Influence of baseline nutritional status on ketogenic diet efficacy in children with drug-resistant epilepsy

BACKGROUND: Nutritional status may influence the efficacy of ketogenic diet (KD) therapy in children with drug-resistant epilepsy. METHODS: This study enrolled 43 children (25 girls, 18 boys) with drug-resistant epilepsy. Pre-KD nutritional status was assessed using 24-h diet recalls and 3-day food records compared against Dietary Reference Intakes (DRIs). Seizure reduction (≥70% vs. <70%) at 3 and 6 months was analyzed using Fisher's exact test and Mann-Whitney U test. RESULTS: KD was initiated at 5.41 ± 4.65 years. At 3 months, children with ≥70% seizure reduction (n = 11) had significantly higher mean energy intake from n-3 polyunsaturated fatty acids (PUFA) (2.23% vs. 0.78%, p = 0.021) and n-6 PUFA (8.98% vs. 5.87%, p = 0.018), and lower phosphorus insufficiency (0% vs. 31.25%, p = 0.043) compared to those with <70% reduction. At 6 months, the ≥70% reduction group (n = 17) exhibited lower rates of insufficient magnesium (86.7% vs. 47.1%, p = 0.019), zinc (53.3% vs. 11.8%, p = 0.021), and vitamin E (53.3% vs. 17.6%, p = 0.034) intake. CONCLUSION: Baseline nutritional status, particularly adequate n-3/n-6 PUFA, phosphorus, magnesium, zinc, and vitamin E intake, may enhance KD efficacy in children with drug-resistant epilepsy. Further study with bigger population may be mandatory to lead to more conclusive results. IMPACT: Children under 2 years often respond better to ketogenic diet possibly due to elevated fatty acid oxidation rates. Nutritional status may also influence the efficacy of ketogenic diet therapy in children with drug-resistant epilepsy. Adolescents with drug-resistant epilepsy show the highest rates of insufficient phosphorus, zinc, and vitamin E intake. The ≥70% seizure reduction group exhibited lower rates of insufficient magnesium, zinc, and vitamin E intake. Baseline nutritional status, particularly adequate n-3/n-6 PUFA, phosphorus, magnesium, zinc, and vitamin E intake, showed a positive association with enhanced KD efficacy in children with drug-resistant epilepsy.