{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T01:45:48Z","timestamp":1785289548313,"version":"3.55.0"},"reference-count":39,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Anton Sch\u00e4r Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Ketogenic diets can treat drug-resistant epilepsy, even in early childhood. However, due to the severely restricted food selection, there is an assumed increased risk of inadequate micronutrient intake. Currently, the available data is limited. Methodology: Optimized daily meal plans were created for infants and children aged 1\u20139 years (physical activity level; PAL 1.6) in three ketogenic ratios (3:1, 2:1, 1:1). Compliance with reference values for micronutrients (\u226595%) was analyzed using the reference values of the German and Austrian Nutrition Societies (DGE\/\u00d6GE) and PRODI\u00ae nutrition software (Germany). Results: Vitamin D never reached more than 25% of the reference values in any age group or ratio, and pantothenic acid consistently remained at around 40\u201370%. At the 3:1 and 2:1 ratios, the mean values for vitamins B1, B2, and B12, as well as for calcium, zinc, iron, and fiber, were all below 95% of the reference values. Although the 1:1 ketogenic ratio was more nutrient-dense, this only partially compensated for potential deficiencies. Conclusions: The results illustrate a limited micronutrient supply dependent on the ratio in ketogenic diets for infants and children. Careful food selection and nutritional therapy support are necessary to avoid potential nutrient gaps.<\/jats:p>","DOI":"10.3390\/nu18101555","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T13:04:09Z","timestamp":1778763849000},"page":"1555","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Critical Nutrients in Ketogenic Diets for Infants and Children Under Ten Years of Age\u2014A Hypothetical Study"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-7505-2417","authenticated-orcid":false,"given":"Marc","family":"Assmann","sequence":"first","affiliation":[{"name":"Center for Nutrition and Therapy (NuT), University of Applied Sciences Muenster, Corrensstra\u00dfe 25, 48149 Muenster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Albrecht","sequence":"additional","affiliation":[{"name":"Center for Nutrition and Therapy (NuT), University of Applied Sciences Muenster, Corrensstra\u00dfe 25, 48149 Muenster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9027-2461","authenticated-orcid":false,"given":"Tobias","family":"Fischer","sequence":"additional","affiliation":[{"name":"Center for Nutrition and Therapy (NuT), University of Applied Sciences Muenster, Corrensstra\u00dfe 25, 48149 Muenster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"ref_1","unstructured":"Klepper, J., Della Marina, A., Feucht, M., Leiendecker, B., van Teeffelen-Heithoff, A., Wiemer-Kruel, A., B\u00f6lsterli, B., Male-Dressler, A., Herberhold, T., and H\u00f6ller, A. (2026, April 08). Ketogene Ern\u00e4hrungstherapien (KET): S1-Leitlinie Ketogene Di\u00e4ten. AWMF Online, Available online: https:\/\/register.awmf.org\/assets\/guidelines\/022-021l_S1_Ketogene_Diaeten_2022-02.pdf."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"D\u0105bek, A., Wojtala, M., Pirola, L., and Balcerczyk, A. (2020). Modulation of Cellular Biochemistry, Epigenetics and Metabolomics by Ketone Bodies. Implications of the Ketogenic Diet in the Physiology of the Organism and Pathological States. Nutrients, 12.","DOI":"10.3390\/nu12030788"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/j.1528-1167.2008.01821.x","article-title":"History of the ketogenic diet","volume":"49","author":"Wheless","year":"2008","journal-title":"Epilepsia"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1002\/epi4.12225","article-title":"Optimal clinical management of children receiving dietary therapies for epilepsy: Updated recommendations of the International Ketogenic Diet Study Group","volume":"3","author":"Kossoff","year":"2018","journal-title":"Epilepsia Open"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1234","DOI":"10.1038\/s41430-021-01060-8","article-title":"Ketogenic diet for epilepsy: An overview of systematic review and meta-analysis","volume":"76","author":"Ruan","year":"2022","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.seizure.2020.07.011","article-title":"Efficacy of the ketogenic diet in patients with Dravet syndrome: A meta-analysis","volume":"81","author":"Wang","year":"2020","journal-title":"Seizure"},{"key":"ref_7","first-page":"613","article-title":"Therapeutic Success of the Ketogenic Diet as a Treatment Option for Epilepsy: A Meta-analysis","volume":"23","author":"Li","year":"2013","journal-title":"Iran. J. Pediatr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1007\/s00381-020-04578-7","article-title":"Ketogenic diet for the treatment of pediatric epilepsy: Review and meta-analysis","volume":"36","author":"Sourbron","year":"2020","journal-title":"Childs. Nerv. Syst."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Ruiz Herrero, J., Ca\u00f1edo Villarroya, E., Garc\u00eda Pe\u00f1as, J.J., Garc\u00eda Alcolea, B., G\u00f3mez Fern\u00e1ndez, B., Puerta Macfarland, L.A., and Pedr\u00f3n Giner, C. (2020). Safety and Effectiveness of the Prolonged Treatment of Children with a Ketogenic Diet. Nutrients, 12.","DOI":"10.3390\/nu12020306"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1097\/01.nrl.0000160818.58821.d2","article-title":"The ketogenic diet","volume":"11","author":"Sinha","year":"2005","journal-title":"Neurologist"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"106780","DOI":"10.1016\/j.phrs.2023.106780","article-title":"Ketogenic diet in children and adolescents: The effects on growth and nutritional status","volume":"191","author":"Corsello","year":"2023","journal-title":"Pharmacol. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1111\/j.1365-277X.2011.01172.x","article-title":"The effect of the classical and medium chain triglyceride ketogenic diet on vitamin and mineral levels","volume":"25","author":"Christodoulides","year":"2012","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"111158","DOI":"10.1016\/j.nut.2021.111158","article-title":"Micronutrient supplementation needs more attention in patients with refractory epilepsy under ketogenic diet treatment","volume":"86","author":"Prudencio","year":"2021","journal-title":"Nutrition"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1016\/j.clnesp.2025.07.023","article-title":"The nutritional adequacy of the ketogenic diet in paediatric epilepsy: Detailed nutrient analysis and dietary recommendations","volume":"69","author":"Tsang","year":"2025","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1111\/j.1528-1167.2008.01827.x","article-title":"Long-term management of the ketogenic diet: Seizure monitoring, nutrition, and supplementation","volume":"49","author":"Zupanc","year":"2008","journal-title":"Epilepsia"},{"key":"ref_16","first-page":"597","article-title":"Terapia cetog\u00eanica na inf\u00e2ncia e adolesc\u00eancia: Recomenda\u00e7\u00f5es do grupo de especialistas brasileiros","volume":"81","author":"Lin","year":"2023","journal-title":"Arq. Neuropsiquiatr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1016\/j.jada.2005.02.009","article-title":"Changes in growth and seizure reduction in children on the ketogenic diet as a treatment for intractable epilepsy","volume":"105","author":"Peterson","year":"2005","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1053\/jada.2003.50136","article-title":"A prospective study: Growth and nutritional status of children treated with the ketogenic diet","volume":"103","author":"Liu","year":"2003","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1111\/j.1528-1167.2008.01832.x","article-title":"Low glycemic index treatment: Implementation and new insights into efficacy","volume":"49","author":"Pfeifer","year":"2008","journal-title":"Epilepsia"},{"key":"ref_20","unstructured":"DGE (2026, April 08). Wasser. Available online: https:\/\/www.dge.de\/wissenschaft\/referenzwerte\/wasser\/."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"533","DOI":"10.32641\/andespediatr.v95i5.4969","article-title":"Ingesta de micronutrientes en pacientes con epilepsia refractaria tratados con dieta cetog\u00e9nica","volume":"95","author":"Velandia","year":"2024","journal-title":"Andes Pediatr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1016\/j.jada.2007.03.011","article-title":"Nutrient intake of children with intractable epilepsy compared with healthy children","volume":"107","author":"Volpe","year":"2007","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Armeno, M., Verini, A., Del Pino, M., Araujo, M.B., Mestre, G., Reyes, G., and Caraballo, R.H. (2019). A Prospective Study on Changes in Nutritional Status and Growth Following Two Years of Ketogenic Diet (KD) Therapy in Children with Refractory Epilepsy. Nutrients, 11.","DOI":"10.3390\/nu11071596"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1678","DOI":"10.3945\/ajcn.2008.26099","article-title":"Progressive bone mineral content loss in children with intractable epilepsy treated with the ketogenic diet","volume":"88","author":"Bergqvist","year":"2008","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_25","unstructured":"Mensink, G.B.M., Haftenberger, M., Lage Barbosa, C., Brettschneider, A.-K., Lehmann, F., Frank, M., Heide, K., Moosburger, R., Patelakis, E., and Perlitz, H. (2026, February 24). EsKiMo II\u2014Die Ern\u00e4hrungsstudie als KiGGS-Modul, 2021. Available online: https:\/\/edoc.rki.de\/handle\/176904\/6887.2."},{"key":"ref_26","unstructured":"(2025, July 14). Max Rubner-Institut (MRI) Ergebnisbericht Teil 2, Nationale Verzehrsstudie II. Available online: https:\/\/www.bmel.de\/SharedDocs\/Downloads\/DE\/_Ernaehrung\/NVS_ErgebnisberichtTeil2.pdf?__blob=publicationFile&v=2."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Burgard, L., Jansen, S., Spiegler, C., Brettschneider, A.-K., Stra\u00dfburg, A., Alexy, U., Storcksdieck Genannt Bonsmann, S., Ensenauer, R., and Heuer, T. (2023). Unfavorable nutrient intakes in children up to school entry age: Results from the nationwide German KiESEL study. Front. Nutr., 10.","DOI":"10.3389\/fnut.2023.1302323"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1210\/clinem\/dgae290","article-title":"Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline","volume":"109","author":"Demay","year":"2024","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_29","unstructured":"DGE (2026, May 08). Vitamin D. Available online: https:\/\/www.dge.de\/wissenschaft\/referenzwerte\/vitamin-d\/."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1093\/jn\/135.2.317","article-title":"Circulating 25-hydroxyvitamin D levels indicative of vitamin D sufficiency: Implications for establishing a new effective dietary intake recommendation for vitamin D","volume":"135","author":"Hollis","year":"2005","journal-title":"J. Nutr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2995","DOI":"10.1017\/S1368980023002537","article-title":"The nutrient profile and cost of specialty dietary patterns: A hypothetical case study","volume":"26","author":"Zinn","year":"2023","journal-title":"Public Health Nutr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1111\/epi.17169","article-title":"Substantial early changes in bone and calcium metabolism among adult pharmacoresistant epilepsy patients on a modified Atkins diet","volume":"63","author":"Molteberg","year":"2022","journal-title":"Epilepsia"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.seizure.2022.04.015","article-title":"Clinical implementation of ketogenic diet in children with drug-resistant epilepsy: Advantages, disadvantages, and difficulties","volume":"99","author":"Tong","year":"2022","journal-title":"Seizure"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"100830","DOI":"10.1016\/j.crfs.2024.100830","article-title":"Effect of cooking conditions on iron release from pots and development of kinetic models for iron supplementation in NIPs","volume":"9","author":"Shi","year":"2024","journal-title":"Curr. Res. Food Sci."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"994","DOI":"10.3126\/nje.v11i2.36682","article-title":"Effect of cooking food in iron-containing cookware on increase in blood hemoglobin level and iron content of the food: A systematic review","volume":"11","author":"Sharma","year":"2021","journal-title":"Nepal J. Epidemiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"110522","DOI":"10.1016\/j.nut.2019.06.003","article-title":"Assessment of micronutrients in a 12-wk ketogenic diet in obese adults","volume":"67\u201368","author":"Kenig","year":"2019","journal-title":"Nutrition"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2667","DOI":"10.1007\/s00394-024-03459-y","article-title":"Low thiamine status in adults following low-carbohydrate\/ketogenic diets: A cross-sectional comparative study of micronutrient intake and status","volume":"63","author":"Churuangsuk","year":"2024","journal-title":"Eur. J. Nutr."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Lasekan, J., Yao, Q., Choe, Y., Niemiro, G.M., and Hicks, P. (2025). Key Nutrient Intakes at Risk Among US Children in the National Health and Nutrition Examination Survey (NHANES) 2015\u20132016 Stratified by Age and Gender. Children, 12.","DOI":"10.3390\/children12020238"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"101377","DOI":"10.1016\/j.tjnut.2026.101377","article-title":"Usual Nutrient Intake Adequacy and Nutritional Status of United States Children and Adolescents: National Health and Nutrition Examination Survey 2001\u2013March 2020","volume":"156","author":"Bailey","year":"2026","journal-title":"J. Nutr."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/10\/1555\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T13:14:00Z","timestamp":1778764440000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/10\/1555"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,14]]},"references-count":39,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["nu18101555"],"URL":"https:\/\/doi.org\/10.3390\/nu18101555","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,14]]}}}