Abstract

The classical ketogenic diet (cKD) is an isocaloric, high fat, very low-carbohydrate diet that induces ketosis, strongly influencing leptin and ghrelin regulation. However, not enough is known about the impact of a long-term cKD. This study evaluated the effects of a 12-month cKD on ghrelin and leptin concentrations in children, adolescents and adults affected by the GLUT1-Deficiency Syndrome or drug resistant epilepsy (DRE). We also investigated the relationship between the nutritional status, body composition and ghrelin and leptin variations. We carried out a longitudinal study on 30 patients: Twenty-five children and adolescents (15 females, 8 ± 4 years), and five adults (two females, 34 ± 16 years). After 12-monoths cKD, there were no significant changes in ghrelin and leptin, or in the nutritional status, body fat, glucose and lipid profiles. However, a slight height z-score reduction (from −0.603 ± 1.178 to −0.953 ± 1.354, p ≤ 0.001) and a drop in fasting insulin occurred. We found no correlations between ghrelin changes and nutritional status and body composition, whereas leptin changes correlated positively with variations in the weight z-score and body fat (ρ = 0.4534, p = 0.0341; ρ = 0.5901, p = 0.0135; respectively). These results suggest that a long-term cKD does not change ghrelin and leptin concentrations independently of age and neurological condition.

Highlights

  • The classic ketogenic diet is an isocaloric, high-fat, very low-carbohydrate and normal-protein diet

  • These results suggest that a long-term classical ketogenic diet (cKD) does not change ghrelin and leptin concentrations independently of age and neurological condition

  • The main aim of our longitudinal study was to investigate the effects of a 12-month cKD on ghrelin and leptin concentrations in children, adolescents and adult patients affected by glucose carrier protein type 1 (GLUT1)-DS or drug resistant epilepsy (DRE)

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Summary

Introduction

The classic ketogenic diet (cKD) is an isocaloric, high-fat, very low-carbohydrate and normal-protein diet. Nutrients 2019, 11, 1716 plus proteins (gr), generally equal to 3:1 or 4:1 [1] It has been used safely and effectively for decades as a recognized treatment for drug-resistant epilepsy (DRE) [2,3,4], in GLUT1-Deficiency Syndrome (GLUT1-DS) [5,6] and in pyruvate dehydrogenase complex deficiency (PDCD) [7,8]. The cKD produces the highest ketogenic effect among the various ketogenic diets (KDs) It induces a constant production of KBs, called ketosis, aimed at mimicking the starvation state while providing adequate calories to support growth and energy needs in childhood and adult age, respectively [2,14]

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