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Prospective study of growth and bone mass in Swedish children treated with the modified Atkins diet

Journal article
Authors Anna Svedlund
Tove Hallböök
P. Magnusson
Jovanna Dahlgren
Diana Swolin-Eide
Published in European Journal of Paediatric Neurology
Volume 23
Issue 4
Pages 629-638
ISSN 1090-3798
Publication year 2019
Published at Institute of Clinical Sciences, Department of Pediatrics
Pages 629-638
Language en
Keywords Pediatric, Epilepsy, Vitamin D, Skeleton, Height, dual x-ray, ketogenic diet, intractable epilepsy, absorptiometry, osteoporosis, calcaneus, impact, igf-1, age, Neurosciences & Neurology, Pediatrics
Subject categories Pediatrics, Neuroscience


Purpose: The modified Atkins diet (MAD) is a less restrictive treatment option than the ketogenic diet (KD) for intractable epilepsy and some metabolic conditions. Prolonged KD treatment may decrease bone mineralization and affect linear growth; however, long-term studies of MAD treatment are lacking. This study was designed to assess growth, body composition, and bone mass in children on MAD treatment for 24 months. Methods: Thirty-eight patients, mean age (SD) 6.1 years (4.8 years), 21 girls, with intractable epilepsy (n = 22), glucose transporter type 1 deficiency syndrome (n = 7), or pyruvate dehydrogenase complex deficiency (n = 9) were included. Body weight, height, body mass index (BMI), bone mass, and laboratory tests (calcium, phosphorus, magnesium, alkaline phosphatase, cholesterol, 25-hydroxyvitamin D, insulin-like growth factor-I and insulin-like growth factor binding protein 3) were assessed at baseline and after 24 months of MAD treatment. Results: Approximately 50% of the patients responded with more than 50% seizure reduction. Weight and height standard deviation score (SDS) were stable over 24 months, whereas median (minimum maximum) BMI SDS increased from 0.2 (-3.3 to 4.5) to 0.7 (-0.9 to 2.6), p < 0.005. No effects were observed for bone mass (total body, lumbar spine and hip) or fat mass. Conclusions: The MAD was efficient in reducing seizures, and no negative effect was observed on longitudinal growth or bone mass after MAD treatment for 24 months. (C) 2019 Published by Elsevier Ltd on behalf of European Paediatric Neurology Society.

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