The ketogenic diet (KD) is an established, effective, nonpharmacologic treatment for children with pharmacoresistant epilepsy. Although the KD is the most well-established dietary therapy for epilepsy, it is too restrictive and is associated with serious complications; therefore, alternative lower-fat diets, including a modified Atkins diet and low-glycemic index diet, have been developed. Recent ongoing clinical evidence suggests that other dietary therapies have an efficacy almost comparable to that of the KD. In addition, a diet rich in polyunsaturated fatty acids appears to increase the efficacy of diet therapy and reduce the complications of a high-fat diet. Here, we review the systematic information about lower-fat diets and better-quality dietary therapies and the current clinical status of each of these dietary approaches.
Child ; Diet ; Diet, Carbohydrate-Restricted ; Diet, High-Fat ; Epilepsy ; Fatty Acids, Unsaturated ; Humans ; Ketogenic Diet

The ketogenic diet (KD) is an established, effective, nonpharmacologic treatment for children with pharmacoresistant epilepsy. Although the KD is the most well-established dietary therapy for epilepsy, it is too restrictive and is associated with serious complications; therefore, alternative lower-fat diets, including a modified Atkins diet and low-glycemic index diet, have been developed. Recent ongoing clinical evidence suggests that other dietary therapies have an efficacy almost comparable to that of the KD. In addition, a diet rich in polyunsaturated fatty acids appears to increase the efficacy of diet therapy and reduce the complications of a high-fat diet. Here, we review the systematic information about lower-fat diets and better-quality dietary therapies and the current clinical status of each of these dietary approaches.
Child ; Diet ; Diet, Carbohydrate-Restricted ; Diet, High-Fat ; Epilepsy ; Fatty Acids, Unsaturated ; Humans ; Ketogenic Diet

With the recent assertions made by certain Korean media that low-carbohydrate, high-fat diets are panaceas for weight reduction and health improvement, such diets have been in the public spotlight. Medical and nutrition professionals have claimed that the inordinate popularity of low-carbohydrate, high-fat diets may pose a significant threat to public health. The aim of this review was to explore the latest evidence on the effectiveness and safety of low-carbohydrate diets. Recent clinical trials have shown that low-carbohydrate diets result in favorable changes in body weight and biochemical cardiovascular risk factors. However, the safety of low-carbohydrate diets remains inconclusive in the long term. Although the latest guidelines for the management of obesity recommend obese adults to use low-carbohydrate diets as an alternative dietary approach to achieve weight loss depending on each patient's dietary habits and medical status, such diets cannot currently be recommended as a strategy for health promotion among the general population due to long-term safety concerns. The results of cohort studies in Japan that have shown moderate diets lower in carbohydrates to be associated with decreased risks of cardiovascular mortality, total mortality, and type 2 diabetes in Japanese women, suggest that a low-glycemic load diet might be an optimal dietary approach for Korean obese adults with insulin resistance.
Adult ; Asian Continental Ancestry Group ; Body Weight ; Carbohydrates ; Cohort Studies ; Diet ; Diet, Carbohydrate-Restricted ; Diet, High-Fat ; Female ; Food Habits ; Health Promotion ; Humans ; Insulin Resistance ; Japan ; Mortality ; Obesity ; Public Health ; Risk Factors ; Weight Loss

Prevalence of non-alcoholic fatty liver disease (NAFLD) is about 20-25% in Korean adults population. Obesity is strongly associated with NAFLD and the prevention of obesity is a major public issue. Unfortunately, pharmacological treatment of obesity and NAFLD remains uncertain. Only weight loss by dietary changes been shown to lead to histological improvement in fatty liver. So the nutrition therapy is a cornerstone of treatment for NAFLD. Epidemiologic studies show that saturated fat, trans-fatty acid, carbohydrate, and simple sugar have strong correlation with intrahepatic fat accumulation. But, true associations with specific nutrients still remain unclear. Recently, fructose consumption has been rising in many countries and several epidemiologic studies show that fructose consumption has strong correlation with metabolic diseases. The consumption of excessively added sugar in the pathogenesis of steatohepatitis has received attention. Most clinicians agree with lifestyle modification are effective in histologic improvement. Total energy intake restriction is the most important action to reduce intrahepatic fat accumulation. Macronutrient composition may also have correlation with the development of NAFLD. To reduce the incidence of NAFLD, public statements on optimal dietary education program have been issused. Various specific dietary programs are suggested. Among them low fat diet and low carbohydrate diet are suggested in patients with NAFLD. However, there is no ideal diet to obtain the histological improvement in NAFLD. Further randomised controlled studies about specific diet are needed to determine the long-term benefit and histological improvement by ideal diet. Tailoring diet therapy to a patient's lifestyle is more important than universal specific dietary program.
*Diet ; Diet, Carbohydrate-Restricted ; Diet, Fat-Restricted ; Dietary Proteins/metabolism ; Energy Intake ; Fatty Acids, Monounsaturated/metabolism ; Fatty Liver/diet therapy/epidemiology/*etiology ; Humans

BACKGROUND AND OBJECTIVES: Endothelial dysfunction is an early change in the process of atherosclerosis. To evaluate endothelial function, expensive and specialized medical devices like high-resolution vascular ultrasound are necessary. Therefore, we sought to compare this atherosclerotic parameter of endothelial function using the inexpensive and simple method of peripheral pulse arrival time (PPAT) measurement. SUBJECTS AND METHODS: Before and after meals, we measured PPAT and flow-mediated vasodilation (FMD). Resting PPAT in both arms was measured with a PPAT device that was designed by the authors. Hyperemic effect was tested in both arms after raising the blood pressure to 250 mmHg for 5 minutes by using a blood pressure cuff, after which the cuff was released to 0 mmHg. PPAT was measured within the first 1 minute to observe the hyperemic response. FMD was measured in the same process by 7 MHz high-resolution ultrasound in the left brachial artery. The percent change was calculated from the baseline value and that of the hyperemic response. RESULTS: In low-fat diet, PPAT change was not different (3.8% vs. 4.7%, p>0.05). In high-fat diet, PPAT tended to be shorter, but without statistical significance (4.8% vs. 2.7%, p>0.05). In low-fat diet, the change of FMD was not different (11.7% vs. 11.4%, p>0.05). In high-fat diet, there was a significant difference in FMD (11.4% vs. 6.5%, p<0.05). CONCLUSION: The PPAT measurement could be a method for evaluating endothelial function, but is less sensitive than flow-mediated vasodilation.
Arm ; Atherosclerosis ; Blood Pressure ; Brachial Artery ; Diet, Fat-Restricted ; Diet, High-Fat ; Meals ; Ultrasonography ; Vasodilation

In this study, we determined how rosiglitazone (RSG) differentially affected hippocampal neurogenesis in mice fed a low-fat diet (LFD) or high-fat diet (HFD; 60% fat). LFD and HFD were given to the mice for 8 weeks. Four weeks after initiating the LFD and HFD feeding, vehicle or RSG was administered orally once a day to both groups of mice. We measured cell proliferation and neuroblast differentiation in the subgranular zone of the dentate gyrus using Ki67 and doublecortin (DCX), respectively, as markers. In addition, we monitored the effects of RSG on the levels of DCX and brain-derived neurotrophic factor (BDNF) in hippocampal homogenates. At 8 weeks after the LFD feeding, the numbers of Ki67- and DCX-positive cells as well as hippocampal levels of DCX and BDNF were significantly decreased in the RSG-treated group compared to the vehicle-treated animals. In contrast, the numbers of Ki67- and DCX-positive cells along with hippocampal levels of DCX and BDNF in the HFD fed mice were significantly increased in the RSG-treated mice compared to the vehicle-treated group. Our data demonstrate that RSG can modulate the levels of BDNF, which could play a pivotal role in cell proliferation and neuroblast differentiation in the hippocampal dentate gyrus.
Animals ; Blotting, Western ; Brain-Derived Neurotrophic Factor/metabolism ; Cell Differentiation/drug effects ; Cell Proliferation/drug effects ; Dentate Gyrus/growth & development ; Dentate Gyrus/physiology ; Diet, Fat-Restricted ; Diet, High-Fat ; Hippocampus/growth & development ; Hippocampus/physiology ; Hypoglycemic Agents/pharmacology ; Immunohistochemistry ; Ki-67 Antigen/metabolism ; Male ; Mice, Inbred C57BL ; Microtubule-Associated Proteins/metabolism ; Neurogenesis/drug effects ; Neuropeptides/metabolism ; Thiazolidinediones/pharmacology

Obesity is associated with a state of chronic low-grade inflammation. This abnormal inflammation state may cause metabolic dysfunction. Many studies have supported the claim that immune cells such as adipose tissue macrophage and invariant natural killer T-cells (iNKT) are related to the development of metabolic diseases like diabetes. It has recently been reported that while human adenovirus 36 (Ad36) infection is associated with human obesity, it also helps to improve the serum level of lipid factors (glycemic control). However, the detailed cellular mechanism remains unclear. This study (The Journal of Clinical Investigation, 2012;122:3343-54) showed that iNKT cell-deficient mice on a low-fat diet used as a control for high-fat diet boasted insulin resistance phenotype without adipose tissue inflammation. The results of this study offer insight into the possibility of a novel role for iNKT related to the improvement of metabolic diseases, especially insulin resistance, and hint that Ad36-induced inflammation may be associated with iNKT in adipose tissue, while also playing a role in the improvement of glycemic control.
Adenoviruses, Human ; Adipose Tissue ; Animals ; Diet, Fat-Restricted ; Diet, High-Fat ; Humans ; Inflammation ; Insulin Resistance ; Macrophages ; Metabolic Diseases ; Mice ; Natural Killer T-Cells ; Obesity ; Phenotype

PURPOSE: The prevalence of metabolic syndrome has increased in both the adult population and in adolescents. How-ever, few studies have been conducted for adolescents. The aim of this study was to examine the association of metabolic syndrome and its risk factors with high carbohydrate diet and high fat diet using data from the Korea National Health and Nutrition Examination Survey (1998-2009). METHODS: Using the Acceptable Macronutrient Distribution Range for Korean Dietary Reference Intakes, subjects whose energy intake from carbohydrate was greater than 70% and from fat was less than 15% were classified as the 'High-carbohydrate & low-fat diet (HCLF)' group and subjects whose energy intake from carbohydrate was less than 60% and from fat was 25% or more were classified as the 'Low-carbohydrate & high-fat Diet (LCHF)' group. Among 5,931 eligible subjects, HCLF included 853 subjects and LCHF included 1,084 subjects. RESULTS: The mean age in both groups was 14 years and significant difference in age, BMI, sex, physical activity, and household income was observed between the HCLF and LCHF groups. Regarding the energy intake compared to Estimated Energy Re-quirement, the HCLF group met 79.0% and the LCHF group met 100.3%. Regarding nutrient intake per 1,000 kcal, carbo-hydrate, iron, potassium, and vitamin C intake in the HCLF group were significantly higher, but protein, fat, calcium, phos-phorus, vitamin A, thiamin, riboflavin, and niacin intakes were significantly lower in the HCLF group compared to the LCHF group. After adjusting for age, sex, BMI, study year, household income, physical activity, and energy intake, the serum tri-glycerides level and systolic blood pressure were slightly higher, while the serum HDL-cholesterol level was significantly lower in HCLF than LCHF. The odds ratio of metabolic syndrome did not differ significantly between HCLF and LCHF. CONCLUSION: Our findings indicate an association of a high carbohydrate diet with increased risks for metabolic syndrome components. Conduct of future studies would be necessary in order to explore the underlying mechanism and to confirm our findings in a prospective study.
Adolescent* ; Adult ; Ascorbic Acid ; Blood Pressure ; Calcium ; Diet* ; Diet, Fat-Restricted* ; Diet, High-Fat ; Energy Intake ; Family Characteristics ; Humans ; Iron ; Korea ; Motor Activity ; Niacin ; Nutrition Surveys ; Odds Ratio ; Potassium ; Prevalence ; Recommended Dietary Allowances ; Riboflavin ; Risk Factors* ; Vitamin A

BACKGROUND AND PURPOSE: Despite the successful use of a ketogenic diet in pediatric epilepsy, its application in adults has been limited. The aim of this meta-analysis was to summarize the findings of relevant published studies in order to identify the efficacy of and compliance with a ketogenic diet and its main subtypes (i.e., classic ketogenic diet and modified Atkins diet) in adults with intractable epilepsy, and to provide useful information for clinical practice. METHODS: Electronic searches of PubMed, EMBASE, Google Scholar, and the ISI Web of Science were conducted to identify studies of the efficacy of and patient compliance with a ketogenic diet in adults with intractable epilepsy; the included studies were reviewed. Meta-analyses were performed using STATA to determine combined efficacy rates and combined rates of compliance with the ketogenic diet and its main subtypes. RESULTS: In total, 12 studies qualified for inclusion, and data from 270 patients were evaluated.The results of the meta-analysis revealed combined efficacy rates of all types of ketogenic diet, a classical ketogenic diet, and a modified Atkins diet were 42%, 52%, and 34%, respectively; the corresponding combined compliance rates were 45%, 38%, and 56%. CONCLUSIONS: The results indicate that a ketogenic diet is a promising complementary therapy in adult intractable epilepsy, and that while a classical ketogenic diet may be more effective, adult patients are likely to be less compliant with it than with a modified Atkins diet.
Adult* ; Compliance ; Diet, Carbohydrate-Restricted ; Epilepsy* ; Humans ; Ketogenic Diet* ; Patient Compliance*

A ketogenic diet (KD) is a dietary approach to treat intractable epilepsy. The KD begins with hospitalization and the child and their parents can adapt to the KD for 1-2 weeks. Recently, various type of dietary intervention such as the modified Atkins diet (MAD) and the low glycemic index treatment (LGIT) have been performed. Since 2010, we carried out the KD, MAD, and LGIT for total of 802 patients; 489 patients (61%) for the KD, 147 patients (18.3%) with the MAD, and 166 patients (20.7%) for the LGIT. In this report, application of these dietary practices in Severance Hospital is shared.
Child* ; Diet, Carbohydrate-Restricted ; Epilepsy* ; Glycemic Index ; Hospitalization ; Humans ; Ketogenic Diet* ; Meals* ; Parents