Student UCL Great Ormond Street Institute of Child Health Macclesfield, England, United Kingdom
Rationale: Ketogenic diet therapy (KDT), a group of high-fat, low-carbohydrate, moderate-protein diets, are an effective treatment for drug-resistant epilepsy. There is conflicting evidence regarding impacts of KDT on growth. We aimed to determine if linear growth and weight were affected in children following KDT in the U.K., and whether there were any associations with clinical, dietary or demographic factors. Methods: A retrospective case note review was conducted, including children with epilepsy who followed KDT at two UK KD centers. Response was categorized as ≥ 50% seizure frequency in the 28 days prior to the one-year appointment compared to before diet onset. Height and weight measurements taken as part of routine clinical management were recorded at one, two and three years on diet, and one-year post diet discontinuation. Anthropometric measurements were converted to z-scores and differences from baseline were analyzed using Wilcoxon Signed Rank tests. Subgroup analyses of growth changes were performed to compare between feeding methods, ambulatory status, diet type, diet response, age at diet onset, blood beta-hydroxybutyrate level and protein prescription. Results: One hundred forty-four patients were included, of which 43 had one year post-diet data available. Median weight z-scores showed no significant change compared to baseline at any timepoint. Median height z-scores significantly decreased at two and three years on diet (p=0.000 and p=0.019). Tube-fed children had greater height z-score decrease at two years compared to orally fed children (p=0.031), as did non-ambulatory compared to ambulatory children (p=0.031). Height z-score at two years decreased less from baseline in individuals following modified KDs compared with those following a classical or medium-chain triglyceride KD at two years (p=0.030). A positive correlation was found between height z-score change at two years and age at diet onset (p=0.012), and also with beta-hydroxybutyrate level at one year (p=0.029). Responders had greater decrease in height z-scores compared to non-responders at one year (p=0.040). No significant changes in z-scores one-year post diet discontinuation, compared to pre-diet, were found. Conclusions: In our cohort, linear growth was significantly decreased in children following KDT for two years, with no significant effect on weight. Tube feeding, non-ambulatory status, younger age, lower beta-hydroxybutyrate levels and ≥ 50% seizure reduction at one year were associated with greater decrease in height z-score, whilst modified KDs had less impact compared to other KD variants. However, height z-scores were no longer significantly different from baseline one-year post diet. This may be due to the limited number of patients with post diet data available or the relatively short-term follow-up. These findings add to the literature regarding long-term side effects of KDT and help inform which groups may be at greater risk of impacted growth. Further investigation is warranted with prospective data collection and longer post diet follow-up. Funding: Please list any funding that was received in support of this abstract.: No funding was received in support of this abstract.