Summary of findings 2. Summary of findings ‐ Ketogenic diets compared with other ketogenic diets for people with epilepsy.

Ketogenic diets compared with other ketogenic diets for people with epilepsy
Patient or population: people with epilepsy Settings: outpatients Intervention: ketogenic diets Control: other ketogenic diets
Outcomes	Illustrative comparative risks* (95% CI)		Relative effect (95% CI)	No. of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Other Ketogenic Diets	Ketogenic Diets
Seizure freedom (100% reduction in seizure frequency) Follow‐up: 3 months to 6 months	Proportion of individuals achieving seizure freedom ranged from 10% to 25% on MAD: 21% on 2:5:1 KD, fasting‐onset KD and gradual‐onset KD, ranged from 26% to 55% on 4:1 KD, 33% on the classic KD, and 35% on the 3:1 KD		Not estimable	286 (5 studies)	⊕⊕⊝⊝ Very low1,2,3
Seizure reduction (50% or greater reduction in seizure frequency) Follow‐up: 3 months to 6 months	Proportion of individuals achieving seizure freedom ranged from 42% to 60% on MAD: 43% on the classic KD, 58% on the fasting‐onset KD, ranged from 58% to 85% on 4:1 KD, 63% on 2:5:1 KD, 67% on the gradual‐onset KD, and 72% on the 3:1 KD		Not estimable	326 (6 studies)	⊕⊕⊝⊝ Very low1,2,3	One study reported a statistically significant advantage for 10 g carbohydrate MAD over 20 g carbohydrate MAD One study reported no significant difference between classic KD and MAD One study reported no significant difference between 4:1 KD and 2:5:1 KD
Adverse effects Follow‐up: 3 months to 6 months	The most frequent adverse effects reported by participants in dietary intervention groups were: vomiting and constipation. Other adverse effects reported included diarrhoea, dysphagia, lethargy, lower respiratory tract infection, hyperammonaemic encephalopathy, weight loss, nausea, infections (pneumonia, sepsis), acute pancreatitis, decrease in bone matrix density, gallstones, fatty liver, nephrocalcinosis, hypercholesterolaemia, status epilepticus, acidosis, dehydration, tachycardia, hypoglycaemia, hunger,abdominal pain, clinically relevant reduction in height, hypercalcinaemia and renal stones.		Not estimable	326 (6 studies)	⊕⊕⊝⊝ Very low1,2,3	Few statistically significant differences were found between KD groups
Cognition and behaviour Follow‐up: NA	Outcome not reported				NA
Quality of life Follow‐up: NA	Outcome not reported				NA
Attrition rate Follow‐up: 3 months to 6 months	Proportion of individuals withdrawing from KD groups were 8% gradual‐onset KD, 16% on 2:5:1 KD and 4:1 KD, 17% fasting‐onset KD and on the 3:1 KD, 32% on MAD and 33% on the classic KD		Not estimable	326 (6 studies)	⊕⊕⊝⊝ Very low1,2,3
*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; KD: ketogenic diet;MAD: modified Atkins diet; MCT: medium‐chain triglyceride; NA: not applicable.
GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate.

¹Downgraded once due to inconsistency: studies are heterogeneous with regards to interventions examined and comparisons made.
 ²Downgraded once due to risk of bias: some included studies were not blinded, had missing data or unclear methodological details reported.
 ³Downgraded once due to applicability: included studies recruited children and young people under the age of 18, therefore results are not applicable to adults over the age of 18.