Zagrożenia związane z używaniem standardowych norm laboratoryjnych dla metabolizmu węglowodanów i tłuszczów u pacjentów na diecie niskogłowodanowej: doświadczenia z terapią dietą ketogeniczną u dzieci z epilepsją opornąna leki
Risks of using standard reference ranges for carbohydrate and lipid metabolism in low-carbohydrate diets: insights from ketogenic diet therapy in children with refractory epilepsy
W skrócie
Dieta ketogeniczna jest skuteczna w leczeniu epilepsji opornej na leki u dzieci, ale znacząco zmienia wartości cukru i tłuszczów we krwi. Badacze wykazali, że standardowe normy laboratoryjne nie są odpowiednie dla pacjentów na tej diecie, ponieważ mogą ukrywać problemy z metabolizmem glukozy. Dlatego dzieci leczone dietą ketogeniczną powinny być badane przy użyciu specjalnych norm dostosowanych do ich rodzaju diety, aby nie przegapić ważnych zaburzeń metabolicznych.
Oryginalny abstract (angielski)
INTRODUCTION: Ketogenic diet (KD) therapy is effective for refractory epilepsy but significantly impacts carbohydrate and lipid metabolism. We previously encountered a patient who developed diabetes during KD; metabolic abnormalities were undetected by conventional criteria for diabetes, suggesting standard criteria are inapplicable. This study aimed to establish specialized metabolic reference ranges for patients on KD. METHODS: We retrospectively analyzed laboratory data from 18 pediatric patients with refractory epilepsy treated with KD. Geometric means and reference ranges (mean ± 2SD) were calculated using mixed-effects models to account for repeated measures. RESULTS: Before KD, geometric means (reference ranges) were: random plasma glucose (RPG), 96.7 (79.1-118.3) mg/dL; HbA1c (NGSP), 4.76% (4.22-5.36); HbA1c (IFCC), 29 (23-35) mmol/mol; total cholesterol (T-Cho), 159.1 (98.8-256.5) mg/dL; and triglycerides (TG), 107.3 (41.4-277.8) mg/dL. During KD, values were: RPG, 77.6 (59.8-100.6) mg/dL; HbA1c (NGSP), 4.09% (3.58-4.69); HbA1c (IFCC), 21 (16-28) mmol/mol; T-Cho, 184.5 (113.3-300.7) mg/dL; and TG, 155.5 (48.2-501.7) mg/dL. Multiple mixed-effects models showed that KD significantly lowered HbA1c and RPG but increased T-Cho, HDL-Cho, TG, and free fatty acids. Changes in LDL-Cho were not statistically significant. CONCLUSION: KD therapy significantly lowers HbA1c and RPG while increasing lipid profiles. Consequently, impaired glucose tolerance may be masked by "normal" values if conventional criteria are used. To avoid delayed diagnosis, patients on KD should be evaluated using specialized reference ranges specific to their dietary therapy. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13340-026-00906-5.