Abstracts

RATIONALE: Ketogenic diet (KD) has been accepted as effective treatment for epilepsy. The nutritional impact of KD needs to be elucidated. We have previously reported on decreased linear growth in children on KD. Bone mineral density (BMD)is an indicator of growth and development in children. As part of this prospective study of KD impact on nutrition we measured BMD. METHODS: We prospectively assessed BMD in 9 children, aged 1-10 years, for at least 1 year after KD initiation (5 Males; 4 Females). 3/9 children have reached the 2 year follow-up visit. All patients were initiated on KD at a 4:1 ratio, as add-on therapy to standard anti-epileptic drugs (AEDs). KD and AEDs wre adjusted as clinically appropriate. All patients took a multi-vitamin and mineral supplement plus a minimum of 600 additional milligrams of calcium. Whole body BMD (WBBMD) and spine BMD (SBMD)were measured using a Lunar dual energy x-ray absorptiometer (DEXA) at baseline, 1 year and 2 years after KD initiation. Growth was assessed using Z scores. RESULTS: At baseline all SBMD Z scores were within normal limits. Normative data of WBBMD is not available. 7/9 children remained on KD at the 1 year follow-up visit. 2/9 discontinued KD by 9 months and were no longer in ketosis. All 7 children who remained in ketosis had a reduction in WBBMD, whereas the 2 children who were not in ketosis had an increase in WBBMD. 8/9 patients' SBMD Z scores were decreased at 1 year. All children had blood calcium, magnesium and albumin levels within normal limits. 1/9 had a decreased vitamin D level. 3/3 children had discontinued KD at the 2 year follow-up visit. WBBMD in all 3 children at 2 years was increased above both baseline and 1 year levels. CONCLUSIONS: We conclude that BMD may be negatively impacted during KD treatment. As we have previously reported, height for age Z scores suggest linear growth is comprimised during KD treatment. This decrease in linear growth appears to parallel a decrease in the body's ability to accrete bone mineral at the normal rate. WBBMD does seem to catch-up once KD is discontinued. This study again demonstrates nutritional impact of KD. In addition, this suggests the need for prospective studies examing BMD in all children with epilepsy.