The effect of olive oil-based ketogenic diet on serum lipid levels in epileptic children

Abstract

Ketogenic diet (KD) is one of the most effective therapies for intractable epilepsy. Olive oil is rich in monounsaturated fatty acids and antioxidant molecules and has some beneficial effects on lipid profile, inflammation and oxidant status. The aim of this study was to evaluate the serum lipid levels of children who were receiving olive oil-based KD for intractable seizures at least 1 year. 121 patients (mean age 7.45 ± 4.21 years, 57 girls) were enrolled. At baseline and post-treatment 1, 3, 6, and 12 months body mass index-SDS, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol and triglyceride levels were measured. Repeated measure ANOVA with post hoc Bonferroni correction was used for data analysis. The mean duration of KD was 15.4 ± 4.1 months. Mean total cholesterol, LDL-cholesterol and triglyceride levels were significantly higher at 1st, 3rd, 6th and 12th months of the KD treatment, compared to pre-treatment levels (p = 0.001), but showed no difference among during-treatment measurements. Mean body mass index-SDS and HDL-cholesterol levels were not different among the baseline and follow-up time points (p = 0.113 and p = 0.067, respectively). No child in this study discontinued the KD because of dyslipidemia. Even if rich in olive oil, high-fat KD causes significant increase in LDL-cholesterol and triglyceride levels. More studies are needed to determine the effect of KD on serum lipids in children using different fat sources in the diet.

Optimal clinical management of children receiving dietary therapies for epilepsy: Updated recommendations of the International Ketogenic Diet Study Group

“…146 Strategies to prevent KDinduced hyperlipidemia include increasing consumption of MCT and olive oil, supplementing with omega-3 fatty acid or carnitine while decreasing the intake of trans fat, saturated fat, and cholesterol; decreasing the KD ratio; and excluding all fatty meats, egg yolk, cream, butter, animal fat, palm oil and coconut oil; and using a solely formulabased KD. [146][147][148] Although the risk for coronary artery disease may increase with long-term elevations of cholesterol levels, previous pediatric studies showed no change in the carotid intima-media thickness compared to baseline at 6 and 12 months of therapy. 150,151 On the other hand, local and systemic arterial stiffness was significantly increased in 2 studies involving children and young adults, correlated with serum cholesterol and triglycerides levels.…”

“…137,[145][146][147][148] Increased serum triglycerides and total and low-density lipoprotein (LDL) cholesterol levels have been reported in 14-59% of children on the classic KD. 129,137,147,148 Hyperlipidemia can be seen as early as the first month of therapy. 148 Preliminary data suggest that despite an early increase in serum lipids during the first months of KDT, this increase is usually temporary.…”

“…129,137,147,148 Hyperlipidemia can be seen as early as the first month of therapy. 148 Preliminary data suggest that despite an early increase in serum lipids during the first months of KDT, this increase is usually temporary. In one study, 60% of those on the classic KD had hypercholesterolemia (>200 mg/dl).…”

Non-ketogenic combination of nutritional strategies provides robust protection against seizures

“…In this regard, the combined nutritional strategy we propose herein would most likely be beneficial as, besides its much lower fat content, it provides several nutrients with beneficial effects. Indeed, polyunsaturated fatty acids provided in rapeseed oil were found to improve lipid content of children with hypercholesterolaemia 43 and a polyunsaturated fatty acids rich olive oil based KD showed reduced dyslipidaemia 44 . Medium-chain fatty acids have also been found to reduce cholesterol, triglycerides and lipoproteins levels 36 .…”

Advances in clinical neurology through the journal “Neurological Sciences” (2015–2016)

“…The best withdrawal rate of antiepileptic monotherapy in seizure-free adult patients with epilepsy is questionable [157]. Ketogenic diet (KD) is one of the most effective therapies for intractable epilepsy, and, even if rich in olive oil, high-fat KD causes significant increase in LDL-cholesterol and triglyceride levels [158].…”