The ketogenic diet is traditionally introduced with an initial period of fasting. This study compares the efficacy and tolerability of the introduction of a prediet (2:1 ratio of fat:protein + carbohydrates) before hospitalization with the aim at reducing the time of same and the period of fasting necessary to reach ketosis. For a minimum period of 1 year, adverse effects, metabolic profile, and linear growth were prospectively evaluated in 46 children. Twenty-three children received a prediet for a period of 10 days, and in the other 23 children, the ketogenic diet was introduced by hospitalization regimen after a fasting period. The use of the prediet led to a shorter fasting period of a mean 18.3 hours compared with the group without prediet, in which the fasting period was 41.3 hours (P = .001). At the end, there was no difference in the adverse effects between the groups. In those submitted to the prediet, a better adaptation to the diet and acceptance to the proposal of introducing the ketogenic diet were observed.
Talbot FB, Metcalf KM, Moriarty MEEpilepsy, chemical investigation of rational treatment by production of ketosis . Am J Dis Child.1927;33:218-225.
3.
McQuarrie I.Epilepsy in children: the relationship of water balance to the occurrence of seizures. Am J Dis Child.1929;38:451-467.
4.
McQuarrie I., Keith HMEpilepsy in children. Relationship of variations in the degree of ketonuria to occurrence of convulsions in epileptic children on ketogenic diets. Am J Dis Child.1927;34:1013-1029.
5.
Commission on Classification and Terminology of the International League Against Epilepsy.Proposal for revised clinical and electroencephalographic classification of epileptic seizures . Epilepsia. 1981;22:489-501.
6.
Freeman JM, Kelly MT, Freeman JBThe Epilepsy Diet Treatment: An Introduction to the Ketogenic Diet. New York, NY: Demos Vermande; 1996 .
7.
Huttenlocher PRKetonaemia and seizures: metabolic and anticonvulsant effects of the two ketogenic diets in childhood epilepsy. Pediatr Res.1976;10:536-540.
8.
Panico LR, Rios VG, Demartini MG, Carniello MAEvolución electroencefalográfica de un grupo de pacientes en tratamiento con dieta cetogénica. Rev Neurol.2000;30:8-15.
9.
Centers for Disease Control and Prevention.Growth Charts for the United States: Methods and Development. Series Report 11, No. 246.201. Atlanta, Ga: Centers for Disease Control and Prevention; 2000.
10.
Kim DW, Kang HC, Park JC, Kim HDBenefits of the nonfasting ketogenic diet compared with the initial fasting ketogenic diet. Pediatrics. 2004;114:1627-1630.
11.
Shields L.A review of the literature from developed and developing countries relating to effects of hospitalization on children and parents. Int Nurs Rev. 2001;48:29-37.
12.
Agazio JB, Ephraim P., Flaherty NJ, Gurney CAEffects of non-local geographically separated hospitalizations upon families . Mil Med.2003;168:778-783.
13.
Child Life Services.Committee on Hospital Care. American Academy of Pediatrics. Pediatrics . 2000;106:1156-1159.
14.
Katyal NG, Koehler AN, McGhee B., Foley CM, Crumrine PKThe ketogenic diet in refractory epilepsy: the experience of children's Hospital of Pittsburgh. Clin Pediatr.2000;39:153-159.
15.
Prasad AN, Stafstrom CF, Holmes GLAlternative epilepsy therapies: the ketogenic diet, immunoglobulins and steroids . Epilepsia. 1996;37(suppl 1):S81-S95.
16.
Wirrell EC, Darwish HZ, Williams-Dyjur C., Blackman M., Lange V.Is a fast necessary when initiating the ketogenic diet?J Child Neurol.2002;17:179-182.
17.
Nordli DR, De Vivo DCThe ketogenic diet revisited: back to the future. Epilepsia . 1997;38:743-749.
18.
Nordli DR, Kuroda MM, Carrol J., et al. Experience with the ketogenic diet in infants. Pediatrics. 2001;108:129-133.
19.
Couch SC, Schwarzman F., Carroll J., et al. Growth and nutritional outcomes of children treated with the ketogenic diet. J Am Diet Assoc.1999;99:1573-1575.
20.
Schwartz RM , Boyes S., Aynsley-Green A.Metabolic effects of three ketogenic diets in the treatment of severe epilepsy. Dev Med Child Neurol.1989;31:152-160.
21.
Galván-Manso M., Arellano M., Sans A., Sanmarti FX, Gómez L.Dieta cetogénica: una alternativa válida en epilepsias refractarias. Rev Neurol.2001;33:1010-1014.
22.
Hemingway C. , McGrogan J., Freeman JMEnergy requirements of spasticity. Dev Med Child Neurol.2001;43:277-278.
23.
Kraus H., Schlenker S., Schwedesky D.Developmental changes of cerebral ketone body utilization in human infants. Hoppe SeylerZ Physiol Chem. 1974;355:164-170.
24.
Dahlquist G. , Persson B.The rate of cerebral utilization of glucose, ketone bodies and oxygen: a comparative in vivo study of infant and adult rats. Pediatr Res.1976;10:910-917.
25.
Kinsman SL, Vining Epg, Quaskey SA, Mellits D., Freeman JMEfficacy of the ketogenic diet for intractable seizure disorders: review of 58 cases. Epilepsia. 1992;33:1132-1136.
26.
Livingston S., Pauli LL, Pruce I.Ketogenic diet in the treatment of childhood epilepsy. Dev Med Child Neurol.1977;19: 833-834.
27.
Vining Epg, Freeman JM, Ballaban-Gil K., et al. A multicenter study of the efficacy of the ketogenic diet. Arch Neurol.1998; 55:1433-1437.
28.
Huttenlocher PR, Hapke RJA follow-up study of intractable seizures in childhood. Ann Neurol.1990;28:699-705.
29.
Nordli D.The ketogenic diet: uses and abuses. Neurology. 2002;58(suppl 7):S21-S24.
30.
Stafstrom CE , Spencer S.The ketogenic diet: a therapy in search of an explanation. Neurology. 2000;54:282-283.
31.
Santoro KBChildren and the ketogenic diet. J Am Diet Assoc.2005;105:725-726.
