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Effect of Ketogenic diet (KD) on Growth Parameters – what is the reality?

Several reports had mentioned that growth is affected negatively by the KD. But a few reported to the contrary. Let us analyze these reports as this is a very important aspect of the safety of KD as it is mainly used in infants and children. Along with this we should also look at the impact of the KD on brain development. Our centre will soon be collating and publishing our data on both these aspects. Till then let us summarize the existing published data.

The first report from Johns Hopkins by Vining et al found in a prospective study spanning 24 months that the height-Z scores did indeed decline but fell more than 2SDs only in the younger children and not in older children 1.

Williams et al. from the UK in a retrospectively analysis found that height percentiles to fall from baseline in 18 children after 24 months on the diet 2. Similarly, Peterson et al. also found height Z-score to show a significant decrease between the 6th to 12th month 3. However, Neal et al. from the UK found a more marked drop in height in boys than girls 4.

Kim et al from South Korea found significant effect on height and weight gain among children with epilepsy after prolonged KD 5.

All of the above trials had used a restricted form of KD (usually75% of the RDA).

In a recent publication where calorie restriction was not used only 4 of 34 patients had a more than 1SDS drop in height. However, the authors rightly point out that only BMI Z-scores values should not be analyzed as an increase in weight with halted or even decreased height will reflect as an increase in BMI scores. On the other hand, a simultaneous weight and height will give a fallacious steady BMI Z-score 6.

We will be soon looking at all these angles and growth parameters after withdrawal of the KD. Most importantly we will analyze what in our opinion is the most important – a correlation with the all-important mental growth in children and adolescents.   

References:    

  1. Vining, E. P., Pyzik, P., McGrogan, J., Hladky, H., Anand, A., Kriegler, S., & Freeman, J. M. (2002). Growth of children on the ketogenic diet. Developmental medicine and child neurology44(12), 796-802.
  2. Williams, S., Basualdo-Hammond, C., Curtis, R., & Schuller, R. (2002). Growth retardation in children with epilepsy on the ketogenic diet: a retrospective chart review. Journal of the Academy of Nutrition and Dietetics102(3), 405.
  3. Peterson, S. J., Tangney, C. C., Pimentel-Zablah, E. M., Hjelmgren, B., Booth, G., & Berry-Kravis, E. (2005). Changes in growth and seizure reduction in children on the ketogenic diet as a treatment for intractable epilepsy. Journal of the American Dietetic Association105(5), 718-724.
  4. Neal, E. G., Chaffe, H. M., Edwards, N., Lawson, M. S., Schwartz, R. H., & Cross, J. H. (2008). Growth of children on classical and medium-chain triglyceride ketogenic diets. Pediatrics122(2), e334-e340.
  5. Kim, J. T., Kang, H. C., Song, J. E., Lee, M. J., Lee, Y. J., Lee, E. J., … & Kim, H. D. (2013). Catch-up growth after long-term implementation and weaning from ketogenic diet in pediatric epileptic patients. Clinical nutrition32(1), 98-103.
  6. Ferraris, C., Guglielmetti, M., Pasca, L., De Giorgis, V., Ferraro, O. E., Brambilla, I., Leone, A., De Amicis, R., Bertoli, S., Veggiotti, P., & Tagliabue, A. (2019). Impact of the Ketogenic Diet on Linear Growth in Children: A Single-Center Retrospective Analysis of 34 Cases. Nutrients11(7), 1442. https://doi.org/10.3390/nu11071442

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