A Multifaceted Assessment of Eating Behaviors, Anthropometric Measurements and Body Composition in Pediatric Patients With Drug-resistant Epilepsy on a Ketogenic Diet and Healthy Children

It is planned to measure the participants' height and weight. The following measurements will be taken among the study participants: height, using a free-standing, portable Tanita HR-001 (Tanita, Tokyo, Japan) stadiometer, and weight, using a Tanita BC 545 scale (Tanita, Tokyo, Japan). Additionally, the thickness of skinfolds above and below the biceps, below the shoulder blade (subscapular), and above the iliac crest (suprailiac) will be measured. Furthermore, calf, arm, and waist circumferences will be measured.

Based on the data obtained, BMI will be calculated and compared against the OLA and OLAF percentile growth charts dedicated to the Polish pediatric population. As recommended, <5th percentile will be adopted as underweight, 5th-85th percentile as normal weight, >85th percentile as overweight, and >95th percentile as obesity.

Furthermore, based on body weight, circumference, and skinfold thickness, an assessment of body fat content is planned.

To assess dietary habits, parents and children from both the study and control groups, together with a qualified dietitian, will complete the following questionnaires: the Modified Children's Food Neophobia Scale (Modified CFNS) (parent), the Children's Eating Behavior Questionnaire (CEBQ) (parent), and the Child Food Texture Preference Questionnaire (CFTPQ) (child), translated into Polish.

To supplement information regarding dietary style, the authors will ask parents of children from both the study and control groups additional questions concerning meal variety, meal repetitiveness, and the occurrence of periods of selective eating. The obtained data will be statistically processed and used to create scientific publications.

In addition, resting metabolic rate will be measured in both groups of children using indirect calorimetry. Participants will undergo an approximately 10-minute indirect calorimetry test while fasting and in a supine position, using a COSMED Fitmate WM calorimeter with an age-appropriate breathing mask. The test will be conducted in the presence of a parent.

The obtained RMR results from indirect calorimetry will be compared to standard RMR prediction equations for children, i.e., the Schofield equation, the FAO/WHO equation, and the equations developed by the Institute of Medicine of the National Academies and the Food and Nutrition Board, and expressed as a percentage of their predicted values.

A comparison of results between the control group and the study group is planned. Furthermore, correlation graphs between the studied variables will be created, as well as a PCA (Principal Component Analysis) chart to assess the occurrence of clustered eating habits present in the pediatric population.

Inclusion criteria

, studied group:

• consent of the child and guardians/caregivers to participate in the study,
• diagnosis of drug-resistant epilepsy and use of a ketogenic diet for at least 3 months,
• age above 2 years, full or partial use of an oral diet (to an extent that allows the child to express their food preferences)
• possibility of measuring RMR via indirect calorimetry

Exclusion criteria

, studied group :

• lack of consent from the child and guardians/caregivers to participate in the study
• non-adherence to ketogenic diet recommendations,
• 100% nutrition supply via PEG (n=2),
• age below 2 years (n=2)
• treatment at a clinical center other than the Lower Silesian one
• inability to perform anthropometric measurements and RMR

Inclusion criteria

, control group:

• consent of the parent and child to participate in the study
• absence of chronic diseases, no permanent use of medications
• no diagnoses/certificates from a pedagogical-psychological counseling center, e.g., dyslexia, dysgraphia, social relationship disorders, no diagnoses such as Asperger's, Autism, or other spectrum disorders or nervous system function disorders
• ability to perform anthropometric measurements
• Polish citizenship and residence in Poland
• residence in the Lower Silesia region.

Exclusion criteria

, control group:

• lack of consent to perform/participate in the study
• chronic diseases including neurological disorders, certificates and/or diagnoses from a psychological-pedagogical counseling center
• use of specialized diets related to illness or exclusion diets (vegetarian, vegan, ketogenic diet)
• chronic use of medications related to illness, inability to perform anthropometric measurements and RMR meaurements.