Comparison of The Effect of Ketogenic Diet and Low Caloric Diet On Weight Loss in Iranian Obese and Overweight Children


1 Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 Professor of pediatric Endocrinology and Metabolism, Mashhad University of medical Sciences, Mashhad Iran.

3 Metabolic Syndrome Research Center, Mashhad University of Medical Sciences & Department of Nutrition, Varastegan Institute for Medical Science, Mashhad, Iran

4 Cardiovascular Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

5 Brighton & Sussex Medical School, Division of Medical Education, Falmer, Brighton, Sussex BN1 9PH, UK


Overweight and obesity has increased in prevalence over the last two decades in many developed and developing countries including Iran. The aim of this present study was to compare the weight reduction effects of ketogenic and low calorie diets on overweight and obese Iranian children. Seventy-six overweight or obese children aged 9-16 years recruited from outpatient Ghaem Hospital, Nutritional Clinic, were randomized into two groups: a low calorie diet (n=38), a ketogenic diet (n=38). Both groups were treated for three months and followed up weekly. Fasting lipid profiles, blood sugar, uric acid, high-sensitivity C-reactive protein, , and weight were measured. Body fat percentages were measured using Bioimpedance Analysis (Tanita body composition analyzer, BC-418, Japan) for all subjects’ in each visit. Both ketogenic and low caloric diets reduced obesity indices including body fat percentage and improved lipid profiles (P<0.05). Changes in body weight and BMI did not differ significantly between two groups (P>0.05). However, low caloric diet had more potential beneficial effect on body fat percentage and lipid profile than ketogenic diet (P<0.05).Results showed ketogenic diet did not have any remarkable effect on weight loss versus low caloric diet and it seems that both diets had similar effect on weight loss in overweight and obese children. This study revealed the low caloric diet had more potential beneficial effect on body fat percentage and lipid profile than ketogenic diet.


1.Deeb A, Attia S, Mahmoud S, Elhaj G, Elfatih A. Dyslipidemia and Fatty Liver Disease in Overweight and Obese Children. Journal of obesity. 2018;2018:8626818.
2.Shatat IF, Brady TM. Editorial: Pediatric Hypertension: Update. Frontiers in pediatrics. 2018;6:209.
3. Barzin M, Aryannezhad S, Serahati S, Beikyazdi A, Azizi F, Valizadeh M, et al. Incidence of obesity and its predictors in children and adolescents in 10 years of follow up: Tehran lipid and glucose study (TLGS). BMC pediatrics. 2018;18(1):245.
4.Garipagaoglu M, Budak N, Süt N, Akdikmen Ö, Oner N, Bundak R. Obesity Risk Factors in Turkish Children. Journal of Pediatric Nursing. 2009;24(4):332-7.
5. Cooper C, Sarvey S, Collier D, Willson C, Green I, Pories ML, et al. For comparison: experience with a children's obesity camp. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2006;2(6):622-6.
6.Dressler A, Haiden N, Trimmel-Schwahofer P, Benninger F, Samueli S, Groppel G, et al. Ketogenic parenteral nutrition in 17 pediatric patients with epilepsy. Epilepsia open. 2018;3(1):30-9.
7. Park EG, Lee J, Lee J. Use of the Modified Atkins Diet in Intractable Pediatric Epilepsy. Journal of epilepsy research. 2018;8(1):20-6.
8.Cohen IA. A model for determining total ketogenic ratio (TKR) for evaluating the ketogenic property of a weight-reduction diet. Medical hypotheses. 2009;73(3):377-81.
9. Blunck JR, Newman JW, Fields RK, Croom JE. Therapeutic augmentation of ketogenic diet with a sodium-glucose cotransporter 2 inhibitor in a super-refractory status epilepticus patient. Epilepsy & behavior case reports. 2018;10:61-4.
10. Westman EC, Yancy WS, Jr., Olsen MK, Dudley T, Guyton JR. Effect of a low-carbohydrate, ketogenic diet program compared to a low-fat diet on fasting lipoprotein subclasses. International journal of cardiology. 2006;110(2):212-6.
11. L. Kathleen Mahan SE-S. Krause's Food N, & Diet Therapy 12th ed ed: Saunders, United States of America; 2008.
12.Krebs NF, Gao D, Gralla J, Collins JS, Johnson SL. Efficacy and safety of a high protein, low carbohydrate diet for weight loss in severely obese adolescents. The Journal of pediatrics. 2010;157(2):252-8.
13. Astrup A, Meinert Larsen T, Harper A. Atkins and other low-carbohydrate diets: hoax or an effective tool for weight loss? Lancet (London, England). 2004;364(9437):897-9.
14.Skov AR, Toubro S, Ronn B, Holm L, Astrup A. Randomized trial on protein vs carbohydrate in ad libitum fat reduced diet for the treatment of obesity. International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity. 1999;23(5):528-36.
15.  Westerterp-Plantenga MS, Lejeune MPGM. Protein intake and body-weight regulation. Appetite. 2005;45(2):187-90.
16.Mobbs CV, Mastaitis J, Yen K, Schwartz J, Mohan V, Poplawski M, et al. Low-carbohydrate diets cause obesity, low-carbohydrate diets reverse obesity: a metabolic mechanism resolving the paradox. Appetite. 2007;48(2):135-8.
17. Westman EC, Yancy WS, Edman JS, Tomlin KF, Perkins CE. Effect of 6-month adherence to a very low carbohydrate diet program. The American journal of medicine. 2002;113(1):30-6.
18.Sharman MJ, Kraemer WJ, Love DM, Avery NG, Gomez AL, Scheett TP, et al. A ketogenic diet favorably affects serum biomarkers for cardiovascular disease in normal-weight men. The Journal of nutrition. 2002;132(7):1879-85.
19. Samaha FF, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, et al. A low-carbohydrate as compared with a low-fat diet in severe obesity. The New England journal of medicine. 2003;348(21):2074-81.
20.Foster GD, Wyatt HR, Hill JO, McGuckin BG, Brill C, Mohammed BS, et al. A randomized trial of a low-carbohydrate diet for obesity. The New England journal of medicine. 2003;348(21):2082-90.
21. Metz JA, Stern JS, Kris-Etherton P, Reusser ME, Morris CD, Hatton DC, et al. A randomized trial of improved weight loss with a prepared meal plan in overweight and obese patients: impact on cardiovascular risk reduction. Archives of internal medicine. 2000;160(14):2150-8.
22. Fleming RM. The effect of high-, moderate-, and low-fat diets on weight loss and cardiovascular disease risk factors. Preventive cardiology. 2002;5(3):110-8.
23. Miller ER, 3rd, Erlinger TP, Young DR, Jehn M, Charleston J, Rhodes D, et al. Results of the Diet, Exercise, and Weight Loss Intervention Trial (DEW-IT). Hypertension (Dallas, Tex : 1979). 2002;40(5):612-8.
24. Parks EJ, German JB, Davis PA, Frankel EN, Kappagoda CT, Rutledge JC, et al. Reduced oxidative susceptibility of LDL from patients participating in an intensive atherosclerosis treatment program. The American journal of clinical nutrition. 1998;68(4):778-85.
25. Larosa JC, Fry AG, Muesing R, Rosing DR. Effects of high-protein, low-carbohydrate dieting on plasma lipoproteins and body weight. Journal of the American Dietetic Association. 1980;77(3):264-70.
26.Tashev T, Goranov I, Ekimova S, Shishkov G, Dzhamba I. [Treatment of obesity with a high-protein, high-fat, "carbohydrate-free" diet]. Vutreshni bolesti. 1976;15(5):50-6.
27. Santoro KB, O'Flaherty T. Children and the ketogenic diet. Journal of the American Dietetic Association. 2005;105(5):725-6.
28. Vining EP. Clinical efficacy of the ketogenic diet. Epilepsy research. 1999;37(3):181-90.