Ketogenic dietary therapy (KDT) initiation in the home setting - Does this influence adherence?

INTRODUCTION: The 45% MCT Ketogenic Diet is an established efficacious therapy; however a recent UK survey suggested <10% of children starting Ketogenic Dietary Therapy commenced an MCT‐based diet. The diet can be onerous for families to implement as all MCT, LCT (Long Chain Triglycerides), carbohydrate and fat adjusted protein portions should be weighed. Few foods are allowed freely. OBJECTIVES: This retrospective study investigated whether liberalising the MCT diet negatively affects compliance, degree of ketosis achieved, clinical efficacy or body weight. Liberalisation allowed low carbohydrate and protein‐based foods freely. Portions of LCT, carbohydrate (>5g) and MCT continued to be weighed according to the child’s calculated allowance. METHODS: Case notes of 54 consecutive patients prescribed a 45% MCT diet were reviewed; the last 27 to follow the traditional MCT diet (MCT KD) and the first 27 following the more flexible approach (fMCT). There were no exclusions. RESULTS: Dietary compliance improved on the fMCT diet; 23/27 had excellent compliance compared to 15/27 of children following the MCT KD. Optimal ketone levels were achieved earlier and were stronger at 3 months on the fMCT diet compared to the MCT KD; 29.5% and 18.5% respectively. Improved seizure burden (˃50% seizure reduction) at 3 months comparable; 12/27 on MCT KD compared to 13/27 on fMCT diet. Weight change and interquartile range were comparable with median weight Z score changes of 0.06 (MCT KD) and 0.05 (fMCT diet). However, the interquartile range of those following the fMCT diet indicated poorer weight gain in the first 3 months on therapy. CONCLUSIONS: The fMCT diet is an agreeable alternative way to teach and implement the use of a 45% MCT KDT; parents found it easier to comply with and the efficacy, degree of ketosis and rate of weight gain were not compromised.