Classic KD
The classic KD is fat: (protein+carbohydrate) with the mass ratio of 4: 1, that is to say, there are 4 parts of fat with the ratio of 1 (protein+carbohydrate), and the energy is 75-85% of the normal recommended amount. At the same time, we need to supplement a variety of vitamins and minerals. Fine food preparation and weighing are relatively complicated. Studies have shown that the effect of seizure control is positively related to the compliance of children and their families.
Modified Atkins diet
Atkins diet was originally invented by Dr. Atkins as a high-fat diet, and was later developed and popularized by Hopkins Hospital [1]. According to the low-carbon food measurement book, children's daily carbohydrate intake starts from 65,438+00g/d, and gradually increases to 65,438+05g/d after 65,438+0-3 months, and can increase to 20-30g/d according to the condition of illness. For teenagers and adults, 15g/d starts and gradually increases to 20-30g/d after 1 month; There are no special restrictions on calories, protein and liquids, so it is recommended to take them normally according to the daily dietary standard; Encourage eating high-fat foods, accounting for 60-70% of energy sources. Fat: (protein+carbohydrate) = 1.5: 1 or 2:1; Supplement low carbohydrate, multivitamins and minerals.
Low glycemic index (LGID)
The specific operation steps of Massachusetts General Hospital [2] are as follows: ① LGID is started in outpatient department, and experienced nutritionists educate patients, including the concept of GI and the role of LGID in epilepsy treatment, guide patients to read the labels of finished food, judge the content and source of carbohydrates, provide recipes, recommend the varieties of recipes and the trademarks of finished food; (2) According to the patient's three-day dietary survey and recommended energy intake, ensure the patient's growth and nutrition, set daily target calories, and distribute energy supply in proportion, in which fat accounts for 60% and protein accounts for 20%-30%; Menu plan can be discussed. Nutritionists will teach patients how to balance the amount of protein, fat and carbohydrates in each meal in a day. Food does not need to be weighed. According to the size of the food, patients can get a general idea of the food ingredients they eat every day. For example, an apple is equivalent to 15g carbohydrate, 1 ounce chicken is equivalent to 7g protein, and 1 teaspoon of tea oil contains 5g fat. ③ carbohydrate should be limited to 40~60g/d, and only foods with GI < 50g should be selected; ④ Encourage drinking water and supplement vitamins and minerals. ⑤ Inform possible adverse reactions, such as constipation, acidosis, weight loss, etc. If the patient is taking carbonic anhydrase inhibitors, potassium citrate can be added to prevent acidosis. ⑥ Follow-up once every three months after the first month, focusing on checking whether the growth, development and nutritional status of the children are appropriate, rechecking blood-related indexes, measuring height and weight, evaluating the efficacy and tolerance of LGID, and properly adjusting diet and taking oral antiepileptic drugs (AEDs).
Medium chain fatty acid diet (MCT)
Compared with KD, the medium-chain fatty acids used in MCT can be directly absorbed by intestinal epithelial cells without bile salt digestion, resulting in faster intestinal-liver circulation and higher ketone body production efficiency. Therefore, the restriction on carbohydrate and protein intake is smaller than KD, and the food selectivity is more. Food intake should be accurate to the gram. The preparation of MCT pays more attention to the percentage of heat provided by medium-chain fatty acid oil in total heat. In order to ensure that ketone body is the main energy supply substance, it generally needs to account for 50%-70% of the total heat. Medium-chain fatty acid oil is generally divided into 6 portions, which are fed in three meals and three meals [3]; Or improve MCT by absorbing 30% energy from medium-chain fatty acid oil and 40% energy from long-chain fatty acid, so as to reduce the gastrointestinal reaction caused by patients' intolerance to it. Follow-up was conducted one month after the start and every three months thereafter. During this period, according to the patient's tolerance and epilepsy control, the medium-chain fatty acid oil was increased by 0. 1g each time, or by 1g/d every 1-3 days. There is no clear limit on the intake ratio of the three nutrients; Need to supplement a variety of vitamins and minerals that do not contain carbohydrates.
To sum up, the classic KD is the earliest, the most widely used, the relatively complicated operation and the most widely used in clinic. At present, the research shows that MAD has no significant statistical difference with classical KD in effectiveness and effectiveness, and its operation is relatively simple and convenient. It can be used as a substitute for KD, and it can also be used in the normal diet stage after the seizure is completely controlled by strict KD. LGID reduces the proportion of fat, improves the taste of food, has simple operation, less adverse reactions, is more suitable for teenagers and adults, and the effective rate is close to KD. It is suggested that patients with intractable epilepsy without surgical indications try LGIT[4]. There are relatively few reports about MCT used alone in China.
[65] Liu Guoming, Liu Guoming, et al. Atkins Diet Therapy for Refractory Epilepsy [J]. China Journal of Epilepsy, 2002. Neurology, 2003.
[2] Pfeifer HH, Litzkowski, Tiller EA. Hypoglycemic index therapy: implementation and new understanding of curative effect. [J]。 Epilepsy, 2008
[3]Ym L, HS W. Medium-chain triglyceride ketogenic diet, an effective method to treat drug-resistant epilepsy and its comparison with other ketogenic diets [J]. Journal of Biomedicine, 20 13
[4] Li Shang, Gong Deshan, Guo Hui and so on. Research progress of low glycemic index diet in the treatment of epilepsy [J]. Journal of Epilepsy, 20 18