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The Relationship Between Serum Carnitine Levels and Ketones in Children with Epilepsy Following a Ketogenic Diet

Linek, Madison K
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1573571647173707

Abstract Details

2019, MS, University of Cincinnati, Allied Health Sciences: Nutrition.
The ketogenic diet (KD) has been used to treat epilepsy since the 1920s. The diet mimics the effects of starvation, which has been shown to significantly reduce seizure frequency by an unknown mechanism. The KD is high in fat (90% of total calories) and, in the absence of sufficient carbohydrate, promotes fat oxidation and the production of ketones to be used for energy. Carnitine is a protein that plays a key role in the transfer of long chain fatty acids into the mitochondria for oxidation and conversion to ketones from acetyl-CoA. Current literature indicates that children with epilepsy on a KD tend to become carnitine deficient, presumably due to the high demand for carnitine to metabolize dietary fat. This deficiency may affect the state of ketosis and therefore, reduce efficacy of the diet in preventing seizures. Thus, carnitine supplementation has been considered helpful in this population to prevent deficiency and maintain ketosis. However, the necessity and efficacy of this supplementation practice has not been fully assessed and the relationship between serum carnitine and ketone levels is not well defined. OBJECTIVE: To examine the relationship between carnitine supplementation, free serum carnitine, and ketone levels in children with epilepsy following a ketogenic diet either given by mouth or by enteral feeding. METHODS: A retrospective chart review was conducted on 38 pediatric patients with epilepsy following a KD for seizure control. Free carnitine levels, carnitine supplement dose (if applicable) and blood ketones were collected after KD initiation. Data were analyzed using generalized linear mixed models and repeated measures regression to determine changes over time in serum carnitine and ketone levels. Covariates included were age, gender, feeding method (enteral or oral), presence of comorbidities, and BMI. RESULTS: On average, patients were 9 years old, (3-26 years old) and followed KD for approximately 10.5 months. There was no significant relationship detected between serum carnitine or carnitine supplementation and ketone levels in this population. Of the patients visits recorded, 24% involved the patient taking a carnitine supplement, 25% of serum carnitine measurements were considered low (<25 umol/L), 12% were considered high (>50 umol/L), and the majority was within normal range. In terms of ketone measurements, only 1% were considered low (<10 mg), 29% were considered high (>54 mg), and the majority was within normal range. CONCLUSION: While carnitine supplementation is commonly prescribed to prevent inadequate ketosis and related complications in this population, no significant relationship was observed between serum carnitine and ketone levels. This practice should be further evaluated to determine the necessity and efficacy of providing carnitine supplementation to patients with epilepsy following a KD.
Abigail Peairs, Ph.D. (Committee Chair)
Sarah Couch, Ph.D. (Committee Member)
38 p.
Nutrition
Epilepsy; Ketogenic Diet; Carnitine; Carnitine Supplement; Ketones; Pediatric

Recommended Citations

Citations

  • Linek, M. K. (2019). The Relationship Between Serum Carnitine Levels and Ketones in Children with Epilepsy Following a Ketogenic Diet [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1573571647173707

    APA Style (7th edition)

  • Linek, Madison. The Relationship Between Serum Carnitine Levels and Ketones in Children with Epilepsy Following a Ketogenic Diet. 2019. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1573571647173707.

    MLA Style (8th edition)

  • Linek, Madison. "The Relationship Between Serum Carnitine Levels and Ketones in Children with Epilepsy Following a Ketogenic Diet." Master's thesis, University of Cincinnati, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1573571647173707

    Chicago Manual of Style (17th edition)

ucin1573571647173707
845
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This open access ETD is published by University of Cincinnati and OhioLINK.