Effect of a High-Fat Ketogenic Diet on Plasma Levels of Lipids, Lipoproteins, and Apolipoproteins in Children

Peter O. Kwiterovich, Eileen P.G. Vining, Paula Pyzik, Richard Skolasky, John M. Freeman

Research output: Contribution to journalArticle

Abstract

Context: Little prospective long-term information is available on the effect of a ketogenic diet on plasma lipoproteins in children with difficult-to-control seizures. Objective: To determine the effect in children with intractable seizures of a high-fat ketogenic diet on plasma levels of the major apolipoprotein B (apoB)-containing lipoproteins, low-density lipoprotein (LDL) and very LDL (VLDL); and the major apolipoprotein A-I (apoA-I)-containing lipoprotein, high-density lipoprotein (HDL). Design, Setting, and Patients A 6-month prospective cohort study of 141 children (mean [SD] age, 5.2 [3.8] years for 70 boys and 6.1 [4.4] years for 71 girls) with difficult-to-treat seizures who were hospitalized for initiation of a high-fat ketogenic diet and followed up as outpatients. This cohort constituted a subgroup of the 371 patients accepted into the ketogenic diet program between 1994 and 2001. A subset of the cohort was also studied after 12 (n = 59) and 24 (n = 27) months. Intervention: A ketogenic diet consisting of a high ratio of fat to carbohydrate and protein combined (4:1 [n=102], 3.5:1 [n=71, or3:1 [n=32]). After diet initiation, the calories and ratio were adjusted to maintain ideal body weight for height and maximal urinary ketosis for seizure control. Main Outcome Measures: Differences at baseline and 6-month follow-up for levels of total, VLDL, LDL, HDL, and non-HDL cholesterol; triglycerides; total apoB; and apoA-I. Results: At 6 months, the high-fat ketogenic diet significantly increased the mean plasma levels of total (58 mg/dL [1.50 mmol/L]), LDL (50 mg/dL [1.30 mmol/L]), VLDL (8 mg/dL [0.21 mmol/L]), and non-HDL cholesterol (63 mg/dL [1.63 mmol/L]) mmol/L]) (P>.001 vs baseline for each); triglycerides (58 mg/dL [0.66 mmol/L]) (P>.001); and total apoB (49 mg/dL) (P>.001). Mean HDL cholesterol decreased significantly (P>.001), although apoA-I increased (4 mg/dL) (P=.23). Significant but less marked changes persisted in children observed after 12 and 24 months. Conclusions: A high-fat ketogenic diet produced significant increases in the atherogenic apoB-containing lipoproteins and a decrease in the anti-atherogenic HDL cholesterol. Further studies are necessary to determine if such a diet adversely affects endothelial vascular function and promotes inflammation and formation of atherosclerotic lesions.

Original languageEnglish (US)
Pages (from-to)912-920
Number of pages9
JournalJournal of the American Medical Association
Volume290
Issue number7
DOIs
StatePublished - Aug 20 2003

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Ketogenic Diet
Apolipoproteins
High Fat Diet
Lipoproteins
Lipids
Apolipoproteins B
Apolipoprotein A-I
Seizures
VLDL Lipoproteins
HDL Lipoproteins
LDL Lipoproteins
HDL Cholesterol
Triglycerides
Diet
Ideal Body Weight
Ketosis
Body Height
Blood Vessels
Cohort Studies
Outpatients

ASJC Scopus subject areas

  • Medicine(all)

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Effect of a High-Fat Ketogenic Diet on Plasma Levels of Lipids, Lipoproteins, and Apolipoproteins in Children. / Kwiterovich, Peter O.; Vining, Eileen P.G.; Pyzik, Paula; Skolasky, Richard; Freeman, John M.

In: Journal of the American Medical Association, Vol. 290, No. 7, 20.08.2003, p. 912-920.

Research output: Contribution to journalArticle

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title = "Effect of a High-Fat Ketogenic Diet on Plasma Levels of Lipids, Lipoproteins, and Apolipoproteins in Children",
abstract = "Context: Little prospective long-term information is available on the effect of a ketogenic diet on plasma lipoproteins in children with difficult-to-control seizures. Objective: To determine the effect in children with intractable seizures of a high-fat ketogenic diet on plasma levels of the major apolipoprotein B (apoB)-containing lipoproteins, low-density lipoprotein (LDL) and very LDL (VLDL); and the major apolipoprotein A-I (apoA-I)-containing lipoprotein, high-density lipoprotein (HDL). Design, Setting, and Patients A 6-month prospective cohort study of 141 children (mean [SD] age, 5.2 [3.8] years for 70 boys and 6.1 [4.4] years for 71 girls) with difficult-to-treat seizures who were hospitalized for initiation of a high-fat ketogenic diet and followed up as outpatients. This cohort constituted a subgroup of the 371 patients accepted into the ketogenic diet program between 1994 and 2001. A subset of the cohort was also studied after 12 (n = 59) and 24 (n = 27) months. Intervention: A ketogenic diet consisting of a high ratio of fat to carbohydrate and protein combined (4:1 [n=102], 3.5:1 [n=71, or3:1 [n=32]). After diet initiation, the calories and ratio were adjusted to maintain ideal body weight for height and maximal urinary ketosis for seizure control. Main Outcome Measures: Differences at baseline and 6-month follow-up for levels of total, VLDL, LDL, HDL, and non-HDL cholesterol; triglycerides; total apoB; and apoA-I. Results: At 6 months, the high-fat ketogenic diet significantly increased the mean plasma levels of total (58 mg/dL [1.50 mmol/L]), LDL (50 mg/dL [1.30 mmol/L]), VLDL (8 mg/dL [0.21 mmol/L]), and non-HDL cholesterol (63 mg/dL [1.63 mmol/L]) mmol/L]) (P>.001 vs baseline for each); triglycerides (58 mg/dL [0.66 mmol/L]) (P>.001); and total apoB (49 mg/dL) (P>.001). Mean HDL cholesterol decreased significantly (P>.001), although apoA-I increased (4 mg/dL) (P=.23). Significant but less marked changes persisted in children observed after 12 and 24 months. Conclusions: A high-fat ketogenic diet produced significant increases in the atherogenic apoB-containing lipoproteins and a decrease in the anti-atherogenic HDL cholesterol. Further studies are necessary to determine if such a diet adversely affects endothelial vascular function and promotes inflammation and formation of atherosclerotic lesions.",
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T1 - Effect of a High-Fat Ketogenic Diet on Plasma Levels of Lipids, Lipoproteins, and Apolipoproteins in Children

AU - Kwiterovich, Peter O.

AU - Vining, Eileen P.G.

AU - Pyzik, Paula

AU - Skolasky, Richard

AU - Freeman, John M.

PY - 2003/8/20

Y1 - 2003/8/20

N2 - Context: Little prospective long-term information is available on the effect of a ketogenic diet on plasma lipoproteins in children with difficult-to-control seizures. Objective: To determine the effect in children with intractable seizures of a high-fat ketogenic diet on plasma levels of the major apolipoprotein B (apoB)-containing lipoproteins, low-density lipoprotein (LDL) and very LDL (VLDL); and the major apolipoprotein A-I (apoA-I)-containing lipoprotein, high-density lipoprotein (HDL). Design, Setting, and Patients A 6-month prospective cohort study of 141 children (mean [SD] age, 5.2 [3.8] years for 70 boys and 6.1 [4.4] years for 71 girls) with difficult-to-treat seizures who were hospitalized for initiation of a high-fat ketogenic diet and followed up as outpatients. This cohort constituted a subgroup of the 371 patients accepted into the ketogenic diet program between 1994 and 2001. A subset of the cohort was also studied after 12 (n = 59) and 24 (n = 27) months. Intervention: A ketogenic diet consisting of a high ratio of fat to carbohydrate and protein combined (4:1 [n=102], 3.5:1 [n=71, or3:1 [n=32]). After diet initiation, the calories and ratio were adjusted to maintain ideal body weight for height and maximal urinary ketosis for seizure control. Main Outcome Measures: Differences at baseline and 6-month follow-up for levels of total, VLDL, LDL, HDL, and non-HDL cholesterol; triglycerides; total apoB; and apoA-I. Results: At 6 months, the high-fat ketogenic diet significantly increased the mean plasma levels of total (58 mg/dL [1.50 mmol/L]), LDL (50 mg/dL [1.30 mmol/L]), VLDL (8 mg/dL [0.21 mmol/L]), and non-HDL cholesterol (63 mg/dL [1.63 mmol/L]) mmol/L]) (P>.001 vs baseline for each); triglycerides (58 mg/dL [0.66 mmol/L]) (P>.001); and total apoB (49 mg/dL) (P>.001). Mean HDL cholesterol decreased significantly (P>.001), although apoA-I increased (4 mg/dL) (P=.23). Significant but less marked changes persisted in children observed after 12 and 24 months. Conclusions: A high-fat ketogenic diet produced significant increases in the atherogenic apoB-containing lipoproteins and a decrease in the anti-atherogenic HDL cholesterol. Further studies are necessary to determine if such a diet adversely affects endothelial vascular function and promotes inflammation and formation of atherosclerotic lesions.

AB - Context: Little prospective long-term information is available on the effect of a ketogenic diet on plasma lipoproteins in children with difficult-to-control seizures. Objective: To determine the effect in children with intractable seizures of a high-fat ketogenic diet on plasma levels of the major apolipoprotein B (apoB)-containing lipoproteins, low-density lipoprotein (LDL) and very LDL (VLDL); and the major apolipoprotein A-I (apoA-I)-containing lipoprotein, high-density lipoprotein (HDL). Design, Setting, and Patients A 6-month prospective cohort study of 141 children (mean [SD] age, 5.2 [3.8] years for 70 boys and 6.1 [4.4] years for 71 girls) with difficult-to-treat seizures who were hospitalized for initiation of a high-fat ketogenic diet and followed up as outpatients. This cohort constituted a subgroup of the 371 patients accepted into the ketogenic diet program between 1994 and 2001. A subset of the cohort was also studied after 12 (n = 59) and 24 (n = 27) months. Intervention: A ketogenic diet consisting of a high ratio of fat to carbohydrate and protein combined (4:1 [n=102], 3.5:1 [n=71, or3:1 [n=32]). After diet initiation, the calories and ratio were adjusted to maintain ideal body weight for height and maximal urinary ketosis for seizure control. Main Outcome Measures: Differences at baseline and 6-month follow-up for levels of total, VLDL, LDL, HDL, and non-HDL cholesterol; triglycerides; total apoB; and apoA-I. Results: At 6 months, the high-fat ketogenic diet significantly increased the mean plasma levels of total (58 mg/dL [1.50 mmol/L]), LDL (50 mg/dL [1.30 mmol/L]), VLDL (8 mg/dL [0.21 mmol/L]), and non-HDL cholesterol (63 mg/dL [1.63 mmol/L]) mmol/L]) (P>.001 vs baseline for each); triglycerides (58 mg/dL [0.66 mmol/L]) (P>.001); and total apoB (49 mg/dL) (P>.001). Mean HDL cholesterol decreased significantly (P>.001), although apoA-I increased (4 mg/dL) (P=.23). Significant but less marked changes persisted in children observed after 12 and 24 months. Conclusions: A high-fat ketogenic diet produced significant increases in the atherogenic apoB-containing lipoproteins and a decrease in the anti-atherogenic HDL cholesterol. Further studies are necessary to determine if such a diet adversely affects endothelial vascular function and promotes inflammation and formation of atherosclerotic lesions.

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