The ketogenic diet (KD) is an established, effective, nonpharmacologic treatment for children with pharmacoresistant epilepsy. Although the KD is the most well-established dietary therapy for epilepsy, it is too restrictive and is associated with serious complications; therefore, alternative lower-fat diets, including a modified Atkins diet and low-glycemic index diet, have been developed. Recent ongoing clinical evidence suggests that other dietary therapies have an efficacy almost comparable to that of the KD. In addition, a diet rich in polyunsaturated fatty acids appears to increase the efficacy of diet therapy and reduce the complications of a high-fat diet. Here, we review the systematic information about lower-fat diets and better-quality dietary therapies and the current clinical status of each of these dietary approaches.
Child ; Diet ; Diet, Carbohydrate-Restricted ; Diet, High-Fat ; Epilepsy ; Fatty Acids, Unsaturated ; Humans ; Ketogenic Diet

BACKGROUND AND OBJECTIVES: Endothelial dysfunction is an early change in the process of atherosclerosis. To evaluate endothelial function, expensive and specialized medical devices like high-resolution vascular ultrasound are necessary. Therefore, we sought to compare this atherosclerotic parameter of endothelial function using the inexpensive and simple method of peripheral pulse arrival time (PPAT) measurement. SUBJECTS AND METHODS: Before and after meals, we measured PPAT and flow-mediated vasodilation (FMD). Resting PPAT in both arms was measured with a PPAT device that was designed by the authors. Hyperemic effect was tested in both arms after raising the blood pressure to 250 mmHg for 5 minutes by using a blood pressure cuff, after which the cuff was released to 0 mmHg. PPAT was measured within the first 1 minute to observe the hyperemic response. FMD was measured in the same process by 7 MHz high-resolution ultrasound in the left brachial artery. The percent change was calculated from the baseline value and that of the hyperemic response. RESULTS: In low-fat diet, PPAT change was not different (3.8% vs. 4.7%, p>0.05). In high-fat diet, PPAT tended to be shorter, but without statistical significance (4.8% vs. 2.7%, p>0.05). In low-fat diet, the change of FMD was not different (11.7% vs. 11.4%, p>0.05). In high-fat diet, there was a significant difference in FMD (11.4% vs. 6.5%, p<0.05). CONCLUSION: The PPAT measurement could be a method for evaluating endothelial function, but is less sensitive than flow-mediated vasodilation.
Arm ; Atherosclerosis ; Blood Pressure ; Brachial Artery ; Diet, Fat-Restricted ; Diet, High-Fat ; Meals ; Ultrasonography ; Vasodilation

It appears that a low-carbohydrate high-fat diet is more effective in weight loss than conventional low-fat diets for short-term periods of approximately 6 months. However, for long-term periods of about 1 year or more, the effects of a low-carbohydrate diet are reduced and the difference in weight loss between low-carbohydrate and low-fat diets disappears. A low-carbohydrate diet can lead to low triglycerides and high HDL cholesterol, and may even lead to an increase in LDL cholesterol. The effects of a low-carbohydrate diet on glycemic control are not clear, and there is no effect on blood pressure. A low-carbohydrate diet may lead to cardiovascular disease, and can increase cardiovascular and all-cause mortality.
Blood Pressure ; Cardiovascular Diseases ; Cholesterol, HDL ; Cholesterol, LDL ; Diet ; Diet, Fat-Restricted ; Diet, High-Fat ; Mortality ; Triglycerides ; Weight Loss

Globally, metabolic-asssociated fatty liver disease has become a significant health burden due to its complex pathogenesis, and there are no specific and effective therapeutic drugs to date. The onset and progression of metabolic-asssociated fatty liver disease is closely associated with improper dietary habits. The cornerstone to treat metabolic-asssociated fatty liver disease is weight loss through a well-balanced diet. This article summarizes and discusses the research progress at home and abroad in relationship to metabolic-asssociated fatty liver disease and dietary patterns such as the Mediterranean diet, the DASH diet, an energy-restricted balanced diet, a low fat diet, a low carbohydrate diet, a western diet, an animal food diet, a traditional diet, and others. In addition, it categorizes the effects of various dietary patterns on the prevention, treatment, or induction of several issues that need further metabolic-asssociated fatty liver disease research for subsequent reference.
Animals ; Non-alcoholic Fatty Liver Disease/etiology* ; Diet, Fat-Restricted ; Weight Loss ; Diet, Mediterranean ; Liver

Prevalence of non-alcoholic fatty liver disease (NAFLD) is about 20-25% in Korean adults population. Obesity is strongly associated with NAFLD and the prevention of obesity is a major public issue. Unfortunately, pharmacological treatment of obesity and NAFLD remains uncertain. Only weight loss by dietary changes been shown to lead to histological improvement in fatty liver. So the nutrition therapy is a cornerstone of treatment for NAFLD. Epidemiologic studies show that saturated fat, trans-fatty acid, carbohydrate, and simple sugar have strong correlation with intrahepatic fat accumulation. But, true associations with specific nutrients still remain unclear. Recently, fructose consumption has been rising in many countries and several epidemiologic studies show that fructose consumption has strong correlation with metabolic diseases. The consumption of excessively added sugar in the pathogenesis of steatohepatitis has received attention. Most clinicians agree with lifestyle modification are effective in histologic improvement. Total energy intake restriction is the most important action to reduce intrahepatic fat accumulation. Macronutrient composition may also have correlation with the development of NAFLD. To reduce the incidence of NAFLD, public statements on optimal dietary education program have been issused. Various specific dietary programs are suggested. Among them low fat diet and low carbohydrate diet are suggested in patients with NAFLD. However, there is no ideal diet to obtain the histological improvement in NAFLD. Further randomised controlled studies about specific diet are needed to determine the long-term benefit and histological improvement by ideal diet. Tailoring diet therapy to a patient's lifestyle is more important than universal specific dietary program.
*Diet ; Diet, Carbohydrate-Restricted ; Diet, Fat-Restricted ; Dietary Proteins/metabolism ; Energy Intake ; Fatty Acids, Monounsaturated/metabolism ; Fatty Liver/diet therapy/epidemiology/*etiology ; Humans

We experienced a case of primary intestinal lymphangiectasia in a 20-month-old boy, which was confirmed gastrofiberscopically and histologically only after a high-fat meal before the procedure. A characteristic endoscopic finding was the appearance of tiny white dots scattered in the duodenal mucosa, which were proved dilated lymph vessels in the lamina propria on histological examination. Treatment with low-fat diet and medium chain triglycerides supplementation was satisfactory.
Diagnosis* ; Diet, Fat-Restricted ; Humans ; Infant* ; Male* ; Meals* ; Mucous Membrane ; Triglycerides

We described a 22-month-old girl, who suffered from a gereralized edema and intermittent diarrhea for 1 month. Intestinal lymphangiectasia was confirmed by endoscopic biopsy. Endoscopic examination revealed showed the characteristic appearance of tiny white flakes scattered in the duodenum, which a histological examination confirmed to be dilated lymph vessels. The other findings from laboratory examinations included lymphopenia, hypoproteinemia, hypogammaglobulinemia and increased fecal a1-antitrypsin clearance. Treatment consisting of a low-fat diet and MCT supplementation was successful. The therapy has resulted in the disappearance of duodenal lesions previously observed endoscopically.
Agammaglobulinemia ; Biopsy ; Diarrhea ; Diet, Fat-Restricted ; Duodenum ; Edema ; Endoscopy ; Female ; Humans ; Hypoproteinemia ; Infant ; Lymphopenia

Obesity is associated with a state of chronic low-grade inflammation. This abnormal inflammation state may cause metabolic dysfunction. Many studies have supported the claim that immune cells such as adipose tissue macrophage and invariant natural killer T-cells (iNKT) are related to the development of metabolic diseases like diabetes. It has recently been reported that while human adenovirus 36 (Ad36) infection is associated with human obesity, it also helps to improve the serum level of lipid factors (glycemic control). However, the detailed cellular mechanism remains unclear. This study (The Journal of Clinical Investigation, 2012;122:3343-54) showed that iNKT cell-deficient mice on a low-fat diet used as a control for high-fat diet boasted insulin resistance phenotype without adipose tissue inflammation. The results of this study offer insight into the possibility of a novel role for iNKT related to the improvement of metabolic diseases, especially insulin resistance, and hint that Ad36-induced inflammation may be associated with iNKT in adipose tissue, while also playing a role in the improvement of glycemic control.
Adenoviruses, Human ; Adipose Tissue ; Animals ; Diet, Fat-Restricted ; Diet, High-Fat ; Humans ; Inflammation ; Insulin Resistance ; Macrophages ; Metabolic Diseases ; Mice ; Natural Killer T-Cells ; Obesity ; Phenotype

Chylothorax is a rare postoperative complication of a thoracic surgical procedure. Here, we report a case of chylothorax after thoracic endovascular aortic repair with debranching for the distal arch aneurysm of the aorta. First, the patient was treated by a medical method (nil per os, fat-free diet, and octreotide), but this method failed. The patient strongly refused surgical treatment. Therefore, we tried to occlude the thoracic duct by lymphangiography Lipiodol, and this line of treatment was successful.
Aneurysm ; Aorta ; Chylothorax* ; Diet, Fat-Restricted ; Ethiodized Oil* ; Humans ; Lymphography ; Postoperative Complications ; Thoracic Duct* ; Thoracic Surgical Procedures

BACKGROUND: Recent studies indicate postprandial triglyceride (TG) had a better association with cardiovascular events and metabolic syndrome than fasting TG. The authors of the present study investigated the metabolic and clinical relevance of postprandial TG. METHODS: In a cross-sectional retrospective study, the authors of the present study compared fasting and postprandial TG and analyzed the relationship between postprandial TG and various demographic and metabolic parameters in 639 Korean subjects with type 2 diabetes (T2D, group I, n=539) and impaired fasting glucose (IFG, group II, n=100) after ingestion of a standardized liquid meal (total 500 kcal, 17.5 g fat, 68.5 g carbohydrate, and 17.5 g protein). RESULTS: Fasting and postprandial TG were significantly correlated (r=0.973, r=0.937, P<0.001) in group I and II, respectively. Of the variables, total cholesterol, waist circumference and body mass index were significantly correlated with fasting and postprandial TG in both groups. Only postprandial TG showed a significant correlation with glucose metabolic parameters (e.g., postprandial glucose, homeostatic model assessment of insulin resistance [HOMA-IR], and fasting C-peptide) in subjects with T2D. Multiple regression analysis showed fasting TG and HOMA-IR could be predictable variables for postprandial TG in subjects with T2D. CONCLUSION: Postprandial TG was very strongly correlated with fasting TG. The authors of the present study suggest insulin resistance may be more associated with postprandial TG than fasting TG in Korean T2D patients on a low-fat diet.
Body Mass Index ; Cholesterol ; Diet, Fat-Restricted ; Eating ; Fasting ; Glucose ; Humans ; Insulin Resistance ; Meals ; Retrospective Studies ; Triglycerides ; Waist Circumference