Treatment adherence, defined as the degree to which the patient actively follows the plan of care, is very difficult for subjects undergoing ketogenic dietary therapies (KDTs). This is a relevant issue because adherence to dietary therapies is considered 1 of the primary determinants of the treatment's success. This paper aimed to review the literature evidence about KDT adherence according to age and diagnosis of patients. Performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method, this systematic review included clinical trials and observational studies. The risk of bias was assessed by the RoB 2.0 Cochrane tool and the quality of evidence according to the Mixed Methods Appraisal Tool system. Twenty-two articles were included, with more than half ( = 12) having average quality (2–3 stars). The studies’ heterogeneity in measuring adherence and diagnosis made it difficult to compare results. Mean adherence rates were 71.5%, 66%, and 63.9% for children, adolescents, and adults, respectively. Adherence and compliance rates varied according to the follow-up period (79.7%, 66.7%, and 37.7% at 6, 24, and 36 months, respectively). The most frequent reasons for low adherence were linked to inefficacy in seizure control, adverse effects, food refusal, difficulty in preparing KDT meals or diet restrictiveness, lack of motivation, poor parental compliance, or cost of the diet. To conclude, there is a lack of standardized tools to measure adherence. Several studies highlighted the families’ challenges in adhering to KDTs. These factors should be considered when creating strategies and resources on family education.

中文翻译：

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癫痫患者坚持生酮饮食疗法：文献的系统回顾

治疗依从性（定义为患者积极遵循护理计划的程度）对于接受生酮饮食疗法（KDT）的受试者来说非常困难。这是一个相关问题，因为坚持饮食疗法被认为是治疗成功的主要决定因素之一。本文旨在根据患者年龄和诊断回顾有关 KDT 依从性的文献证据。该系统评价是根据系统评价和荟萃分析方法的首选报告项目进行的，包括临床试验和观察性研究。偏倚风险通过 RoB 2.0 Cochrane 工具进行评估，证据质量根据混合方法评估工具系统进行评估。纳入了 22 篇文章，其中一半以上 (= 12) 具有平均质量（2-3 星）。这些研究在测量依从性和诊断方面的异质性使得比较结果变得困难。儿童、青少年和成人的平均依从率分别为 71.5%、66% 和 63.9%。依从性和依从性随随访期的不同而变化（6、24 和 36 个月分别为 79.7%、66.7% 和 37.7%）。依从性低的最常见原因与癫痫控制无效、不良反应、拒食、准备 KDT 膳食困难或饮食限制、缺乏动力、父母依从性差或饮食成本有关。总而言之，缺乏衡量依从性的标准化工具。几项研究强调了家庭在遵守 KDT 方面面临的挑战。在制定家庭教育策略和资源时应考虑这些因素。