Ketocal

This diet is a high-fat, low-carbohydrate diet (3:1 ratio of fat to carbohydrate and protein) that includes ~75% total energy as fat, ~20% as protein and ~5% as carbohydrate and fiber. Dietary fat sources focus on animal and vegetable (for vegetarians) fats. Dietary fat resources for vegan participants include nuts, seeds, avocados and coconut oil. Dietary protein sources include animal, plant and nut and seed proteins, and dietary carbohydrate resources include vegetarian and vegan sources. KetoCal®, a nutritionally complete, ready-to-feed ketogenic formula in a 3:1 ratio (fat to carbohydrate and protein), is provided by Nutricia for the patients who receive enteral nutrition. Nutricia is a global health company that has been the main provider of KDs for clinical trials, hospitals, health care professionals and communities around the world. Patients who are able to swallow receive liquid or solid high-fat meals that are prepared by the UAB research kitchen, with the overall energy amount determined according to REE assessed via indirect calorimetry and multiplied by an activity factor. REE is measured after a 12-h fast.

The patients on a partial KD received KetoCal (Nutricia, Gaithersburg, MD, USA), a high-fat content formula (based on 4:1 ketogenic ratio) combined with a based milk standard infant formula, as part of their diet, with 60–70% of the total energy coming from fat. Protein was provided to meet infant dietary reference intake and above (2.5–3.5 g/kg) according to their nutritional needs. (Dietary details presented in Table 1).