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This cohort constituted a subgroup of the patients accepted into the ketogenic diet program between and After diet initiation, the calories and ratio were adjusted to maintain ideal body weight for height and maximal urinary ketosis for seizure control. Significant but less marked changes persisted in children observed after 12 and 24 months. Further studies are necessary to determine if such a diet adversely affects endothelial vascular function and promotes inflammation and formation of atherosclerotic lesions. The ketogenic diet is a high-fat low-carbohydrate adequate protein diet first developed 8 decades ago for the management of difficult-to-control seizures in children. The classic ketogenic diet consists of a ratio of fat to carbohydrate and protein combined. Younger rapidly growing children and adolescents are often started in treatment by receiving a less stringent ratio of fat to carbohydrate plus protein to allow sufficient protein
While these studies are generally retrospective or epidemiologic, experimental studies also provide compelling evidence that diet-induced obesity in rodents causes significant brain injury and cognitive impairment. There are several critically important reasons why the damaging effects of obesity on brain homeostasis must be experimentally resolved. First, despite the availability of various weight-loss interventions, obesity remains stubbornly prevalent and highly refractory to clinical remediation. Secondly, notwithstanding emotional devastation and family disruption, the monetary costs of caring just for Alzheimer’s patients in the US could reach a staggering 1. These experiments show that the loss of NOX2 signaling in visceral macrophages confers dramatic decreases in visceral adiposopathy and inflammation, while additional recent data reveal a significant linear relationship between NADPH oxidase activity in visceral adipose and cognitive impairment in wild-type mice. These data collectively suggest that NOX2-based signaling in visceral macrophages links visceral adiposity to sustained and progressive cascades of inflammation that trigger brain injury and dysfunction. However, NOX2 is only a single component of the NADPH oxidase system, which is a pleiotropic enzyme complex mediating variety of physiologic processes. Therefore, to advance this important field and optimize therapeutic potential of NADPH oxidase in obesity, we have designed proof-of-concept studies using novel mouse models and cell type-specific pharmacologic targeting strategies in which the NOX2 subunit of NADPH oxidase will be individually manipulated only in macrophages. Obesity caused by an unhealthy, high-fat diet can cause brain injury and dramatically increase the risk of dementia. This is a significant public health concern, as both the prevalence of obesity and the costs required to treat dementia continue to increase. This suggests that it may not be necessary to ‘cure’ obesity to dramatically improve public health.