Long-term follow-up of nutritional status in children with GLUT1 Deficiency Syndrome treated with classic ketogenic diet: a 5-year prospective study

Weight Loss Diets, Fads, and Trends

PURPOSE OF REVIEW

To review popular dietary trends and provide recommendations regarding validated dietary approaches for weight loss in the pediatric population.

RECENT FINDINGS

Like adults, children and adolescents trying to lose weight will succumb to diets promoted by the media. Many of these so-called "fad" diets tout unsupported claims for health but prove very difficult for long-term adherence. Since childhood is a pivotal time for establishing lifestyle habits, we need to provide practical dietary advice supported by scientific research. Studies suggest that emphasizing macronutrient balance while limiting both ultraprocessed foods and sugar-sweetened beverages can help our pediatric patients achieve and maintain a healthy weight. We review literature discouraging the use of restrictive dieting in the pediatric population and instead encourage a whole-foods-based, balanced dietary approach, along with regular physical activity. The goal is to support reasonable and sustainable lifestyle habits that ultimately allow children to establish lifelong health-promoting behaviors.

Charting the Progress of Epilepsy Classification: Navigating a Shifting Landscape

Epilepsy, a neurological disorder characterized by recurrent seizures, has witnessed a remarkable transformation in its classification paradigm, driven by advances in clinical understanding, neuroimaging, and molecular genetics. This narrative review navigates the dynamic landscape of epilepsy classification, offering insights into recent developments, challenges, and the promising horizon. Historically, epilepsy classification relied heavily on clinical observations, categorizing seizures based on their phenomenology and presumed etiology. However, the field has profoundly shifted from a symptom-based approach to a more refined, multidimensional system. One pivotal aspect of this evolution is the integration of neuroimaging techniques, particularly magnetic resonance imaging (MRI) and functional imaging modalities. These tools have unveiled the intricate neural networks implicated in epilepsy, facilitating the identification of distinct brain abnormalities and the categorization of epilepsy subtypes based on structural and functional findings. Furthermore, the role of genetics has become increasingly prominent in epilepsy classification. Genetic discoveries have not only unraveled the molecular underpinnings of various epileptic syndromes but have also provided valuable diagnostic and prognostic insights. This narrative review delves into the expanding realm of genetic testing and its impact on tailoring treatment strategies to individual patients. As the classification landscape evolves, there are accompanying challenges. The narrative review underscores the transformative potential of artificial intelligence and machine learning in epilepsy classification. These technologies hold promise in automating the analysis of complex neuroimaging and genetic data, offering enhanced accuracy and efficiency in epilepsy diagnosis and classification. In conclusion, navigating the shifting landscape of epilepsy classification is a journey marked by progress, complexity, and the prospect of improved patient care. We are charting a course toward more precise diagnoses and tailored treatments by embracing advanced neuroimaging, genetics, and innovative technologies. As the field continues to evolve, collaborative efforts and a holistic understanding of epilepsy's diverse manifestations will be instrumental in harnessing the full potential of this dynamic landscape.

Validation of an Italian Questionnaire of Adherence to the Ketogenic Dietary Therapies: iKetoCheck

Ketogenic dietary therapies (KDTs) are an effective and safe non-pharmacological treatment for drug-resistant epilepsy, but adherence can be challenging for both patients and caregivers. In Europe, there are no adequate tools to measure it other than monitoring ketosis. This study aimed to adapt and validate the Brazilian adherence questionnaire, Keto-check, into the Italian version: iKetoCheck. Using the Delphi technique, 12 judges validated the contents through agreement rates and the Content Validity Index (CVI). The iKetocheck was self-completed electronically by 61 drug-resistant epilepsy or GLUT1 deficiency patients within an interval of 15 days to measure its reproducibility. The test-retest reliability was evaluated using Pearson's correlation and relative significance test. Exploratory and confirmatory factorial analyses were made using Factor software version 12.03.02. The final tool, iKetoCheck, consists of 10 questions with 5-point Likert scale answers. It evaluates various aspects such as informing caregivers about the diet, organization of meals, measurement of ketosis, weighing food consumed, diet negligence, use of carbohydrate-free medications, attending follow-up visits, reading food labels, consulting an expert for dietary concerns, and cooking at home. The factorial analysis resulted in three factors: "attention," "organization," and "precision," with satisfactory results for indices in exploratory and confirmatory analyses. Although higher mean values of ketonemia measurement were observed in patients with a higher adherence score, these values were not statistically significant (p = 0.284). In conclusion, despite the small sample size, iKetoCheck is a valid tool for evaluating KDTs' adherence in Italian drug-resistant epilepsy or GLUT1 deficiency patients. It can provide valuable information to improve patient management and optimize the effectiveness of KDTs.

Factor Analysis of the Brazilian Questionnaire on Adherence to Ketogenic Dietary Therapy: Keto-Check

BACKGROUND

several strategies are used to assess adherence to ketogenic dietary therapies (KDTs), the most commonly used being ketonemia or ketonuria, despite their limitations. The purpose of this article is to carry out an exploratory and confirmatory factor analysis on the proposed Keto-check (adherence's KDT Brazilian questionnaire).

METHODS

there was a methodological study of a quantitative nature, complementary to the analysis realized previously, with a complimentary sample. The factorial analysis was performed with Factor software for parallel exploratory analysis, replicability, and confirmatory factor analysis. Graphical representation was created according to the number of factors resulting from the analysis.

RESULTS

116 questionnaires were reached by complementary data collection (n = 69 actual data, complementing n = 47 previous data) through online forms. A polychoric correlation matrix suitability analysis resulted in a significant Bartlett statistic (p = 0.0001) and a Kaiser-Meyer-Olkin (KMO) test of 0.56. The parallel factorial analysis resulted in two factors, graphically represented as "efficacy" and "adherence". A confirmatory factor analysis, considered fair, indicated an RMSEA of 0.063, NNFI resulted in 0.872, CFI in 0.926, and GFI in 0.897.

CONCLUSION

this study confirms the validity of Keto-check through a more detailed analysis. Adherence is the key to improving the effectiveness of KDTs; therefore, improving knowledge about it can lead to a better healthcare approach.