Objective. The ketogenic diet (KD) can result in hyperlipidemias. We report improvements in the lipid profiles of 3 children who were switched from KetoCal 4:1 powder (formulation prior to fall 2013) to KetoCal 4:1 Liquid formula. Compared with the KetoCal 4:1 powder formulation prior to fall 2013, KetoCal 4:1 Liquid has no trans-fatty acids, reduced saturated fatty acids, added omega-3 fatty acids, and added fiber. Methods. A retrospective chart review revealed 3 patients in our KD program with elevated lipid profiles while receiving 100% of their nutritional needs from KetoCal 4:1 powder. The patients were switched to KetoCal 4:1 Liquid and treated for >3 months. Fasting lipid profiles were obtained before and 2 to 3 months after the formula switch. All patients were on ≥4:1 ratio KD formula. Results. After changing formulas, the lipid profiles of all 3 patients improved. Mean total cholesterol, triglycerides, and low-density lipoprotein were reduced by 29%, 33%, and 58%, respectively. High-density lipoprotein increased by 10% on average. Conclusion. A decrease in lipid levels was observed with the transition to KetoCal 4:1 Liquid after an average of 2.1 months. Changes in dietary fat profile (including addition of omega-3 fatty acids) and the addition of fiber in enteral formulas can positively affect lipid profiles of tube-fed KD patients.