What are The Barriers to Initiating or Sustaining The Ketogenic Diet in Pediatric Patients; Single Centre Experience

Abstract

Objective: The ketogenic diet (KD) is an effective treatment for drug-resistant epilepsy in children. Despite its proven efficacy, a considerable number of eligible patients do not initiate or discontinue therapy prematurely. This study aimed to investigate the barriers to KD initiation and continuation following structured education provided by a specialized ketogenic care team. Materials and Methods: This retrospective study included pediatric patients referred to the Ketogenic Diet Clinic at Marmara University between 2014 and 2024 who either did not initiate the KD or discontinued it within the first three months. Out of 250 patients educated about the KD, 140 met the inclusion criteria and were contacted by phone. Seventy-two patients agreed to participate. Data were collected using a structured questionnaire and analyzed using descriptive statistics, chi-square and Mann-Whitney U tests, and logistic regression modeling to identify potential predictive factors. Results: This retrospective study included pediatric patients referred to the Ketogenic Diet Clinic at Marmara University between 2014 and 2024 who either did not initiate the KD or discontinued it within the first three months. Out of 250 patients educated about the KD, 140 met the inclusion criteria and were contacted by phone. Seventy-two patients agreed to participate. Data were collected using a struc tured questionnaire and analyzed using descriptive statistics, chi-square and Mann-Whitney U tests, and logistic regression modeling to identify potential predictive factors. Conclusion: Barriers to KD implementation were largely related to caregiver concerns, perceived dietary complexity, and doubts about effectiveness. These findings highlight the need for enhanced education, individualized support, and structured follow-up strategies to improve adherence and outcomes in clinical practice.

Keywords

• Ketogenic diet
• epilepsy
• adherence
• barriers
• dietary therapy

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