Partial substitution of ketogenic Diet Therapy with a blended diet: Evaluation of clinical practice in neurologically impaired fully tube fed children

Background and Aim
Gastrointestinal (GI) symptoms are common in neurologically impaired, tube-fed patients and may impact quality of life. A blended diet (BD) might reduce these symptoms. This study evaluated whether replacing one daily portion of a ketogenic diet therapy (KDT) regimen with BD could improve GI complaints in gastrostomy-fed children with severe neurological impairment and drug-resistant epilepsy.
Methods
Children (1–18 y) on KDT with recurrent GI complaints were included, along with two historical cases. Over 3 mo, one daily BD portion replaced standard KDT formula. Data on GI, neurological, nutritional, and anthropometric parameters were collected. Feasibility and well-being were assessed, and parents participated in interviews. Ethical approval was granted (MEC-2023-0557).
Results
Nine patients (6 males, 3 females; median age 9 y) participated; six completed the study. BD was introduced over 2–4 wk. Two patients reduced laxative use by half, one improved stool frequency (from several times/d to once/d), and one historical case reported fewer hospital visits. Promotility medications remained unchanged. All six completers adhered to one BD portion and continued its use. Seizure frequency improved in two cases (33.3%). No significant changes occurred in other parameters.
Conclusions
Replacing just one KDT portion with BD improved GI symptoms and was feasible even in severely impaired children. It did not compromise ketosis or dietary effectiveness. Partial BD may be considered early in managing persistent GI issues during KDT, but should be personalized and carefully monitored.