Abstracts

Rationale: Rationale: The modified Atkins diet (MAD) is the most common ketogenic diet therapy used in the management of drug-resistant epilepsy in adults. The diet stimulates ketone body production by increasing fat intake and restricting carbohydrates. Some patients who begin MAD therapy experience an increase in serum levels of total cholesterol and low-density lipoprotein (LDL) cholesterol. As a sub-analysis of a larger randomized trial exploring whether a liquid ketogenic formula improved dietary compliance and seizure control, we explored whether dietary fat composition predicts short-term elevations in serum lipid levels in diet-naïve adults who begin MAD. Methods: Methods: Participants self-reported their diet intake with 3-day food records at baseline, 1 month and 2 months. Food records were analyzed using Nutrition Data System for Research software. Fasting serum levels of total cholesterol (TC), high-density lipoprotein (HDL) cholesterol, and triglycerides were also collected and LDL level calculated at baseline, 1 month, and 2 months. Results: Results: Of 80 patients enrolled in the larger study, 38 patients submitted complete food records at each study visit (baseline, 1 month, and 2 month). As expected, compared to baseline diet intake, there was a significant reduction in daily carbohydrate intake at 1 and 2 months (p<0.001) and a significant increase in daily fat intake at 1 and 2 months (p<0.001). There was also a significant increase in daily saturated fatty acid (SFA) intake at 1 and 2 months (p<0.001), daily mono-unsaturated fatty acid (MUFA) intake at 1 and 2 months (p<0.001), and daily cholesterol intake at 1 month (p<0.05) and 2 months (p<0.001), but no change in daily poly-unsaturated fatty acid (PUFA) intake over time. Compared to baseline, there was a significant increase in serum LDL at 1 month (p<0.001) and 2 months (p<0.01) and an increase in serum TC at 1 month (p<0.01) but not 2 months. There was no significant change in serum levels of HDL or TG following MAD initiation. Correlation analyses and automatic linear modeling were performed to explore whether diet composition predicted lipid outcomes, specifically TC and LDL levels. Using these approaches, only 1 month MUFA intake significantly correlated with 1 month TC level with a negative relationship (r= -0.3568, p=0.0415). Although 2 month MUFA intake weakly predicted 2 month TC level (ß=-0.217, p=0.005), neither total fat intake nor fat type (SFA, MUFA, or PFA) predicted 1 month TC and LDL levels. Instead, the most important predictors of 1 and 2 month TC and LDL levels were other lipid values (i.e., LDL level for TC prediction and TC level for LDL prediction). Conclusions: Conclusions: Despite a significant increase in total fat, saturated fat and mono-unsaturated fat intake as well as an increase in total cholesterol and LDL levels following MAD initiation, dietary fat composition appears to minimally predict serum lipid values in the short term. Whether foods rich in mono-unsaturated fatty acids and/ or poly-unsaturated fatty acids can help to counteract short-term elevations in total cholesterol will need further investigation. Funding: Study was supported by Nutricia North America.