Impact of dietetic fatty acids on lipid, inflammatory and oxidative profile and its activation in NF-kB and Nrf2 transcriptions factors in epileptic patients treated with ketogenic diet

Author(s)

Mariana Baldini Prudencio

• Document type: Master's Dissertation
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Faculdade de Saúde Pública (FSP/CIR)
• Defense date: 2018-10-16

Examining board members

Nágila Raquel Teixeira Damasceno; Dennys Esper Corrêa Cintra; Alceu Afonso Jordao Junior

• Advisor: Nágila Raquel Teixeira Damasceno

Abstract

Introduction: epilepsy is a neurological disease, its prevalence is estimated about 0,5 to 1 % in the population and 20 to 30% are refractory to the drug treatment. The ketogenic diet (KD) composed by high content of fat, low quantity of carbohydrate and adequate content of protein it is an adjuvant treatment with high efficacy in seizure control. Although it is well known about the efficacy of the diet, in humans there are few studies about the influence of the diet in oxidative biomarkers and its modulation in transcription factors such as NF-kB and Nrf2. Moreover it is not known about the impact of different types of dietetic fatty acids offers in KD could be influence in oxidative biomarkers and transcription factors. Objective: to evaluate and compare the impact of two different ketogenic diet, one composed by high content of saturated fatty acids (KD SAFA) and another one composed by high content of monounsaturated fatty acids and polyunsaturated fatty acids (KD NSAFA), on lipid and oxidative profile and activations of NF-kB and Nrf2 transcriptions factors in children and adolescents with refractory epilepsy on dietetic treatment with KD. Methods: clinical study, with 6 months of follow up, the patients was divided in two groups: one received a KD rich in saturated fatty acids and cholesterol (KD SAFA) and other received a KD with 20% less content of saturated fatty acids, increase in 50% of monounsaturated and polyunsaturated fatty acids comparing to KD SAFA (KD NSAFA). It was evaluated socioeconomic and clinical characteristics, anthropometric measure, food intake and lipids, oxidative and inflammatory biomarkers. The patients was evaluated in three different moments: before start the diet (T0), three months after start the KD (T1) and six months after start the KD (T2). The statistical analysis was performed using the software SPSS. Results: It was included 26 children and adolescents in KD SAFA and 26 in KD NSAFA. The participants treated with KD NSAFA had less modifications on classical lipid profile with less increase of: total cholesterol, LDL-C, APO B, LDL-C/HDL-C, HDL-C/APO A, LDL-C/APO B, non HDL cholesterol and non esterified fatty acids comparing to the participants treated with KD SAFA. In both diets there was a significant increase in oxidized LDL. It was observed increase of NFkB in the group treated with KD SAFA, without differences on the percentage of change of this biomarker between the interventions, in addition on the KD SAFA there was decrease in Nrf2 and the percentage of change it was different between the interventions with more reduction of this biomarker on KD SAFA. Conclusion: the KD SAFA showed worst profile in lipid, oxidative and inflammatory parameters comparing to KD NSAFA, suggesting that the use of KD NSAFA could be attenuate one of the main negative effect that are dyslipidemias. (AU)

• FAPESP's process: 16/12535-4 - Impact of dietetic fatty acids on lipidomics and oxidative profile, and its activation in NF-kB e NRF2 transcriptions factors in epileptic patients treated with ketogenic diet
• Grantee: Mariana Baldini Prudencio
• Support Opportunities: Scholarships in Brazil - Master