Evaluation of bone health in children with intractable epilepsy treated with the ketogenic diet on a long-term basis
A combination of quantitative, retrospective longitudinal cohort and survey research at the Erasmus MC Sophia Children’s HospitalEvaluation of bone health in children with intractable epilepsy treated with the ketogenic diet on a long-term basis
A combination of quantitative, retrospective longitudinal cohort and survey research at the Erasmus MC Sophia Children’s HospitalSamenvatting
Introduction: Intractable epilepsy can be treated with the Ketogenic diet (KD). One of the side-effects of the KD is poor bone health. Experience from the Erasmus MC Sophia Children’s Hospital (EMCS) shows that the status of bone mineral density (BMD) is unknown in many cases. This makes it difficult for the dietitian to ascertain the required amount of vitamin D and calcium supplementation. By investigating the status of bone health, vitamin D and calcium supplementation can be adjusted and suggestions to improve the treatment protocol can be made. The main question of this research is: ‘What is the status of bone health in patients with intractable epilepsy treated with the ketogenic diet on a long-term basis (>1 year) aged 0 to 18 years at the Erasmus MC Sophia Children’s Hospital?’
Method: This thesis exists of quantitative retrospective longitudinal cohort and descriptive survey research. The research population was derived from 136 patients aged 0 to 18 years with intractable epilepsy treated with the KD at the EMCS. Multiple patient characteristics and variables were collected among which the amount of calcium supplementation. BMD measurements and SD Z-scores were collected to the extent of availability. Multiple tests were used to research whether BMD of the research population deviated from the reference value and if there was loss of BMD during treatment. Furthermore, it was tested whether there was a significant correlation between patient characteristics, variables and BMD. A survey was held among KD-professionals. The survey focused on information regarding monitoring of BMD and their point of view on bone health to create an evaluation framework for the EMCS.
Results: BMD was known in 39% of the research population (N=18) which existed of 46 patients. The median BMD was -2 (IQR 1,6) SD Z-score, which is equal to the reference value. The median calcium supplementation was 36% of the Dutch RDA (ADH). There was no significant loss of BMD during treatment with the KD, neither was there a significant correlation between patient characteristics, variables and BMD. However, there was a trend found in calcium supplementation (P0,075). A total of 8 surveys were completed with a 100% response. Immobility, use of anti-epileptic drugs, darker skin, limited exposure to sunlight and treatment with the Modified Atkins KD were considered risk factors for decreased BMD. The median calcium supplementation in other institutes was 100%/ADH (IQR 94).
Conclusion and discussion: Status of bone health can be considered as ‘just in range’. However, this deserves a critical note due to the wide spread (IQR 1,6) and little availability of BMD measurements (N=18). There was no significant loss of BMD during treatment, although the study by Bergqvist et al. (2008) does show this. There was no significant correlation found between patient characteristics, variables and BMD, although there are multiple studies that show significant correlation. Other institutes also scored multiple risk factors for decreased BMD. Nevertheless, calcium supplementation was notably lower in patients with decreased BMD (P0,075). Furthermore, calcium supplementation was notably lower than in other institutes (36%/ADH versus 100%/ADH).
Organisatie | De Haagse Hogeschool |
Opleiding | GVS Voeding en Diëtetiek |
Afdeling | Faculteit Gezondheid, Voeding & Sport |
Partner | Erasmus MC Sophia Kinderziekenhuis, Rotterdam |
Jaar | 2018 |
Type | Bachelor |
Taal | Engels |