{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T05:57:30Z","timestamp":1790575050636,"version":"4.1.0"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Ketogenic diet therapy (KDT) is an established treatment for children with drug-resistant epilepsy (DRE), but the prognostic value of early blood beta-hydroxybutyrate (BHB) during diet stabilization remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center prospective cohort study enrolled children with DRE who initiated classical KDT at Peking University First Hospital between June 2023 and January 2025. First-month BHB was defined as the mean of two fasting pre-breakfast BHB measurements obtained during the final week of the first month after KDT initiation. Continuous first-month BHB was analyzed in relation to 3-month seizure reduction. An exploratory group-based analysis used a 3.0\u202fmmol\/L cutoff. The primary outcome was 3-month treatment response, defined as \u226550% seizure reduction from baseline. Later response and retention were summarized descriptively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 40 screened children, 38 were analyzed (19 per group). Seizure type differed between groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.028). At 3\u202fmonths, response was 42.1% (8\/19) in the higher-BHB group and 52.6% (10\/19) in the lower-BHB group, with an absolute risk difference of \u221210.5 percentage points (95% CI, \u221238.1 to 19.6), risk ratio of 0.80 (95% CI, 0.41\u20131.58), and unadjusted OR of 0.65 (95% CI, 0.18\u20132.36). The adjusted OR was 0.64 (95% CI, 0.13\u20133.09;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.575). Continuous BHB showed no clear monotonic association with 3-month seizure reduction (Spearman\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u202f=\u202f\u22120.105;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.532). Overall treatment response was 47.4, 39.5, 26.3, and 26.3% at 3, 6, 9, and 12\u202fmonths, respectively. Adverse events occurred in 13 patients (34.2%) and did not lead to KDT discontinuation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Continuous first-month BHB showed no clear monotonic association with 3-month seizure reduction; an exploratory 3.0\u202fmmol\/L cutoff analysis similarly did not distinguish subsequent responders from non-responders. These findings describe the prognostic value of first-month BHB measured after individualized KDT titration and should not be interpreted as evidence regarding the benefit of deliberately targeting higher BHB levels.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1923059","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T05:47:04Z","timestamp":1790574424000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of first-month beta-hydroxybutyrate levels with subsequent ketogenic diet response in children with drug-resistant epilepsy: a prospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Quanzhen","family":"Tan","sequence":"first","affiliation":[{"name":"Children's Medical Center, Department of Pediatric Neurology, Peking University First Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuqian","family":"Zhang","sequence":"additional","affiliation":[{"name":"Children's Medical Center, Department of Pediatric Neurology, Peking University First Hospital","place":["Beijing, China"]},{"name":"The Second Qilu Hospital of Shandong University","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yulan","family":"Li","sequence":"additional","affiliation":[{"name":"Children's Medical Center, Department of Pediatric Neurology, Peking University First Hospital","place":["Beijing, China"]},{"name":"Peking University First Hospital Ningxia Women and Children's Hospital, Ningxia Hui Autonomous Region Maternal and Child Health Hospital","place":["Yinchuan, Ningxia, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junhong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Children's Medical Center, Department of Pediatric Neurology, Peking University First Hospital","place":["Beijing, China"]},{"name":"Peking University First Hospital Ningxia Women and Children's Hospital, Ningxia Hui Autonomous Region Maternal and Child Health Hospital","place":["Yinchuan, Ningxia, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuting","family":"Chang","sequence":"additional","affiliation":[{"name":"Children's Medical Center, Department of Pediatric Neurology, Peking University First Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Wu","sequence":"additional","affiliation":[{"name":"Children's Medical Center, Department of Pediatric Neurology, Peking University First Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Zhang","sequence":"additional","affiliation":[{"name":"Children's Medical Center, Department of Pediatric Neurology, Peking University First Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1111\/j.0013-9580.2005.03504.x","article-title":"Cognitive function in preschool children after epilepsy surgery: rationale for early intervention","volume":"46","author":"Freitag","year":"2005","journal-title":"Epilepsia"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1809","DOI":"10.3390\/nu12061809","article-title":"Efficacy and safety of a ketogenic diet in children and adolescents with refractory epilepsy\u2014a review","volume":"12","author":"Wells","year":"2020","journal-title":"Nutrients"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1542\/peds.108.1.129","article-title":"Experience with the ketogenic diet in 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