Low-Carbohydrate (Ketogenic) Diet in Children with Obesity: Part 1—Diet Impact on Anthropometric Indicators and Indicators of Metabolic Syndrome and Insulin Resistance
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants Selection and Study Design
2.2. Characteristics of the Group of 58 Patients Who Completed the Study
2.3. Ketogenic Diet
- Carbohydrate intake: up to 40 g per day, divided into 10–13 g per meal.
- Protein intake: 1–1.5 g per kilogram of ideal body weight per day.
- Fat intake: enough to induce satiety without excessive consumption.
- Three to four meals per day: breakfast, lunch, dinner, and a small afternoon snack if hungry.
- Calorie counting is not necessary. Patients should eat until satisfied while adhering to the guidelines given in the individual menu. Skipping a meal is permissible if not hungry, but prolonged and intentional starvation is not recommended.
- Preference for natural foods: meat, fish, full-fat dairy products, eggs, low-carbohydrate vegetables, and a small number of low-carb fruits.
- Avoidance of processed, packaged foods, soft drinks, sweetened juices, and liquids.
- Fluid intake without sugar: 30–40 mL per kilogram per day.
2.4. Clinical Investigations
- Skin and its appendages (acanthosis nigricans, striae, acne, and the presence of increased hair in androgen-dependent areas in pubertal girls).
- Distribution of increased adipose tissue in different parts of the body.
- Cardiovascular system: measurement of heart rate and rhythm by auscultation; measurement of blood pressure (BP) with an age-appropriate sphygmomanometer under standard conditions. AH was diagnosed and classified according to the criteria of the European Society of Hypertension [25] based on historical data or BP measurements by parents and/or the research team.
2.5. Anthropometric Measurements Included
- Height, weight, and waist circumference.
- Calculation of BMI and waist-to-height ratio.
2.6. Laboratory Investigations
- Oral glucose tolerance test (OGTT) with measurement of blood glucose and insulin at 0, 30, 60, and 120 min.
- Complete blood count, glycated hemoglobin, analyzed on an automated hematological analyzer Advita 2120, Siemens Healthcare Diagnostics INC., Erlangen, Germany.
- Biochemical parameters: Lipid profile (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides), transaminases (ALT, AST), gamma-glutamyl transferase (GGT), urea, creatinine, uric acid, analyzed using original turbidimetric and immunoturbidimetric programs on a biochemical analyzer AU 480, Olympus; Beckman Coulter, Inc., Co Clare, Ireland.
- Hormones: Insulin, thyroid hormones (TSH, T3, T4), cortisol, testosterone, LH, FSH, analyzed using chemiluminescent immunoassay (CLIA) on an automated immunochemical analyzer Access 2, Beckman Coulter, Inc., Ireland.
- HOMA-IR and QUICKI indices were calculated (using online calculators) [26].
- Fatty liver index (FLI) was calculated [27].
- Urine analysis for semi-quantitative assessment of sugar and acetone; urine calcium/creatinine ratio (calculated UCa/UCr in mmol/L).
- Adiponectin level was measured using the BioVendor Human Adiponectin ELISA test.
2.7. Ultrasonographic Investigations
- Echocardiogram.
- Ultrasound examination of the urinary tract system and liver.
2.8. Statistical Analysis
3. Results
3.1. Anthropometric Indicators
3.2. Indicators of Glucose Metabolism, Insulin Resistance, Impaired Metabolic Health, and Metabolic Syndrome
3.3. Side Effects and Complaints
3.4. Sensitivity Analysis
3.5. Effect Sizes
4. Discussion
Limitations and Issues of Concern
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variable | N = 58 |
---|---|
Age, years (x ± SD) | (13.79 ± 2.63) |
Age groups, n (%) | |
8–10 years | 8 (13.79) |
11–15 years | 25 (43.10) |
16–18 years | 25 (43.10) |
Gender, n (%) | |
Female | 23 (39.66) |
Male | 35 (60.34) |
Comorbidities, n (%) | |
Metabolic syndrome | 33 (56.89%) |
One or more criteria for impaired metabolic health | 25 (43.10%) |
Polycystic ovary syndrome | 8 (34.78%) |
Primary arterial hypertension Hepatic steatosis | 27 (46.55%) 39 (67.24%) |
Hashimoto’s autoimmune thyroiditis | 7 (12.07%) |
Compliance with the diet, n (%) | |
Good | 26 (44,83) |
Moderate | 15 (25,86) |
Poor | 17 (29,31) |
Variable | Before KD (n = 58) | After KD (n = 58) | p-Value | |
---|---|---|---|---|
Anthropometric indicators | Weight, kg | 89.43 ± 3.30 | 82.98 ± 3.25 | <0.0001 |
BMI, kg/m2 | 33.35 ± 7.29 | 30.23 ± 7.14 | <0.0001 | |
Waist circumference, cm | 103.97 ± 17.17 | 91.38 ± 15.03 | 0.003 | |
Waist-to-hip ratio | 0.64 ± 0.09 | 0.55 ± 0.08 | <0.0001 | |
Laboratory indicators | Fasting glucose (mmol/L) | 4.94 ± 0,45 | 4.80 ± 0,45 | 0.07 |
Fasting insulin (mlU/L) | 20.12 ± 8.88 | 13.17 ± 5.81 | <0.0001 | |
HOMA-IR | 4.51 ± 2.20 | 2.85 ± 1.45 | <0.0001 | |
QUICKI | 0.31 ± 0.019 | 0.33 ± 0.024 | <0.0001 | |
Glycated hemoglobin (HbA1c) % | 5.21 ± 0.37 | 5.30 ± 0.38 | 0.27 | |
Total cholesterol (mmol/L) | 4.38 ± 0.76 | 4.26 ± 0.91 | 0.25 | |
HDL (mmol/L) | 1.17 ± 0.21 | 1.15 ± 0.22 | 0.45 | |
LDL (mmol/L) | 2.739 ± 0.68 | 2.742 ± 0.75 | 0.97 | |
Triglycerides (mmol/L) | 1.07 ± 0.45 | 0.88 ± 0.36 | 0.001 | |
Triglycerides/HDL | 2.22 ± 1.13 | 1.83 ± 0.87 | <0.0001 | |
Creatinine (mmol/L) | 63.48 ± 7.53 | 63.40 ± 10.19 | 0.924 | |
Uric acid (µmol/L) | 380.59 ± 90.91 | 373.36 ± 91.65 | 0.37 | |
Urinary calcium/creatinine ratio (mmol/mmol) | 0.195 ± 8.88 | 0.193 ± 5.81 | 0.71 | |
ALT (IU/L) | 28.87 ± 35.49 | 22.62 ± 16.21 | 0.001 | |
AST (IU/L) | 25.82 ± 12.86 | 23.30 ± 8.54 | 0.006 | |
GGT (IU/L) | 24.17 ± 12.93 | 19.62 ± 8.72 | <0.0001 | |
FLI | 60.60 ± 29.45 | 40.67 ± 31.91 | <0.0001 | |
Adiponectin (mcg/mL) | 8.61 ± 3.61 | 9.13 ± 3.86 | 0.04 |
Reported Complaints and Symptoms During the Diet | Number of Patients | % |
---|---|---|
Constipation | 7 | 12.04 |
Diarrhea | 4 | 6.88 |
Abdominal pains | 4 | 6.88 |
Fatigue | 10 | 17.20 |
Hunger | 5 | 8.60 |
Headache | 14 | 24.08 |
Longer menstrual cycles (girls) | 1 | 1.72 |
Change in breath | 1 | 1.72 |
Nervousness | 1 | 1.72 |
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Paskaleva, I.N.; Kaleva, N.N.; Dimcheva, T.D.; Markova, P.P.; Ivanov, I.S. Low-Carbohydrate (Ketogenic) Diet in Children with Obesity: Part 1—Diet Impact on Anthropometric Indicators and Indicators of Metabolic Syndrome and Insulin Resistance. Diseases 2025, 13, 94. https://doi.org/10.3390/diseases13040094
Paskaleva IN, Kaleva NN, Dimcheva TD, Markova PP, Ivanov IS. Low-Carbohydrate (Ketogenic) Diet in Children with Obesity: Part 1—Diet Impact on Anthropometric Indicators and Indicators of Metabolic Syndrome and Insulin Resistance. Diseases. 2025; 13(4):94. https://doi.org/10.3390/diseases13040094
Chicago/Turabian StylePaskaleva, Ivanka N., Nartsis N. Kaleva, Teodora D. Dimcheva, Petya P. Markova, and Ivan S. Ivanov. 2025. "Low-Carbohydrate (Ketogenic) Diet in Children with Obesity: Part 1—Diet Impact on Anthropometric Indicators and Indicators of Metabolic Syndrome and Insulin Resistance" Diseases 13, no. 4: 94. https://doi.org/10.3390/diseases13040094
APA StylePaskaleva, I. N., Kaleva, N. N., Dimcheva, T. D., Markova, P. P., & Ivanov, I. S. (2025). Low-Carbohydrate (Ketogenic) Diet in Children with Obesity: Part 1—Diet Impact on Anthropometric Indicators and Indicators of Metabolic Syndrome and Insulin Resistance. Diseases, 13(4), 94. https://doi.org/10.3390/diseases13040094