SYSTEMATIC REVIEW article
Front. Nutr.
Sec. Nutrition, Psychology and Brain Health
Volume 12 - 2025 | doi: 10.3389/fnut.2025.1634041
Impact of a High-Fat, Low-Carbohydrate Ketogenic Diet on Seizure Frequency in Children with Drug-Resistant Epilepsy: A Systematic Review and Meta-Analysis
Provisionally accepted
- Chifeng College Affiliated Hospital, Chifeng, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: Drug-resistant epilepsy in children poses significant therapeutic challenges. The ketogenic diet (KD), characterized by high-fat and low-carbohydrate content, has emerged as a potential adjunctive treatment. This meta-analysis aimed to systematically evaluate the impact of the KD on seizure frequency in pediatric patients with drug-resistant epilepsy. Methods: Following PRISMA guidelines, PubMed, Embase, Web of Science, and the Cochrane Library were searched to identify randomized and quasi-randomized trials of classical KD, modified Atkins diet (MAD), and low-glycemic-index treatment (LGIT) in children (≤18 years) with DRE. Two reviewers independently screened studies, extracted data, and assessed quality using the Cochrane Risk of Bias Tool 2.0. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using fixed- or random-effects models. Results: Nine studies met the inclusion criteria. For patients achieving >50% seizure reduction, pooled analysis (random-effects model; I² = 60.5%, p = 0.009) revealed an OR of 7.69 (95% CI [3.42, 17.3]). Analysis of studies reporting >90% seizure reduction (fixed-effects model; I² = 0.0%, p = 0.749) yielded an OR of 8.54 (95% CI [3.13, 23.31]). In the subset evaluating seizure freedom, the pooled OR was 7.35 (95% CI [2.17, 24.88]) with minimal heterogeneity (I² = 4.4%, p = 0.371). Subgroup analyses favored the classical KD and interventions ≥6 months. Sensitivity analysis confirmed result stability, and Egger’s test indicated no significant publication bias (P > 0.05), although the test had limited power due to the small number of included studies. The most frequent adverse events were constipation (37.5%), anorexia (19.5%), and diarrhea (18.9%). Conclusions: The KD significantly improved seizure outcomes, with robust efficacy in reducing seizure frequency and a higher likelihood of achieving seizure freedom, although absolute rates of seizure freedom were modest. These findings support the KD as a promising adjunctive therapy for children with drug-resistant epilepsy; however, further large-scale, long-term studies are needed to confirm its sustained efficacy and safety.
Keywords: Ketogenic Diet, Drug-resistant epilepsy, seizure reduction, pediatric, Meta-analysis
Received: 27 May 2025; Accepted: 28 Aug 2025.
Copyright: © 2025 Liu, E, Zhang and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jian Liu, Chifeng College Affiliated Hospital, Chifeng, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.