and body mass index-standard deviation scores (BMI-SDS) were measured at onset and at 1, 6 and 12 months of treatment, and also in 40 of these patients they were measured at 18 and 24 months of treatment. RESULTS Dyslipidemia was observed in 71.2, 63, 63, 50, and 52.5% of the patients, at 1, 6, 12, 18, and 24 months, respectively. Median total cholesterol and triglyceride concentrations increased significantly at month-1, and although these high levels persisted for 24 months, the increase did not continue and showed a downward trend. However, this increase did not occur in the subset of patients with pre-existing dyslipidemia. Compared to baseline values, total cholesterol and triglyceride concentrations were higher at all time points, except 24-month cholesterol values. During the 24-month treatment period, BMI-SDS increased and the number of antiepileptic drugs decreased significantly. CONCLUSION Total cholesterol and triglyceride concentrations appear to increase during the first month of KD treatment, and although these high values persist for 24 months, the increase does not continue, on the contrary, it approaches the normal values by drawing a downward trend. However, cholesterol and triglyceride concentrations do not increase in the subset of patients with pre-existing dyslipidemia.
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Affiliation(s)
- Ünsal Yılmaz
- University of Health Sciences Turkey, Izmir Faculty of Medicine, Department of Pediatrics, Izmir, Turkey; University of Health Sciences Turkey, Dr. Behçet Uz Children's Education and Research Hospital, Department of Pediatrics, Division of Pediatric Neurology, Izmir, Turkey.
| | - Selvinaz Edizer
- University of Health Sciences Turkey, Dr. Behçet Uz Children's Education and Research Hospital, Department of Pediatrics, Division of Pediatric Neurology, Izmir, Turkey
| | - Melis Köse
- Katip Çelebi University Medical Faculty, Department of Pediatrics, Division of Inborn Errors of Metabolism, Izmir, Turkey
| | - Zeynep Akışin
- University of Health Sciences Turkey, Dr. Behçet Uz Children's Education and Research Hospital, Department of Nutrition and Dietetics, Izmir, Turkey
| | - Yiğithan Güzin
- University of Health Sciences Turkey, Dr. Behçet Uz Children's Education and Research Hospital, Department of Pediatrics, Division of Pediatric Neurology, Izmir, Turkey
| | - Serdar Pekuz
- University of Health Sciences Turkey, Dr. Behçet Uz Children's Education and Research Hospital, Department of Pediatrics, Division of Pediatric Neurology, Izmir, Turkey
| | - Hatice Hilal Kırkgöz
- University of Health Sciences Turkey, Dr. Behçet Uz Children's Education and Research Hospital, Department of Pediatrics, Division of Pediatric Neurology, Izmir, Turkey
| | - Merve Yavuz
- University of Health Sciences Turkey, Dr. Behçet Uz Children's Education and Research Hospital, Department of Pediatrics, Division of Pediatric Neurology, Izmir, Turkey
| | - Aycan Ünalp
- University of Health Sciences Turkey, Izmir Faculty of Medicine, Department of Pediatrics, Izmir, Turkey; University of Health Sciences Turkey, Dr. Behçet Uz Children's Education and Research Hospital, Department of Pediatrics, Division of Pediatric Neurology, Izmir, Turkey
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12
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Rydin AA, Spiegel G, Frohnert BI, Kaess A, Oswald L, Owen D, Simmons KM. Medical management of children with type 1 diabetes on low-carbohydrate or ketogenic diets. Pediatr Diabetes 2021; 22:448-454. [PMID: 33470021 PMCID: PMC10038004 DOI: 10.1111/pedi.13179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 10/21/2020] [Accepted: 12/15/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Low-carbohydrate and ketogenic diets are becoming increasingly popular choices for people with type 1 diabetes (T1D) aiming to achieve optimal glycemic control. A carbohydrate-restricted diet in children has been associated with negative health effects including poor linear growth and inadequate bone mineralization. Guidelines for monitoring children and adolescents choosing to follow a carbohydrate-restricted diet do not exist. We aimed to create a clinical protocol outlining how to clinically and biochemically follow patients choosing a carbohydrate-restricted diet with the goal of medical safety. METHODS An interdisciplinary committee was formed and reviewed current consensus guidelines for pediatric patients on carbohydrate-restricted diets for epilepsy and metabolic disorders. A literature search was done to determine management strategies for children with T1D on a low-carbohydrate or ketogenic diet. Key health parameters that require monitoring were identified: growth, glycemic control, bone health, cardiometabolic health, and nutritional status. These health outcomes were used to develop a protocol for monitoring children on carbohydrate-restricted diets. RESULTS A one-page protocol for medical providers and educational materials for families interested in following a low-carbohydrate or ketogenic diet were developed and successfully implemented into clinical care. CONCLUSION Implementing a protocol for children on carbohydrate-restricted diets in clinic allows medical providers to ensure medical safety while being open to discussing a family's dietary preferences. Following children in the protocol over time will lead to informed clinical guidelines for patients with T1D who choose to follow a carbohydrate-restricted diet.
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Affiliation(s)
- Amy A Rydin
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Gail Spiegel
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Brigitte I Frohnert
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Anne Kaess
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Lauren Oswald
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Darcy Owen
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kimber M Simmons
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
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13
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Zhang W, Guo X, Chen L, Chen T, Yu J, Wu C, Zheng J. Ketogenic Diets and Cardio-Metabolic Diseases. Front Endocrinol (Lausanne) 2021; 12:753039. [PMID: 34795641 PMCID: PMC8594484 DOI: 10.3389/fendo.2021.753039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/13/2021] [Indexed: 12/31/2022] Open
Abstract
While the prevalence of cardio-metabolic diseases (CMDs) has become a worldwide epidemic, much attention is paid to managing CMDs effectively. A ketogenic diet (KD) constitutes a high-fat and low-carbohydrate diet with appropriate protein content and calories. KD has drawn the interests of clinicians and scientists regarding its application in the management of metabolic diseases and related disorders; thus, the current review aimed to examine the evidences surrounding KD and the CMDs to draw the clinical implications. Overall, KD appears to play a significant role in the therapy of various CMDs, which is manifested by the effects of KDs on cardio-metabolic outcomes. KD therapy is generally promising in obesity, heart failure, and hypertension, though different voices still exist. In diabetes and dyslipidemia, the performance of KD remains controversial. As for cardiovascular complications of metabolic diseases, current evidence suggests that KD is generally protective to obese related cardiovascular disease (CVD), while remaining contradictory to diabetes and other metabolic disorder related CVDs. Various factors might account for the controversies, including genetic background, duration of therapy, food composition, quality, and sources of KDs. Therefore, it's crucial to perform more rigorous researches to focus on clinical safety and appropriate treatment duration and plan of KDs.
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Affiliation(s)
- Weiyue Zhang
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Xin Guo
- Department of Nutrition and Food Hygiene, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Lulu Chen
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Ting Chen
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Jiayu Yu
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Chaodong Wu
- Department of Nutrition, Texas A&M University, College Station, TX, United States
- *Correspondence: Juan Zheng, ; Chaodong Wu,
| | - Juan Zheng
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
- *Correspondence: Juan Zheng, ; Chaodong Wu,
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14
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Goldberg IJ, Ibrahim N, Bredefeld C, Foo S, Lim V, Gutman D, Huggins LA, Hegele RA. Ketogenic diets, not for everyone. J Clin Lipidol 2021; 15:61-67. [PMID: 33191194 PMCID: PMC7887024 DOI: 10.1016/j.jacl.2020.10.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND The adoption of low-carbohydrate diets can lead to weight loss in many patients. However, these now widespread diets also have the potential to exacerbate hypercholesterolemia. OBJECTIVE The objective of this study is to display the potentially harmful effects of the ketogenic diet on cholesterol levels in patients with or without underlying hyperlipidemia. METHODS We describe 5 patients who developed marked increases in plasma cholesterol on ketogenic diets and assessed whether they had a well-described underlying genetic hyperlipidemia. RESULTS Three out of 5 patients had extraordinary increases of blood cholesterol levels to over 500 mg/dL. The other 2 patients more than doubled their low-density lipoprotein cholesterol levels on a ketogenic diet. One patient had an APOE E2/E2 genotype. A higher burden of common genetic polymorphisms was found in 2 patients, with no major mutations found. No potential genetic cause was seen in a fourth patient, and the fifth patient had no genetic testing. Three patients, including the one who was most hypercholesterolemic, had a marked reduction in cholesterol after reverting to a more liberal diet. One refused to change his diet but had a satisfactory low-density lipoprotein cholesterol reduction on ezetimibe. CONCLUSION These cases should serve as a caution that high-fat low-carbohydrate diets have the potential to exacerbate or cause hypercholesterolemia in patients with or without underlying genetic hyperlipidemia.
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Affiliation(s)
- Ira J Goldberg
- Division of Endocrinology, Diabetes and Metabolism, NYU Langone Medical Center, New York, NY, USA.
| | - Nouran Ibrahim
- Division of Endocrinology, Diabetes and Metabolism, NYU Langone Medical Center, New York, NY, USA
| | - Cindy Bredefeld
- Winthrop Endocrinology, Diabetes and Metabolism, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Sandra Foo
- Division of Endocrinology, Diabetes and Metabolism, NYU Langone Medical Center, New York, NY, USA
| | - Vivien Lim
- Queens Cardiovascular and Division of Cardiology, Long Island Jewish Hospital, Flushing, NY, USA
| | - Deborah Gutman
- Department of Emergency Medicine, Warren Alpert School of Medicine, Providence, RI, USA
| | - Lesley-Ann Huggins
- Division of Endocrinology, Diabetes and Metabolism, NYU Langone Medical Center, New York, NY, USA
| | - Robert A Hegele
- Departments of Medicine and Biochemistry, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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15
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Neves GS, Lunardi MS, Lin K, Rieger DK, Ribeiro LC, Moreira JD. Ketogenic diet, seizure control, and cardiometabolic risk in adult patients with pharmacoresistant epilepsy: a review. Nutr Rev 2020; 79:931-944. [PMID: 33230563 DOI: 10.1093/nutrit/nuaa112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Pharmacoresistant epilepsy causes serious deleterious effects on the patient's health and quality of life. For this condition, a ketogenic diet (KD) is a treatment option. The KD is a general term for a set of diets that contain high amounts of fat and low content of carbohydrates. The most prominent KD treatments are classical KD (4:1 ratio of fat to carbohydrate), modified Atkins diet (2:1 to 1:1 ratio), medium-chain triglycerides KD (with medium-chain triglyceride as a part of the fat content), and low glycemic index KD (using low glycemic carbohydrates). KD has been widely prescribed for children with epilepsy but not for adult patients. One of the main concerns about adult use of KD is its cardiovascular risk associated with high-fat and cholesterol intake. Therefore, this narrative review provides comprehensive information of the current literature on the effects of KD on lipid profile, glycemic-control biomarkers, and other cardiometabolic risk factors in adult patients with pharmacoresistant epilepsy.
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Affiliation(s)
- Gabriela S Neves
- Postgraduate Program in Nutrition, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.,Translational Nutrition Neuroscience Working Group, CNPq Directory of Research Groups, Florianópolis, Santa Catarina, Brazil
| | - Mariana S Lunardi
- Postgraduate Program in Medical Sciences, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.,Translational Nutrition Neuroscience Working Group, CNPq Directory of Research Groups, Florianópolis, Santa Catarina, Brazil
| | - Katia Lin
- Postgraduate Program in Medical Sciences, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Débora Kurrle Rieger
- Postgraduate Program in Nutrition, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.,Department of Nutrition, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.,Translational Nutrition Neuroscience Working Group, CNPq Directory of Research Groups, Florianópolis, Santa Catarina, Brazil
| | - Letícia C Ribeiro
- Department of Nutrition, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.,Translational Nutrition Neuroscience Working Group, CNPq Directory of Research Groups, Florianópolis, Santa Catarina, Brazil
| | - Júlia D Moreira
- Postgraduate Program in Nutrition, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.,Department of Nutrition, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.,Translational Nutrition Neuroscience Working Group, CNPq Directory of Research Groups, Florianópolis, Santa Catarina, Brazil
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16
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Diet in the Treatment of Epilepsy: What We Know So Far. Nutrients 2020; 12:nu12092645. [PMID: 32872661 PMCID: PMC7551815 DOI: 10.3390/nu12092645] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 08/26/2020] [Accepted: 08/28/2020] [Indexed: 02/07/2023] Open
Abstract
Epilepsy is a chronic and debilitating neurological disorder, with a worldwide prevalence of 0.5–1% and a lifetime incidence of 1–3%. An estimated 30% of epileptic patients continue to experience seizures throughout life, despite adequate drug therapy or surgery, with a major impact on society and global health. In recent decades, dietary regimens have been used effectively in the treatment of drug-resistant epilepsy, following the path of a non-pharmacological approach. The ketogenic diet and its variants (e.g., the modified Atkins diet) have an established role in contrasting epileptogenesis through the production of a series of cascading events induced by physiological ketosis. Other dietary regimens, such as caloric restriction and a gluten free diet, can also exert beneficial effects on neuroprotection and, therefore, on refractory epilepsy. The purpose of this review was to analyze the evidence from the literature about the possible efficacy of different dietary regimens on epilepsy, focusing on the underlying pathophysiological mechanisms, safety, and tolerability both in pediatric and adult population. We believe that a better knowledge of the cellular and molecular biochemical processes behind the anticonvulsant effects of alimentary therapies may lead to the development of personalized dietary intervention protocols.
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17
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Therapeutic Use of the Ketogenic Diet in Refractory Epilepsy: What We Know and What Still Needs to Be Learned. Nutrients 2020; 12:nu12092616. [PMID: 32867258 PMCID: PMC7551948 DOI: 10.3390/nu12092616] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 01/22/2023] Open
Abstract
Ketogenic diet (KD) has been used to treat epilepsy for 100 years. It is a high-fat, low-carbohydrate, and sufficient-protein-for-growth diet that mimics the metabolic changes occurring during starvation. Except for classic KD, its modified counterparts, including modified Atkins diet and low-glycemic-index treatment, have gained grounds to increase palatability and adherence. Strong evidence exists that the KD offers protection against seizures in difficult-to-treat epilepsy and possesses long-lasting anti-epileptic activity, improving long-term disease outcome. The KD can also provide symptomatic and disease-modifying activity in a wide range of neurodegenerative diseases. In an era of highly available new anti-seizure medications (ASMs), the challenge of refractory epilepsy has still not been solved. This metabolic therapy is increasingly considered due to unique mechanisms and turns out to be a powerful tool in the hands of a skillful team. Despite decades of extensive research to explain the mechanism of its efficacy, the precise mechanism of action is to date still largely unknown. The key feature of this successful diet is the fact that energy is derived largely from fat but not from carbohydrates. Consequently, fundamental change occurs regarding the method of energy production that causes alterations in numerous biochemical pathways, thus restoring energetic and metabolic homeostasis of the brain. There are barriers during the use of this special and individualized therapy in many clinical settings worldwide. The aim of this review is to revisit the current state of the art of therapeutic application of KD in refractory epilepsy.
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18
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Arora N, Mehta TR. Role of the ketogenic diet in acute neurological diseases. Clin Neurol Neurosurg 2020; 192:105727. [DOI: 10.1016/j.clineuro.2020.105727] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 01/14/2020] [Accepted: 02/06/2020] [Indexed: 12/31/2022]
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19
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Morris G, Puri BK, Carvalho A, Maes M, Berk M, Ruusunen A, Olive L. Induced Ketosis as a Treatment for Neuroprogressive Disorders: Food for Thought? Int J Neuropsychopharmacol 2020; 23:366-384. [PMID: 32034911 PMCID: PMC7311648 DOI: 10.1093/ijnp/pyaa008] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 01/05/2020] [Accepted: 02/06/2020] [Indexed: 12/12/2022] Open
Abstract
Induced ketosis (or ketone body ingestion) can ameliorate several changes associated with neuroprogressive disorders, including schizophrenia, bipolar disorder, and major depressive disorder. Thus, the effects of glucose hypometabolism can be bypassed through the entry of beta-hydroxybutyrate, providing an alternative source of energy to glucose. The weight of evidence suggests that induced ketosis reduces levels of oxidative stress, mitochondrial dysfunction, and inflammation-core features of the above disorders. There are also data to suggest that induced ketosis may be able to target other molecules and signaling pathways whose levels and/or activity are also known to be abnormal in at least some patients suffering from these illnesses such as peroxisome proliferator-activated receptors, increased activity of the Kelch-like ECH-associated protein/nuclear factor erythroid 2-related factor 2, Sirtuin-1 nuclear factor-κB p65, and nicotinamide adenine dinucleotide (NAD). This review explains the mechanisms by which induced ketosis might reduce mitochondrial dysfunction, inflammation, and oxidative stress in neuropsychiatric disorders and ameliorate abnormal levels of molecules and signaling pathways that also appear to contribute to the pathophysiology of these illnesses. This review also examines safety data relating to induced ketosis over the long term and discusses the design of future studies.
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Affiliation(s)
- Gerwyn Morris
- The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Australia
| | - Basant K Puri
- C.A.R., Cambridge, United Kingdom,Hammersmith Hospital, London, United Kingdom
| | - Andre Carvalho
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Michael Maes
- Department of Psychiatry and Medical Psychology, Medical Faculty, Medical University of Plovdiv, Plovdiv, Bulgaria,Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Michael Berk
- The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Australia,Orygen, The National Centre of Excellence in Youth Mental Health, the Department of Psychiatry, and the Florey Institute for Neuroscience and Mental Health, University of Melbourne, Australia,Correspondence: Michael Berk, PO Box 281 Geelong, Victoria 3220 Australia ()
| | - Anu Ruusunen
- The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Australia
| | - Lisa Olive
- The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Australia
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20
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de Souza Neves G, dos Santos Lunardi M, Papini Gabiatti M, Kurrle Rieger Venske D, Ribeiro LC, Lin K, Dubois Moreira J. Cardiometabolic risk and effectiveness of the modified Atkins Ketogenic Diet for adult patients with pharmacoresistant epilepsies in a middle-income country. Epilepsy Res 2020; 160:106280. [DOI: 10.1016/j.eplepsyres.2020.106280] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/07/2020] [Accepted: 01/16/2020] [Indexed: 12/14/2022]
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21
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Assessment of micronutrients in a 12-wk ketogenic diet in obese adults. Nutrition 2019; 67-68:110522. [DOI: 10.1016/j.nut.2019.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/05/2019] [Accepted: 06/08/2019] [Indexed: 12/14/2022]
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22
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Testa F, Marchiò M, Belli M, Giovanella S, Ligabue G, Cappelli G, Biagini G, Magistroni R. A pilot study to evaluate tolerability and safety of a modified Atkins diet in ADPKD patients. PHARMANUTRITION 2019. [DOI: 10.1016/j.phanu.2019.100154] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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23
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Kossoff EH, Zupec-Kania BA, Auvin S, Ballaban-Gil KR, Christina Bergqvist AG, Blackford R, Buchhalter JR, Caraballo RH, Cross JH, Dahlin MG, Donner EJ, Guzel O, Jehle RS, Klepper J, Kang HC, Lambrechts DA, Liu YMC, Nathan JK, Nordli DR, Pfeifer HH, Rho JM, Scheffer IE, Sharma S, Stafstrom CE, Thiele EA, Turner Z, Vaccarezza MM, van der Louw EJTM, Veggiotti P, Wheless JW, Wirrell EC. Optimal clinical management of children receiving dietary therapies for epilepsy: Updated recommendations of the International Ketogenic Diet Study Group. Epilepsia Open 2018; 3:175-192. [PMID: 29881797 PMCID: PMC5983110 DOI: 10.1002/epi4.12225] [Citation(s) in RCA: 357] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2018] [Indexed: 12/14/2022] Open
Abstract
Ketogenic dietary therapies (KDTs) are established, effective nonpharmacologic treatments for intractable childhood epilepsy. For many years KDTs were implemented differently throughout the world due to lack of consistent protocols. In 2009, an expert consensus guideline for the management of children on KDT was published, focusing on topics of patient selection, pre‐KDT counseling and evaluation, diet choice and attributes, implementation, supplementation, follow‐up, side events, and KDT discontinuation. It has been helpful in outlining a state‐of‐the‐art protocol, standardizing KDT for multicenter clinical trials, and identifying areas of controversy and uncertainty for future research. Now one decade later, the organizers and authors of this guideline present a revised version with additional authors, in order to include recent research, especially regarding other dietary treatments, clarifying indications for use, side effects during initiation and ongoing use, value of supplements, and methods of KDT discontinuation. In addition, authors completed a survey of their institution's practices, which was compared to responses from the original consensus survey, to show trends in management over the last 10 years.
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Affiliation(s)
- Eric H Kossoff
- Departments of Neurology and Pediatrics Johns Hopkins Outpatient Center Baltimore Maryland U.S.A
| | | | - Stéphane Auvin
- Department of Pediatric Neurology CHU Hôpital Robert Debré Paris France
| | - Karen R Ballaban-Gil
- Department of Neurology and Pediatrics Montefiore Medical Center/Albert Einstein College of Medicine Bronx New York U.S.A
| | - A G Christina Bergqvist
- Department of Neurology The Childrens Hospital of Philadelphia Philadelphia Pennsylvania U.S.A
| | - Robyn Blackford
- Department of Nutrition Lurie Children's Hospital Chicago Illinois U.S.A
| | | | - Roberto H Caraballo
- Department of Neurology Hospital J P Garrahan, Capital Federal Buenos Aires Argentina
| | - J Helen Cross
- Department of Clinical & Experimental Epilepsy Great Ormond Street Hospital University College London London United Kingdom
| | - Maria G Dahlin
- Department of Clinical Neuroscience, Women's and Children's Health Karolinska Institute Stockholm Sweden
| | - Elizabeth J Donner
- Division of Neurology The Hospital for Sick Children Toronto Ontario Canada
| | - Orkide Guzel
- Department of Pediatric Neurology Izmir Dr. Behcet Uz Children's Hospital Izmir Turkey
| | - Rana S Jehle
- Department of Neurology Montefiore Medical Center Bronx New York U.S.A
| | - Joerg Klepper
- Department of Pediatrics and Neuropediatrics Children's Hospital Aschaffenburg Aschaffenburg Germany
| | - Hoon-Chul Kang
- Department of Pediatrics Pediatric Epilepsy Clinic Severance Children's Hospital Seoul Korea
| | | | - Y M Christiana Liu
- Department of Neurology The Hospital for Sick Children Toronto Ontario Canada
| | - Janak K Nathan
- Department of Child Neurology Shushrusha Hospital Mumbai India
| | - Douglas R Nordli
- Department of Neurology Children's Hospital of Los Angeles Los Angeles California U.S.A
| | - Heidi H Pfeifer
- Department of Neurology Massachusetts General Hospital Boston Massachusetts U.S.A
| | - Jong M Rho
- Department of Paediatrics Alberta Children's Hospital Calgary Alberta Canada
| | - Ingrid E Scheffer
- Epilepsy Research Centre The University of Melbourne Austin Health Heidelberg Victoria Australia
| | - Suvasini Sharma
- Department of Pediatrics Lady Hardinge Medical College New Delhi India
| | - Carl E Stafstrom
- Departments of Pediatrics and Neurology Johns Hopkins Hospital Baltimore Maryland U.S.A
| | - Elizabeth A Thiele
- Department of Neurology Massachusetts General Hospital Boston Massachusetts U.S.A
| | - Zahava Turner
- Department of Pediatrics The Johns Hopkins University Baltimore Maryland U.S.A
| | - Maria M Vaccarezza
- Department of Neurology Hospital Italiano de Buenos Aires Buenos Aires Argentina
| | - Elles J T M van der Louw
- Department of Dietetics Sophia Children's Hospital Erasmus Medical Centre Rotterdam The Netherlands
| | - Pierangelo Veggiotti
- Infantile Neuropsychiatry Neurological Institute Foundation Casimiro Mondino Pavia Italy
| | - James W Wheless
- Department of Pediatric Neurology University of Tennessee Memphis Tennessee U.S.A
| | - Elaine C Wirrell
- Department of Neurology, Child and Adolescent Neurology Mayo Clinic Rochester Minnesota U.S.A
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Meroni E, Papini N, Criscuoli F, Casiraghi MC, Massaccesi L, Basilico N, Erba D. Metabolic Responses in Endothelial Cells Following Exposure to Ketone Bodies. Nutrients 2018; 10:E250. [PMID: 29470430 PMCID: PMC5852826 DOI: 10.3390/nu10020250] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/09/2018] [Accepted: 02/14/2018] [Indexed: 12/17/2022] Open
Abstract
The ketogenic diet (KD) is a high-fat, low-carbohydrate diet based on the induction of the synthesis of ketone bodies (KB). Despite its widespread use, the systemic impact of KD is not completely understood. The purpose of this study was to evaluate the effects of physiological levels of KB on HMEC-1 endothelial cells. To this aim, DNA oxidative damage and the activation of Nrf2, a known transcriptional factor involved in cell responses to oxidative stress, were assessed. The exposure of cells to KB exerted a moderate genotoxic effect, measured by a significant increase in DNA oxidative damage. However, cells pre-treated with KB for 48 h and subjected to a secondary oxidative insult (H₂O₂), significantly decreased DNA damage compared to control oxidized cells. This protection occurred by the activation of Nrf2 pathway. In KB-treated cells, we found increased levels of Nrf2 in nuclear extracts and higher gene expression of HO-1, a target gene of Nrf2, compared to control cells. These results suggest that KB, by inducing moderate oxidative stress, activate the transcription factor Nrf2, which induces the transcription of target genes involved in the cellular antioxidant defense system.
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Affiliation(s)
- Erika Meroni
- Human Nutrition Unit, Department of Food, Environmental and Nutritional Sciences DeFENS, Università degli Studi di Milano, Via Celoria, 2, 20133 Milan, Italy.
| | - Nadia Papini
- Department of Medical Biotechnology and Translational Medicine, L.I.T.A., Università degli Studi di Milano, Via F.lli Cervi, 93, 20090 Segrate, Milan, Italy.
| | - Franca Criscuoli
- Human Nutrition Unit, Department of Food, Environmental and Nutritional Sciences DeFENS, Università degli Studi di Milano, Via Celoria, 2, 20133 Milan, Italy.
| | - Maria C Casiraghi
- Human Nutrition Unit, Department of Food, Environmental and Nutritional Sciences DeFENS, Università degli Studi di Milano, Via Celoria, 2, 20133 Milan, Italy.
| | - Luca Massaccesi
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Via Saldini, 50, 20133 Milan, Italy.
| | - Nicoletta Basilico
- Department of Biomedical Sciences, Surgical and Dental Sciences, Università degli Studi di Milano, Via C. Pascal, 36, 20133 Milan, Italy.
| | - Daniela Erba
- Human Nutrition Unit, Department of Food, Environmental and Nutritional Sciences DeFENS, Università degli Studi di Milano, Via Celoria, 2, 20133 Milan, Italy.
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25
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Safety and tolerability of the ketogenic diet used for the treatment of refractory childhood epilepsy: a systematic review of published prospective studies. World J Pediatr 2017; 13:528-536. [PMID: 28702868 DOI: 10.1007/s12519-017-0053-2] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 03/03/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND To review the available evidence from prospective studies on the safety and tolerability of the ketogenic diet (KD) for the treatment of refractory childhood epilepsy. METHODS A comprehensive bibliographic search was performed with the aim of retrieving prospective studies that monitored adverse effects (AEs) in children after receiving the classic or medium-chain triglyceride KD therapy for refractory epilepsy. RESULTS A total of 45 studies were retrieved, including 7 randomized controlled trials. More than 40 categories of AEs were reported. The most common AEs included gastrointestinal disturbances (40.6%), hyperlipidemia (12.8%), hyperuricemia (4.4%), lethargy (4.1%), infectious diseases (3.8%) and hypoproteinemia (3.8%). Severe AEs, such as respiratory failure and pancreatitis, occurred in no more than 0.5% of children. Specifically, patients receiving KD therapy should be monitored for osteopenia, urological stones, right ventricular diastolic dysfunction, and growth disturbance. The total retention rates of the diet for 1 year and 2 years were 45.7% and 29.2%, respectively. Nearly half of the patients discontinued the diet because of lack of efficacy. AEs were not the main reason for the KD discontinuation. None of the 24 deaths reported after initiation of the diet was attributed to the KD. CONCLUSIONS KD is a relatively safe dietary therapy. However, because the KD can cause various AEs, it should be implemented under careful medical supervision. Continuous follow-up is needed to address the long-term impact of the diet on the overall health of children.
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10 patients, 10 years - Long term follow-up of cardiovascular risk factors in Glut1 deficiency treated with ketogenic diet therapies: A prospective, multicenter case series. Clin Nutr 2017; 37:2246-2251. [PMID: 29199027 DOI: 10.1016/j.clnu.2017.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/05/2017] [Accepted: 11/07/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS Glut1 Deficiency (Glut1D) is caused by impaired glucose transport into brain. The resulting epileptic encephalopathy and movement disorders can be treated effectively by high-fat carbohydrate-restricted ketogenic diet therapies (KDT) mimicking fasting and providing ketones as an alternative cerebral fuel. Recently 6-24 months follow-ups of epileptic patients reported elevated blood lipids and intima thickening of the carotid artery raising concerns about potential cardiovascular risks by KDT. To clarify potential cardiovascular risks we performed a prospective 10 year follow up of 10 Glut1D patients. METHODS Between August 2001 and January 2016 we enrolled Glut1D patients on KDT at two hospitals in Germany in this prospective, multicenter case series. The minimal follow up was 10 years. Standard deviation scores (SDS) of body mass index (BMI), total cholesterol (TC), HDL-/LDL cholesterol, and triglycerides (TG) before initiation of KDT were compared with respective values at 6 months, 2, 5 years, and 10 years after initiation. After 10 years on KDT cardiovascular risk, assessed by BMI, carotid intima-media thickness (CIMT) measurement, and blood pressure, was compared to a healthy reference population (n = 550). RESULTS Baseline and 10 year follow-up investigations were available for 10 individuals with Glut1D on KDT. After two years on KDT BMI increased significantly, while total cholesterol, HDL-cholesterol, and LDL-cholesterol decreased. Within 3-5 years on KDT these differences disappeared, and after 10 years blood lipid parameters reflected the situation at initiation of KDT. Prior to KDT one child had dyslipidaemia, but no child after 10 years on KDT. No significant differences were observed with respect to BMI SDS (p = 0.26), CIMT (p = 0.63) or systolic and diastolic blood pressure (SDS p = 0.11 and p = 0.37, respectively) in Glut1D children treated with KDT for at least 10 years compared to healthy controls. CONCLUSIONS In contrast to previous short-term reports on adverse effects of KDT, 10-year follow-up did not identify cardiovascular risks of dietary treatment for Glut1D.
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Rezaei S, Abdurahman AA, Saghazadeh A, Badv RS, Mahmoudi M. Short-term and long-term efficacy of classical ketogenic diet and modified Atkins diet in children and adolescents with epilepsy: A systematic review and meta-analysis. Nutr Neurosci 2017; 22:317-334. [PMID: 29069983 DOI: 10.1080/1028415x.2017.1387721] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Classical ketogenic diet (KD) and modified Atkins diet (MAD) are two types of KD commonly used for the treatment of intractable epilepsy throughout the world. Studies have shown the efficacy of these diets. However, no systematic review and meta-analysis study has to date compared the efficacy of KD and MAD in a time trend. Therefore, the objectives of the present study were to compare the short-term and long-term efficacy of classical KD and MAD in children and adolescents with epilepsy and to determine the efficacy of classical KD and MAD at multiple time points and in a time trend. METHODS Main electronic literature databases, including MEDLINE/PubMed, Web of Science, Scopus, and EMBASE, were searched in November 2016. Rate difference and random effects model were used to compare the efficacy of the classical KD and MAD. RESULTS Overall, 70 studies were eligible for inclusion. Meta-analysis revealed a non-significant trend toward a higher efficacy of MAD at month-3 and month-6 (P > 0.05). In the classical KD group, the percentage of responder patients achieving ≥50% seizure reduction was 62, 60, 52, 42, and 46% at month-1, 3, 6, 12 and 24 and for the MAD group was 55, 47, 42, and 29% at month-1, 3, 6, and 12, respectively. DISCUSSION Classical KD does not differ substantially from MAD in ≥50% and ≥90% reduction of seizure frequency at month-3 and month-6. Overall, the number of patients achieving seizure freedom increases over time.
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Affiliation(s)
- Shahabeddin Rezaei
- a Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics , Tehran University of Medical Sciences , Tehran , Iran.,b Students' Scientific Research Center , Tehran University of Medical Sciences , Tehran , Iran
| | - Ahmed Abdulahi Abdurahman
- c Department of Community Nutrition, School of Nutritional Sciences and Dietetics , Tehran University of Medical Sciences International Campus (TUMS-IC) , Tehran , Iran
| | - Amene Saghazadeh
- d Molecular Immunology Research Center, Department of Immunology, School of Medicine , Tehran University of Medical Sciences , Tehran , Iran.,e Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN) , Tehran , Iran
| | - Reza Shervin Badv
- f Paediatrics Centre of Excellence, Department of Paediatric Neurology , Children's Medical Centre, Tehran University of Medical Sciences , Tehran , Iran
| | - Maryam Mahmoudi
- a Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics , Tehran University of Medical Sciences , Tehran , Iran.,g Pediatric Gastroenterology and Hepatology Research Center, Children's Medical Center , Tehran University of Medical Sciences , Tehran , Iran.,h Dietitians and Nutrition Experts Team (DiNET), Universal Scientific Education and Research Network (USERN) , Tehran , Iran
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Practice Paper of the Academy of Nutrition and Dietetics: Classic and Modified Ketogenic Diets for Treatment of Epilepsy. J Acad Nutr Diet 2017; 117:1279-1292. [DOI: 10.1016/j.jand.2017.06.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Indexed: 12/19/2022]
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Treatment issues for children with epilepsy transitioning to adult care. Epilepsy Behav 2017; 69:153-160. [PMID: 28188045 DOI: 10.1016/j.yebeh.2016.11.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 11/06/2016] [Indexed: 12/22/2022]
Abstract
This is the third of three papers that summarize the second symposium on Transition in Epilepsies held in Paris in June 2016. This paper focuses on treatment issues that arise during the course of childhood epilepsy and make the process of transition to adult care more complicated. Some AEDs used during childhood, such as stiripentol, vigabatrin, and cannabidiol, are unfamiliar to adult epilepsy specialists. In addition, new drugs are being developed for treatment of specific childhood onset epilepsy syndromes and have no indication yet for adults. The ketogenic diet may be effective during childhood but is difficult to continue in adult care. Regional adult epilepsy diet clinics could be helpful. Polytherapy is common for patients transitioning to adult care. Although these complex AED regimes are difficult, they are often possible to simplify. AEDs used in childhood may need to be reconsidered in adulthood. Rescue medications to stop prolonged seizures and clusters of seizures are in wide home use in children and can be continued in adulthood. Adherence/compliance is notoriously difficult for adolescents, but there are simple clinical approaches that should be helpful. Mental health issues including depression and anxiety are not always diagnosed and treated in children and young adults even though effective treatments are available. Attention deficit hyperactivity disorder and aggressive behavior disorders may interfere with transition and successful adulthood but these can be treated. For the majority, the adult social outcome of children with epilepsy is unsatisfactory with few proven interventions. The interface between pediatric and adult care for children with epilepsy is becoming increasingly complicated with a need for more comprehensive transition programs and adult epileptologists who are knowledgeable about special treatments that benefit this group of patients.
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Effect of classic ketogenic diet treatment on lipoprotein subfractions in children and adolescents with refractory epilepsy. Nutrition 2017; 33:271-277. [DOI: 10.1016/j.nut.2016.06.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 06/01/2016] [Accepted: 06/24/2016] [Indexed: 01/01/2023]
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The effects of classic ketogenic diet on serum lipid profile in children with refractory seizures. Acta Neurol Belg 2016; 116:529-534. [PMID: 26791878 DOI: 10.1007/s13760-016-0601-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 01/09/2016] [Indexed: 10/22/2022]
Abstract
More than 25 % of children with epilepsy develop refractory seizures unresponsive to both old and new generation anticonvulsants. Since such seizures have a serious negative impact on the quality of life, other treatment options are considered. The ketogenic diet is a well-known treatment for managing refractory seizures, although its mechanism of action is unknown. Studies have shown that this diet is as good as, or better than, any of the newer medications in reducing seizure frequency. However, concerns about adverse effects have been raised. We conducted an open label trial to show the effects of this diet on serum lipid profile. Thirty-three children with refractory epilepsy were treated with the ketogenic diet and were followed for 6 months. Their serum lipid profile was assessed at baseline, and at 3 and 6 months after initiating the diet. Seizure frequency was reduced in 63 % of children (no seizures in 2/33 and reduced >50 % in 19/33). However, after 6 months of administering the diet, median triglyceride was significantly increased (from 84 to 180 mg/dl, P < 0.001), median total cholesterol was significantly increased (from 180 to 285 mg/dl, P < 0.001), median serum low-density lipoprotein (LDL) was significantly increased (from 91 to 175 mg/dl, P < 0.001), and median serum high-density lipoprotein (HDL) was significantly increased (from 51 to 58 mg/dl, P < 0.001). Results of this study indicate that a classic ketogenic diet in children with refractory seizures is effective in seizure reduction, but leads to development of hypercholesterolemia and hypertriglyceridemia.
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van der Louw E, van den Hurk D, Neal E, Leiendecker B, Fitzsimmon G, Dority L, Thompson L, Marchió M, Dudzińska M, Dressler A, Klepper J, Auvin S, Cross JH. Ketogenic diet guidelines for infants with refractory epilepsy. Eur J Paediatr Neurol 2016; 20:798-809. [PMID: 27470655 DOI: 10.1016/j.ejpn.2016.07.009] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 07/05/2016] [Accepted: 07/11/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND The ketogenic diet (KD) is an established, effective non-pharmacologic treatment for drug resistant childhood epilepsy. For a long time, the KD was not recommended for use in infancy (under the age of 2 years) because this is such a crucial period in development and the perceived high risk of nutritional inadequacies. Indeed, infants are a vulnerable population with specific nutritional requirements. But current research shows that the KD is highly effective and well tolerated in infants with epilepsy. Seizure freedom is often achieved and maintained in this specific patient group. There is a need for standardised protocols and management recommendations for clinical use. METHOD In April 2015, a project group of 5 experts was established in order to create a consensus statement regarding the clinical management of the KD in infants. The manuscript was reviewed and amended by a larger group of 10 international experts in the KD field. Consensus was reached with regard to guidance on how the diet should be administered and in whom. RESULTS The resulting recommendations include patient selection, pre-KD counseling and evaluation, specific nutritional requirements, preferred initiation, monitoring of adverse effects at initiation and follow-up, evaluation and KD discontinuation. CONCLUSION This paper highlights recommendations based on best evidence, combined with expert opinions and gives directions for future research.
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Affiliation(s)
- Elles van der Louw
- Erasmus Medical Center Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.
| | - Dorine van den Hurk
- Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands.
| | | | | | | | | | | | | | | | | | | | - Stéphane Auvin
- Pediatric Epilepsy & Child Neurology Paris-Diderot University, France.
| | - J Helen Cross
- UCL Institute of Child Health, Great Ormond Street Hospital for Children NHS Trust, London, UK.
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Pasca L, De Giorgis V, Macasaet JA, Trentani C, Tagliabue A, Veggiotti P. The changing face of dietary therapy for epilepsy. Eur J Pediatr 2016; 175:1267-76. [PMID: 27586246 DOI: 10.1007/s00431-016-2765-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 08/07/2016] [Accepted: 08/19/2016] [Indexed: 01/01/2023]
Abstract
UNLABELLED Ketogenic diet is an established and effective non-pharmacologic treatment for drug-resistant epilepsy. Ketogenic diet represents the treatment of choice for GLUT-1 deficiency syndrome and pyruvate dehydrogenase complex deficiency. Infantile spasms, Dravet syndrome and myoclonic-astatic epilepsy are epilepsy syndromes for which ketogenic diet should be considered early in the therapeutic pathway. Recently, clinical indications for ketogenic diet have been increasing, as there is emerging evidence regarding safety and effectiveness. Specifically, ketogenic diet response has been investigated in refractory status epilepticus and encephalopathy with status epilepticus during sleep. New targets in neuropharmacology, such as mitochondrial permeability transition, are being studied and might lead to using it effectively in other neurological diseases. But, inefficient connectivity and impaired ketogenic diet proposal limit ideal availability of this therapeutic option. Ketogenic diet in Italy is not yet considered as standard of care, not even as a therapeutic option for many child neurologists and epileptologists. CONCLUSIONS The aim of this review is to revisit ketogenic diet effectiveness and safety in order to highlight its importance in drug-resistant epilepsy and other neurological disorders. WHAT IS KNOWN • Ketogenic diet efficacy is now described in large case series, with adequate diet compliance and side effects control. • Ketogenic diet is far from being attempted as a first line therapy. Its availability varies worldwide. What is New: • New pharmacological targets such as mitochondrial permeability transition and new epileptic syndromes and etiologies responding to the diet such as refractory status epilepticus are being pointed out. • Ketogenic diet can function at its best when used as a tailor-made therapy. Fine tuning is crucial.
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Affiliation(s)
- Ludovica Pasca
- Department of Child Neurology and Psychiatry, IRCCS "C. Mondino" National Neurological Institute, Pavia, Italy
| | - Valentina De Giorgis
- Department of Child Neurology and Psychiatry, IRCCS "C. Mondino" National Neurological Institute, Pavia, Italy.,Brain and Behaviour Department, University of Pavia, Via Mondino, 2, 27100, Pavia, Italy
| | | | - Claudia Trentani
- Human nutrition and eating disorder center, department of public health, experimental and forensic medicine, University of Pavia, Pavia, Italy
| | - Anna Tagliabue
- Human nutrition and eating disorder center, department of public health, experimental and forensic medicine, University of Pavia, Pavia, Italy
| | - Pierangelo Veggiotti
- Department of Child Neurology and Psychiatry, IRCCS "C. Mondino" National Neurological Institute, Pavia, Italy. .,Brain and Behaviour Department, University of Pavia, Via Mondino, 2, 27100, Pavia, Italy.
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Ozdemir R, Kucuk M, Guzel O, Karadeniz C, Yilmaz U, Mese T. Does ketogenic diet have any negative effect on cardiac systolic and diastolic functions in children with intractable epilepsy?: One-year follow-up results. Brain Dev 2016; 38:842-7. [PMID: 27066714 DOI: 10.1016/j.braindev.2016.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/14/2016] [Accepted: 03/20/2016] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The ketogenic diet (KD) has been referred to as an "effective therapy with side effects" for children with intractable epilepsy. Among the most recognized adverse effects, there are cardiac conduction abnormalities, vascular and myocardial dysfunction. However, very limited and controversial data are available regarding the effects of the KD on cardiac functions. We sought to analyze the mid-term effect of ketogenic diet on cardiac functions in patients with intractable epilepsy who received a ketogenic diet for at least 12months using conventional and relatively new imaging techniques. METHODS This prospective study included 61 patients with intractable epilepsy who received ketogenic diet for at least 12months. Clinical examinations, serum carnitine and selenium levels as well as electrocardiographic and echocardiographic examinations were scheduled prior to the procedure and at 1, 3, 6 and 12months. We utilized two-dimensional, M-mode, colored Doppler, spectral Doppler and pulsed wave tissue Doppler imaging techniques to investigate ventricular systolic and diastolic functions of this subgroup of patients. RESULTS In our study, there was no significant difference after 1year of KD therapy compared to baseline values-except a significantly decreased A wave velocity-in terms of pulse wave Doppler echocardiographic measurements of the diastolic function. The tissue Doppler measurements obtained from the lateral wall of tricuspide and mitral annuli were not different at baseline and at month 12 of the treatment, as well. CONCLUSION The ketogenic diet appears to have no disturbing effect on ventricular functions in epileptic children in the midterm.
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Affiliation(s)
- Rahmi Ozdemir
- Izmir Dr. Behcet Uz Children's Hospital, Department of Pediatric Cardiology, Izmir, Turkey.
| | - Mehmet Kucuk
- Izmir Dr. Behcet Uz Children's Hospital, Department of Pediatric Cardiology, Izmir, Turkey
| | - Orkide Guzel
- Izmir Dr. Behcet Uz Children's Hospital, Department of Pediatric Neurology, Izmir, Turkey
| | - Cem Karadeniz
- Izmir Dr. Behcet Uz Children's Hospital, Department of Pediatric Cardiology, Izmir, Turkey
| | - Unsal Yilmaz
- Izmir Dr. Behcet Uz Children's Hospital, Department of Pediatric Neurology, Izmir, Turkey
| | - Timur Mese
- Izmir Dr. Behcet Uz Children's Hospital, Department of Pediatric Cardiology, Izmir, Turkey
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Özdemir R, Güzel O, Küçük M, Karadeniz C, Katipoglu N, Yılmaz Ü, Yılmazer MM, Meşe T. The Effect of the Ketogenic Diet on the Vascular Structure and Functions in Children With Intractable Epilepsy. Pediatr Neurol 2016; 56:30-34. [PMID: 26774551 DOI: 10.1016/j.pediatrneurol.2015.10.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 10/31/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We aimed to determine the midterm effect of a ketogenic diet on serum lipid levels, carotid intima-media thickness, and the elastic properties of the carotid artery and the aorta in patients with intractable epilepsy. METHODS A total of 52 children aged between 12 months and 18 years with intractable epilepsy who started the ketogenic diet from September 2014 to September 2015 were included into this prospective study. Carotid intima-media thickness and the elastic properties of the carotid artery and the aorta were assessed by echocardiography in all cases before beginning of the ketogenic diet and after at least 12 months on the ketogenic diet. RESULTS Twenty-one patients at the third month and 25 patients at the first year of the ketogenic diet were seizure free. A reduction of greater than 90% in the seizure frequency was achieved in three patients at the sixth month and in five patients at the first year of the treatment. The serum levels of total cholesterol, low-density lipoprotein, and triglyceride were increased significantly at a median of 12.6 months (range: 12 to 13.5 months) of the ketogenic diet treatment, whereas serum levels of high-density lipoprotein did not change. Carotid intima-media thickness, aortic and carotid strain, the stiffness index, distensibility, and elastic modulus did not change after 12 months of the ketogenic diet therapy. CONCLUSION Olive oil-based ketogenic diet appears to have no disturbing effect on the carotid intima-media thickness and the elastic properties of the aorta and the carotid artery in epileptic children, although it may be associated with increased concentrations of serum lipids.
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Affiliation(s)
- Rahmi Özdemir
- Department of Pediatric Cardiology, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey.
| | - Orkide Güzel
- Department of Pediatric Neurology, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Mehmet Küçük
- Department of Pediatric Cardiology, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Cem Karadeniz
- Department of Pediatric Cardiology, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Nagehan Katipoglu
- Department of Pediatrics, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Ünsal Yılmaz
- Department of Pediatric Neurology, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Murat Muhtar Yılmazer
- Department of Pediatric Cardiology, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Timur Meşe
- Department of Pediatric Cardiology, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey
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The effect of olive oil-based ketogenic diet on serum lipid levels in epileptic children. Neurol Sci 2015; 37:465-70. [PMID: 26700799 DOI: 10.1007/s10072-015-2436-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 12/02/2015] [Indexed: 10/22/2022]
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Doksöz Ö, Güzel O, Yılmaz Ü, İşgüder R, Çeleğen K, Meşe T, Uysal U. The Short-Term Effect of Ketogenic Diet on Carotid Intima-Media Thickness and Elastic Properties of the Carotid Artery and the Aorta in Epileptic Children. J Child Neurol 2015; 30:1646-50. [PMID: 25855687 DOI: 10.1177/0883073815576793] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 02/16/2015] [Indexed: 11/16/2022]
Abstract
The aim of this prospective study is to investigate the effect of a 6-month-long ketogenic diet on carotid intima-media thickness, carotid artery, and aortic vascular functions. Thirty-eight drug-resistant epileptic patients who were being treated with ketogenic diet were enrolled. Fasting total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, total cholesterol, and glucose concentrations were measured and echocardiography was performed in all patients before the beginning of ketogenic diet and at the sixth month of treatment. The body weight, height, body mass index, serum levels of triglyceride, total cholesterol, and low-density lipoprotein increased significantly at month 6 when compared to baseline values (P < .05). Carotid intima-media thickness, elastic properties of the aorta, and carotid artery did not change at the sixth month of therapy compared to baseline values. A 6-month-long ketogenic diet has no effect on carotid intima-media thickness and elastic properties of the carotid artery and the aorta.
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Affiliation(s)
- Önder Doksöz
- Department of Pediatric Cardiology, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Orkide Güzel
- Department of Pediatric Neurology, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Ünsal Yılmaz
- Department of Pediatric Neurology, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Rana İşgüder
- Department of Pediatric Intensive Care Unit, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Kübra Çeleğen
- Department of Pediatrics, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Timur Meşe
- Department of Pediatric Cardiology, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Utku Uysal
- Department of Neurology, University of Kansas Medical Center, Kansas, KS, USA
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Vaccarezza MM, Silva WH. Dietary therapy is not the best option for refractory nonsurgical epilepsy. Epilepsia 2015. [PMID: 26198854 DOI: 10.1111/epi.13074] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The ketogenic diet (KD) is currently a well-established treatment for patients with medically refractory, nonsurgical epilepsy. However, despite its efficacy, the KD is highly restrictive and constitutes a treatment with serious potential adverse effects, and often with difficulties in its implementation and compliance. Patients on the KD require strict follow-up and constant supervision by a medical team highly experienced in its management in order to prevent complications. Other alternative treatments for patients with refractory epilepsy include vagus nerve stimulation (VNS), new-generation antiepileptic drugs (AEDs), corpus callosotomy (CC), and responsive focal cortical stimulation (RNS). In this review, we explain not only the difficulties of the KD as a therapeutic option for refractory epilepsy but also the benefits of other therapeutic strategies, which, in many cases, have proven to have better efficacy than the KD itself.
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Abstract
Ketogenic diet therapies for epilepsy have been described since the fifth century and published in scientific literature since the early 1900s. Since that time, the diet's popularity has waxed and waned as newer drugs and other treatments have been introduced. However, in recent years, dietary therapy for epilepsy has been increasingly accepted by physicians and desired by patients as an alternative to new drugs and neurostimulation. The introduction of less restrictive versions of the classic ketogenic diet, such as the modified Atkins diet (MAD), have led to increased numbers of adult patients with refractory epilepsy who are initiating dietary treatment. Approximately half of adults and children who start a ketogenic diet have a >50% seizure reduction, which is impressive given that these patients typically have medically refractory epilepsy. We believe that ketogenic dietary treatment is the best option for children and adults with refractory nonsurgical epilepsy due to its efficacy, rapid seizure reduction, synergistic effects with other antiseizure treatments, known and treatable side effects, potential to treat comorbid medical conditions, and worldwide availability.
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Bertoli S, Neri IG, Trentani C, Ferraris C, De Amicis R, Battezzati A, Veggiotti P, De Giorgis V, Tagliabue A. Short-term effects of ketogenic diet on anthropometric parameters, body fat distribution, and inflammatory cytokine production in GLUT1 deficiency syndrome. Nutrition 2015; 31:981-7. [PMID: 26059372 DOI: 10.1016/j.nut.2015.02.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 01/25/2015] [Accepted: 02/24/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the effects of a 12-wk ketogenic diet (KD) on inflammatory status, adipose tissue activity biomarkers, and abdominal visceral (VAT) and subcutaneous fat (SAT) in children affected by glucose transporter 1 deficiency syndrome GLUT1 DS. METHODS We carried out a short-term longitudinal study on 10 children (mean age: 8.4 y, range 3.3-12 y, 5 girls, 5 boys) to determine fasting serum proinflammatory cytokines (high sensitivity C-reactive protein, tumor necrosis factor-α interleukin-6), adipocyte-derived chemokines (leptin and adiponectin), lipid profile, homeostatic model assessment-insulin resistance (HOMA-IR), quantitative insulin sensitivity index (QUICKI), anthropometric measurements, and VAT and SAT (by ultrasonography). RESULTS Children showed no significant changes in inflammatory and adipose tissue activity biomarkers, blood glucose, lipid profile, anthropometric measurements, VAT, and SAT. Fasting insulin decreased (6 ± 3.2 μU/mL versus 3 ± 2 μU/mL; P = 0.001), and both HOMA-IR and QUICKI indexes were significantly modified (1.2 ± 0.6 versus 0.6 ± 0.4; P = 0.002; 0.38 ± 0.03 versus 0.44 ± 0.05; P = 0.002, respectively). CONCLUSIONS Only HOMA-IR and QUICKI indexes changed after 12 wk on a KD, suggesting that over a short period of time KD does not affect inflammatory cytokines production and abdominal fat distribution despite being a high-fat diet. Long-term studies are needed to provide answers concerning adaptive metabolic changes during KD.
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Affiliation(s)
- Simona Bertoli
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy.
| | - Ilaria Giulini Neri
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy
| | - Claudia Trentani
- Human Nutrition and Eating Disorder Research Center, Department of Public, Health, Experimental and Forensic Medicine University of Pavia, Pavia, Italy
| | - Cinzia Ferraris
- Human Nutrition and Eating Disorder Research Center, Department of Public, Health, Experimental and Forensic Medicine University of Pavia, Pavia, Italy
| | - Ramona De Amicis
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy
| | - Alberto Battezzati
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy
| | - Pierangelo Veggiotti
- Department of Child Neurology and Psychiatry C. Mondino National, Neurological Institute, Via Mondino, Pavia, Italy; Brain and Behaviour Department, University of Pavia, Pavia, Italy
| | | | - Anna Tagliabue
- Human Nutrition and Eating Disorder Research Center, Department of Public, Health, Experimental and Forensic Medicine University of Pavia, Pavia, Italy
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Selamet Tierney ES, Gauvreau K, Jaff MR, Gal D, Nourse SE, Trevey S, O'Neill S, Baker A, Newburger JW, Colan SD. Carotid artery intima-media thickness measurements in the youth: reproducibility and technical considerations. J Am Soc Echocardiogr 2014; 28:309-16. [PMID: 25459501 DOI: 10.1016/j.echo.2014.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Carotid artery intima-media thickness (CIMT), a marker of atherosclerosis, is increased in youth at risk for future cardiovascular disease. Some pediatric studies have used CIMT as a primary outcome in clinical trials, yet data are limited on the standardization of methodology in children. The goal of this study was to evaluate reproducibility of CIMT measurements using two different measurement techniques. METHODS Carotid artery ultrasound studies of children and adolescents obtained as a component of a research study in Kawasaki syndrome were retrospectively analyzed. The CIMTs of both common carotid arteries (CCAs) were measured by one of two sonographers at the time in the cardiac cycle when resolution subjectively was determined to be optimal (Opt-CIMT). These sonographers blindly remeasured a random sample of studies of their own and each other's, using the same method. Another observer made CIMT measurements using exclusively frames on the R wave (R-CIMT). A fourth observer independently measured a random sample of studies twice with the R-CIMT method. RESULTS Carotid artery images from 184 subjects (mean age, 14.7 ± 2.2 years) were analyzed. The intraclass correlation coefficient for interobserver variability was 0.86 (95% confidence interval [CI], 0.69-0.94) compared with 0.85 (95% CI, 0.65-0.93) for the right and 0.86 (95% CI, 0.67-0.94) versus 0.95 (95% CI, 0.87-0.98) for the left CCA for Opt-CIMT and R-CIMT, respectively. R-CIMT was significantly thicker than Opt-CIMT (right CCA, 0.439 ± 0.030 vs 0.428 ± 0.024 mm, P < .001; left CCA, 0.446 ± 0.030 vs 0.434 ± 0.025 mm, P < .001). CONCLUSION Pediatric CIMT measurements have excellent reproducibility when the same methodology is applied but vary significantly throughout the cardiac cycle. This report highlights the need to standardize CIMT measurements in the youth and supports the use of electrocardiographic timing, as recommended in adults, in pediatric longitudinal studies.
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Affiliation(s)
- Elif Seda Selamet Tierney
- Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, California.
| | - Kimberlee Gauvreau
- Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Michael R Jaff
- Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dana Gal
- Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Susan E Nourse
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, California
| | - Shari Trevey
- Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Stephen O'Neill
- Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Annette Baker
- Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Jane W Newburger
- Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Steven D Colan
- Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Cervenka MC, Patton K, Eloyan A, Henry B, Kossoff EH. The impact of the modified Atkins diet on lipid profiles in adults with epilepsy. Nutr Neurosci 2014; 19:131-7. [DOI: 10.1179/1476830514y.0000000162] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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