Barriers and facilitators to starting and staying on ketogenic diet therapy for children with epilepsy: A scoping review

IF 2.9 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN Pub Date : 2025-02-22 DOI:10.1016/j.clnesp.2025.02.020

Humzah Hameed , Lenycia de Cassya Lopes Neri , Natasha Schoeler

{"title":"Barriers and facilitators to starting and staying on ketogenic diet therapy for children with epilepsy: A scoping review","authors":"Humzah Hameed , Lenycia de Cassya Lopes Neri , Natasha Schoeler","doi":"10.1016/j.clnesp.2025.02.020","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Ketogenic diet therapy (KDT) is a group of high-fat, low-carbohydrate, moderate protein diets that are an effective treatment option for children and young people with drug-resistant epilepsy. However, 45 % of patients referred to start KDT, who are medically eligible to do so, do not start diet. A further 25 % discontinue KDT before 3 months.</div></div><div><h3>Aim</h3><div>To explore barriers and facilitators for children and young people with epilepsy to start or continue on KDT, and their families. Based on the Participants, Concept and Context (PCC) framework, this review included children and young people with drug-resistant epilepsy (P) referred for KDT (C) or their families, who had expressed their views regarding barriers or facilitators for starting or continuing on dietary treatment (C).</div></div><div><h3>Methods</h3><div>This scoping review followed JBI methodology. Identified barriers/facilitators were matched to relevant sections of the ‘Capability, Opportunity, Motivation – Behaviour’ (COM-B) model and organised according to the phases of the patient journey: pre-diet, diet initiation and maintenance.</div></div><div><h3>Results</h3><div>60 studies were included. 15 barriers and 9 facilitators were identified for the pre-diet and initiation stages; 19 barriers and 14 facilitators were identified for staying on KDT once the diet had been fully established.</div></div><div><h3>Conclusions</h3><div>Barriers and facilitators for children and young people who are considering starting KDT, or who are currently following KDT, and their families, are multifactorial and extend beyond the level of the individual. Our findings will help identify areas to prioritise for interventions to support patients and their families.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"66 ","pages":"Pages 465-473"},"PeriodicalIF":2.9000,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical nutrition ESPEN","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S240545772500083X","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"NUTRITION & DIETETICS","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Ketogenic diet therapy (KDT) is a group of high-fat, low-carbohydrate, moderate protein diets that are an effective treatment option for children and young people with drug-resistant epilepsy. However, 45 % of patients referred to start KDT, who are medically eligible to do so, do not start diet. A further 25 % discontinue KDT before 3 months.

Aim

To explore barriers and facilitators for children and young people with epilepsy to start or continue on KDT, and their families. Based on the Participants, Concept and Context (PCC) framework, this review included children and young people with drug-resistant epilepsy (P) referred for KDT (C) or their families, who had expressed their views regarding barriers or facilitators for starting or continuing on dietary treatment (C).

Methods

This scoping review followed JBI methodology. Identified barriers/facilitators were matched to relevant sections of the ‘Capability, Opportunity, Motivation – Behaviour’ (COM-B) model and organised according to the phases of the patient journey: pre-diet, diet initiation and maintenance.

Results

60 studies were included. 15 barriers and 9 facilitators were identified for the pre-diet and initiation stages; 19 barriers and 14 facilitators were identified for staying on KDT once the diet had been fully established.

Conclusions

Barriers and facilitators for children and young people who are considering starting KDT, or who are currently following KDT, and their families, are multifactorial and extend beyond the level of the individual. Our findings will help identify areas to prioritise for interventions to support patients and their families.

查看原文本刊更多论文

求助全文

约1分钟内获得全文求助全文

来源期刊

Clinical nutrition ESPEN NUTRITION & DIETETICS-

CiteScore

4.90

自引率

3.30%

发文量

512

期刊介绍： Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.