Effect Of Ketogenic Diet Therapy On Serum Lipid Levels In Children With Drug-resistant Epilepsy

Objective: To investigate the effect of ketogenic diet(KD)therapy on serum lipid levels in children with drug-resistant epilepsy,and to evaluate the risk of cardiovascular adverse events in patients receiving KD therapy by changes in serum lipid levels.Methods: The clinical data of eligible patients with refractory epilepsy who were hospitalized in Shenzhen Children’s Hospital from August 2013 to October 2022 and received KD for at least 12 months were retrospectively collected.Serum lipid levels,including total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),and high-density lipoprotein cholesterol(HDL-C),were collected before and after KD treatment at different time points(3,6,12,18,24,and 36-48 months).The trend of serum lipid levels and the frequency of dyslipidemia at different time points were analyzed,and the risk index of atherosclerosis in KD treatment was calculated according to various blood lipid indexes,including arteriosclerosis index(AI),arteriosclerosis index plasma(AIP),lipid composite index(LCI)and LDL/HDL ratio,and the corresponding statistical analysis was conducted.Results: A total of 59 children who received KD treatment were enrolled.According to the time of KD treatment and blood lipid data,the children were divided into three cohorts to analyze the changes in serum lipid levels before and after KD treatment.51patients received KD treatment for 12 months,TC and LDL-C concentrations at 3,6,and12 months of KD treatment were significantly higher than the baseline values(P < 0.05);Compared with the baseline value,TG concentration increased at 3 and 6 months(P <0.05),but there was no significant difference at 12 months(P > 0.05).HDL-C was significantly lower at 3 months than at baseline(P < 0.05),and there was no significant difference between 6 months and 12 months(P > 0.05).The proportion of patients with dyslipidemia before KD treatment increased significantly at 3 months,then gradually decreased,and there was no significant difference in the proportion of patients with dyslipidemia compared with baseline at 12 months(P > 0.05).21 patients received KD treatment for 24 months.At 3 and 6 months of KD treatment,the concentrations of TC,TG and LDL were significantly higher than the baseline value(P < 0.05),and the concentration of HDL-C was significantly lower than the baseline value(P < 0.05).At 24 months,only TC was significantly higher than the baseline value(P < 0.05).20 patients received KD treatment for more than 36 months.At 36-48 months,only TC was significantly higher than the baseline value(P < 0.05).At 12 months of KD treatment,LDL/HDL ratio,AI and LCI were significantly higher than those before treatment,and the differences were statistically significant(P < 0.05),while AIP had no significant difference before and after treatment.At 24,36-48 months of KD treatment,there were no significant differences in the four variables(AIP,LDL/HDL ratio,AI and LCI)of atherosclerosis compared with those before treatment(P > 0.05).We did not specifically treat patients who developed dyslipidemia during KD treatment.Conclusions: The levels of TG,TC and LDL-C were significantly increased at 3 months of classic KD treatment,but they did not continue to increase,and most of them could gradually return to the baseline level.There was no significant increase in the proportion of patients with dyslipidemia after KD treatment,suggesting that patients with dyslipidemia at baseline can also receive KD treatment.KD treatment for 12 months may increase the risk of atherosclerosis,but at 24 months and 36-48 months,there was no increase in the risk of atherosclerosis.