Long-term cardiometabolic and bone health consequences of ketogenic diet in children with refractory epilepsy.

Background: Ketogenic diet (KD) is a well-tolerated and efficacious therapy for refractory epilepsy (RE). While numerous mild short-term side effects have been reported, long-term cardiometabolic and bone heath consequences of KD need more advanced work-up and were not fully evaluated especially in children. So, we aimed to evaluate cardiac, vascular, metabolic, bone health and growth consequences in children with RE receiving KD for more than 2 years compared to those receiving antiepileptic drugs (AEDs ) without any dietary interference.

Methodes: Fifty-six children following KD for at least 2 years, 27 classic KD and 29 modified atkins diet (MAD), were recruited in addition to 40 children with RE maintained on multiple AEDs. Lipid profile values, atherogenic indices, serum selenium binding protein 1, and anthropometric measurements were measured for all participants. Additionally, echocardiography, electrocardiography, carotid ultrasonography and DEXA scan were performed.

Results: Atherogenic index of plasma (AIP) was high in all groups with no significant correlation with carotid intima-media thickness. Although no cardiac complications were documented, Bone mineral density (BMD) was significantly reduced in all groups. Castelli risk index II and ambulation were the significant predictors for reduced BMD in KD groups in contrast to AIP in AEDs group. Stunted growth was most prevalent in MAD group 44.8% while wasting was highest in AEDs group 40%.

Conclusions: KD did not show additional risk regarding metabolic, cardiovascular, BMD and growth side effects compared to AEDs only. Therefore, KD remains a relatively safe dietary therapy for RE, yet close monitoring is still recommended.