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Progressive bone mineral content loss in children with intractable epilepsy treated with the ketogenic diet.
Am J Clin Nutr 2008; 88(6):1678-84AJ

Abstract

BACKGROUND

The ketogenic diet (KD) is a high-fat, low-carbohydrate, and protein diet that effectively treats intractable epilepsy (IE).

OBJECTIVE

The purpose of this study was to measure the change in bone mineral content (BMC) in children with IE treated with the KD for 15 mo.

DESIGN

Prepubertal children >or=5 y of age with IE were eligible. A 4:1 ketogenic diet was maintained for 15 mo, and whole-body and spine BMCs were measured with dual-energy X-ray absorptiometry. Z scores were generated by comparing the children with IE with a cohort of 847 healthy children. Other measurements included demographics, anthropometry, serum 25-hydroxyvitamin D (25-OHD), intact parathyroid hormone, electrolytes, and dietary intake. All measurements were performed at baseline and at 3, 6, 12, and 15 mo. Longitudinal mixed effects models were used to analyze change in BMC over time.

RESULTS

Twenty-five children (9 girls, 16 boys) with IE [age (x +/- SD): 7.3 +/- 1.9 y] participated. Growth and bone health status were suboptimal as were serum 25-OHD concentrations and dietary intake of calcium and vitamin D. Whole-body and spine BMC-for-age both declined by 0.6 z score/y and whole-body and spine BMC-for-height declined 0.7 z score/y and 0.4 z score/y, respectively. Height declined 0.5 z score/y. Body mass index (BMI; in kg/m(2)) z score, age, and ambulation were positive predictors of BMC, which declined sharply over 15 mo of KD treatment.

CONCLUSION

Bone health in children with IE was poor, particularly for younger nonambulatory children with low BMI status. The KD resulted in progressive loss of BMC. The mechanism is unclear. Further studies are needed.

Authors+Show Affiliations

Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. bergqvist@email.chop.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19064531

Citation

Bergqvist, A G Christina, et al. "Progressive Bone Mineral Content Loss in Children With Intractable Epilepsy Treated With the Ketogenic Diet." The American Journal of Clinical Nutrition, vol. 88, no. 6, 2008, pp. 1678-84.
Bergqvist AG, Schall JI, Stallings VA, et al. Progressive bone mineral content loss in children with intractable epilepsy treated with the ketogenic diet. Am J Clin Nutr. 2008;88(6):1678-84.
Bergqvist, A. G., Schall, J. I., Stallings, V. A., & Zemel, B. S. (2008). Progressive bone mineral content loss in children with intractable epilepsy treated with the ketogenic diet. The American Journal of Clinical Nutrition, 88(6), pp. 1678-84. doi:10.3945/ajcn.2008.26099.
Bergqvist AG, et al. Progressive Bone Mineral Content Loss in Children With Intractable Epilepsy Treated With the Ketogenic Diet. Am J Clin Nutr. 2008;88(6):1678-84. PubMed PMID: 19064531.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Progressive bone mineral content loss in children with intractable epilepsy treated with the ketogenic diet. AU - Bergqvist,A G Christina, AU - Schall,Joan I, AU - Stallings,Virginia A, AU - Zemel,Babette S, PY - 2008/12/10/pubmed PY - 2009/1/14/medline PY - 2008/12/10/entrez SP - 1678 EP - 84 JF - The American journal of clinical nutrition JO - Am. J. Clin. Nutr. VL - 88 IS - 6 N2 - BACKGROUND: The ketogenic diet (KD) is a high-fat, low-carbohydrate, and protein diet that effectively treats intractable epilepsy (IE). OBJECTIVE: The purpose of this study was to measure the change in bone mineral content (BMC) in children with IE treated with the KD for 15 mo. DESIGN: Prepubertal children >or=5 y of age with IE were eligible. A 4:1 ketogenic diet was maintained for 15 mo, and whole-body and spine BMCs were measured with dual-energy X-ray absorptiometry. Z scores were generated by comparing the children with IE with a cohort of 847 healthy children. Other measurements included demographics, anthropometry, serum 25-hydroxyvitamin D (25-OHD), intact parathyroid hormone, electrolytes, and dietary intake. All measurements were performed at baseline and at 3, 6, 12, and 15 mo. Longitudinal mixed effects models were used to analyze change in BMC over time. RESULTS: Twenty-five children (9 girls, 16 boys) with IE [age (x +/- SD): 7.3 +/- 1.9 y] participated. Growth and bone health status were suboptimal as were serum 25-OHD concentrations and dietary intake of calcium and vitamin D. Whole-body and spine BMC-for-age both declined by 0.6 z score/y and whole-body and spine BMC-for-height declined 0.7 z score/y and 0.4 z score/y, respectively. Height declined 0.5 z score/y. Body mass index (BMI; in kg/m(2)) z score, age, and ambulation were positive predictors of BMC, which declined sharply over 15 mo of KD treatment. CONCLUSION: Bone health in children with IE was poor, particularly for younger nonambulatory children with low BMI status. The KD resulted in progressive loss of BMC. The mechanism is unclear. Further studies are needed. SN - 1938-3207 UR - https://www.unboundmedicine.com/medline/citation/19064531/Progressive_bone_mineral_content_loss_in_children_with_intractable_epilepsy_treated_with_the_ketogenic_diet_ L2 - https://academic.oup.com/ajcn/article-lookup/doi/10.3945/ajcn.2008.26099 DB - PRIME DP - Unbound Medicine ER -