Читать книгу Nutrition and Growth - Группа авторов - Страница 18

Svedlund A^1,2, Hallböök T^1,2, Magnusson P³, Dahlgren J^1,2, Swolin-Eide D^1,2

¹Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; ²Region Västra Götaland, Sahlgrenska University Hospital, The Queen Silvia Children’s Hospital, Department of Pediatrics, Gothenburg, Sweden; ³Department of Clinical Chemistry, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden

Eur J Paediatr Neurol 2019;23:629–638

Background: The modified Atkins diet (MAD) is a less restrictive treatment option than the ketogenic diet (KD) for intractable epilepsy and some metabolic conditions. Prolonged KD treatment may decrease bone mineralization and affect linear growth; however, long-term studies of MAD treatment are lacking. This study was designed to assess growth, body composition, and bone mass in children on MAD treatment for 24 months.

Methods: Thirty-eight patients, mean age (SD) 6.1 years (4.8 years), 21 girls, with intractable epilepsy (n = 22), glucose transporter type 1 deficiency syndrome (n = 7), or pyruvate dehydrogenase complex deficiency (n = 9) were included. Body weight, height, body mass index, bone mass, and laboratory tests (calcium, phosphorus, magnesium, alkaline phosphatase, cholesterol, 25-hydroxyvitamin D, insulin-like growth factor-I and insulin-like growth factor binding protein 3) were assessed at baseline and after 24 months of MAD treatment.

Results: Approximately 50% of the patients responded with >50% seizure reduction. Weight and height standard deviation score were stable over 24 months, whereas median (min – max) body mass index standard deviation score increased from 0.2 (–3.3 to 4.5) to 0.7 (–0.9 to 2.6), p < 0.005. No effects were observed for bone mass (total body, lumbar spine and hip) or fat mass.

Conclusions: The MAD was efficient in reducing seizures, and no negative effect was observed on longitudinal growth or bone mass after MAD treatment for 24 months.

Reprinted with permission from Elsevier.

Comments

Safety is an important factor influencing the use of diets. Appropriate linear growth and increased weight are prime indicators of health in growing children. Decreased linear growth caused by dieting would limit its usefulness in most children. To this effect, a study in children with epilepsy, glucose transporter type 1 deficiency syndrome, or pyruvate dehydrogenase complex deficiency, receiving MAD (a less restrictive treatment option than the KD) as a part of their treatment, was undertaken. Reassuringly, no negative effect was observed on longitudinal growth or bone mass after 24 months of diet in this population. Nevertheless, further studies with longer duration of treatment and larger cohorts are needed to determine its safety in growing children [9, 10].

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