Classical and Modified Ketogenic Diets for Children and Young People With Drug-Resistant Epilepsy: A Reflection of International Dietetic Practice and Best Practice Recommendations for Dietitians

Abstract

INTRODUCTION: A global need was identified for a practical, comprehensive tool to guide dietitians internationally working in ketogenic diet therapy (KDT), detailing all aspects of dietetic management. The aim of this project was to develop best practice recommendations for the dietetic management of classical and modified ketogenic diets in the management of epilepsy and neurometabolic conditions. METHODS: Expert ketogenic dietitians from six continents were invited to participate as members of either a core working group or advisory group. A systematic literature review was conducted, covering all aspects of dietetic management, from patient selection to diet discontinuation. To complement this, an international survey was distributed to ketogenic dietitians currently delivering classical and modified ketogenic diets, structured around the same key themes. RESULTS: A total of 111 dietitians responded to the survey, representing six continents. For each theme, findings from the literature were presented alongside survey responses. Recommendations were generated where ≥ 75% consensus was achieved. In areas where this threshold was not met, the most commonly reported practices were presented, acknowledging the variety of international approaches. CONCLUSION: These are the first international best practice recommendations specifically for ketogenic dietitians and nutrition healthcare professionals supporting children following medically advised classical and modified ketogenic diets. The recommendations are informed by both published evidence and prevailing international dietetic practice, whilst recognizing the variety in clinical delivery.