Longitudinal changes in insulin resistance in children with epilepsy on ketogenic diet: Prevalence and risk factors

Introduction: The aim of the study was to evaluate the incidence of insulin resistance (IR) and the associated risk factors in children with epilepsy on a ketogenic diet (KD). Methods: This longitudinal cohort study analyzed data of children with epilepsy on KD. Insulin resistance was assessed using the homeostasis model assessment of insulin resistance (HOMA-IR). The HOMA-IR value, fasting serum insulin levels, fasting glucose (FG) levels, and lipid profiles were measured before the initiation of the KD and at 6- to 12-month intervals. Results: A total of 28 children were enrolled. The median age at the initiation of KD was 2.7 +/- 2.4 years, and the median follow-up duration was 2.1 +/- 1.4 years. The median HOMA-IR (NOMA-IR-1) value before the initiation of KD was 12 +/- 0.2, which significantly increased to 1.8 +/- 03 at the last follow-up (HOMA-IR-2; Delta HOMA-IR = 0.6 +/- 03, p < 0.001). The following factors were associated with patients with higher NOMA-IR-2 values (>= 1.9): younger age at seizure onset (0.3 +/- 02 years, p < 0.001), at the initiation of antiepileptic drugs (AEDs; 0.3 +/- 03 years, p < 0.001), and at the initiation of KD (1.3 +/- 05 years, p < 0.001) and higher serum alanine transaminase (ALT; 84.0 +/- 17.8 U/L, p = 0.022), total cholesterol (TC: 245.0 +/- 20.1 mg/dL, p = 0.001), low-density lipoprotein cholesterol (LDL-C, 103.0 +/- 6.7 mg/dL, p = 0.003), and triglyceride (387.0 +/- 28.8 p < 0.001) levels. Multivariate regression analysis revealed that the age at seizure onset (p <b>= 0.002), at initiation of AEDs (p = 0.021), and at initiation of KD (p = 0.022) and serum levels of LDL-C (p = 0.012) and triglycerides (p = 0.026) were associated with a significantly high HOMA-IR-2 value. Conclusion: Close monitoring of serum lipids levels, especially at younger age, may aid in detecting exacerbation of IR. (C) 2020 Elsevier Inc. All rights reserved.