{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T12:40:55Z","timestamp":1791463255780,"version":"4.3.4"},"reference-count":30,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2022,5,23]],"date-time":"2022-05-23T00:00:00Z","timestamp":1653264000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>This study was undertaken to determine the hemoglobin A1c (HbA1c) and modified glucose\u2010ketone index (mGKI) in children on different types of ketogenic diet (KD) for treatment of drug\u2010resistant epilepsy, with attempts to evaluate their relationships with components of diet regime and other biomarkers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a cross\u2010sectional study in children with drug resistant epilepsy aged between 6\u00a0months and 18\u00a0years, who were on various types of KD therapies without any change in regime for at least 3\u00a0months. Parental interview, review of medical records, and a single measurement for blood ketone, HbA1c, and plasma carnitine were performed. mGKI was the ratio of an average plasma glucose estimated from HbA1c to blood \u03b2\u2010hydroxybutyrate level.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty\u2010four patients were recruited with a median blood ketone of 2.90\u00a0mmol\u00b7L<jats:sup>\u20131<\/jats:sup> and median HbA1c of 4.55%. Those on classical KD (cKD) had higher blood ketone (<jats:italic>p\u00a0<\/jats:italic>=\u00a0.031) and lower HbA1c (<jats:italic>p\u00a0<\/jats:italic>=\u00a0.010) and mGKI (<jats:italic>p\u00a0<\/jats:italic>=\u00a0.021) than those receiving modified Atkins diet, although both shared similar percentages of calories from carbohydrate (<jats:italic>p\u00a0<\/jats:italic>=\u00a0.211). The cKD and medium\u2010chain triglyceride (MCT) KD groups had similar HbA1c (<jats:italic>p\u00a0<\/jats:italic>=\u00a0.252) and mGKI (<jats:italic>p\u00a0<\/jats:italic>=\u00a0.510). Blood ketone (<jats:italic>p\u00a0<\/jats:italic>=\u00a0.045) and the percentage of calories from MCT (<jats:italic>p\u00a0<\/jats:italic>=\u00a0.037) were the two main independent variables, inversely correlating with HbA1c. Other than plasma acylcarnitine (<jats:italic>p\u00a0<\/jats:italic>=\u00a0.047), neither blood ketone (<jats:italic>p\u00a0<\/jats:italic>=\u00a0.188) nor HbA1c (<jats:italic>p\u00a0<\/jats:italic>=\u00a0.170) could predict seizure reduction reliably. Both plasma acylcarnitine \u2265 6\u00a0\u03bcmol\u00b7L<jats:sup>\u20131<\/jats:sup> (<jats:italic>p\u00a0<\/jats:italic>=\u00a0.013) and mGKI \u2264 2.2 (<jats:italic>p\u00a0<\/jats:italic>=\u00a0.013) were significantly associated with good seizure control.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>HbA1c could potentially be useful for monitoring KD adherence or, indirectly, systemic ketosis in nondiabetic children on KD for drug\u2010resistant epilepsy. Plasma acylcarnitine and mGKI could be important biomarkers in the management of KD therapy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/epi.17292","type":"journal-article","created":{"date-parts":[[2022,5,9]],"date-time":"2022-05-09T06:29:35Z","timestamp":1652077775000},"page":"2011-2023","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Glycemic biomarkers in children with drug\u2010resistant epilepsy on various types of ketogenic diet therapies: A cross\u2010sectional study"],"prefix":"10.1111","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1989-4193","authenticated-orcid":false,"given":"Lip\u2010Yuen","family":"Teng","sequence":"first","affiliation":[{"name":"Pediatric Neurology Unit Department of Pediatrics Hospital Tunku Azizah  Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa Wan\u2010Mun","family":"Lee","sequence":"additional","affiliation":[{"name":"Pediatric Neurology Unit Department of Pediatrics Hospital Tunku Azizah  Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1351-572X","authenticated-orcid":false,"given":"Sumitha","family":"Murugesu","sequence":"additional","affiliation":[{"name":"Pediatric Neurology Unit Department of Pediatrics Hospital Tunku Azizah  Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun\u2010Xiong","family":"Lee","sequence":"additional","affiliation":[{"name":"Pediatric Neurology Unit Department of Pediatrics Hospital Tunku Azizah  Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nur Sakinah","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Department of Dietetics and Food Services Hospital Tunku Azizah  Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohd Fatahudin","family":"Ishak","sequence":"additional","affiliation":[{"name":"Department of Dietetics and Food Services Hospital Tunku Azizah  Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad Rithauddin","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Pediatric Neurology Unit Department of Pediatrics Hospital Tunku Azizah  Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2051-3498","authenticated-orcid":false,"given":"Teik\u2010Beng","family":"Khoo","sequence":"additional","affiliation":[{"name":"Pediatric Neurology Unit Department of Pediatrics Hospital Tunku Azizah  Kuala Lumpur 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