Measuring ketone bodies for the monitoring of pathologic and therapeutic ketosis

Abstract

Background The ketone bodies β‐hydroxybutyrate (BOHB) and acetone are generated as a byproduct of the fat metabolism process. In healthy individuals, ketone body levels are ∼0.1 mM for BOHB and ∼1 part per million for breath acetone (BrAce). These levels can increase dramatically as a consequence of a disease process or when used therapeutically for disease treatment. For example, increased ketone body concentration during weight loss is an indication of elevated fat metabolism. Ketone body measurement is relatively inexpensive and can provide metabolic insights to help guide disease management and optimize weight loss. Methods This review of the literature provides metabolic mechanisms and typical concentration ranges of ketone bodies, which can give new insights into these conditions and rationale for measuring ketone bodies. Results Diseases such as heart failure and ketoacidosis can affect caloric intake and macronutrient management, which can elevate BOHB 30‐fold and BrAce 1000‐fold. Other diseases associated with obesity, such as brain dysfunction, cancer, and diabetes, may cause dysfunction because of an inability to use glucose, excessive reliance on glucose, or poor insulin signaling. Elevating ketone body concentrations (e.g., nutritional ketosis) may improve these conditions by forcing utilization of ketone bodies, in place of glucose, for fuel. During weight loss, monitoring ketone body concentration can demonstrate program compliance and can be used to optimize the weight‐loss plan. Conclusions The role of ketone bodies in states of pathologic and therapeutic ketosis indicates that accurate measurement and monitoring of BOHB or BrAce will likely improve disease management. Bariatric surgery is examined as a case study for monitoring both types of ketosis.

Kavalactone Kawain Impedes Urothelial Tumorigenesis in UPII-Mutant Ha-Ras Mice via Inhibition of mTOR Signaling and Alteration of Cancer Metabolism

“…Seventy-five percent of control-diet-fed mice were detected with more than 250 erythrocytes/microliter in urine, whereas only 14.3% (1/7) of kawain-diet-fed male mice were found with more than 250 erythrocytes/microliter at the age of 23 weeks ( Figure 3 C,D). The majority of kawain-diet-fed mice were detected with ketone body in their urine, but this was absent in urine from control-diet-fed mice, suggesting that the kawain diet may have effects on fat catabolism in the UPII mutant Ha-ras model [ 21 ].…”

A user preference analysis of commercial breath ketone sensors to inform the development of portable breath ketone sensors for diabetes management in young people

“…This is especially relevant for ketoacidosis management when device accuracy is fundamental for a patient’s well-being. Further studies are needed to clarify the relationship between breath acetone testing and dynamics during ketoacidosis (also see Anderson et al, 2021 [ 10 ]). Informed by this research, device engineers and designers will be able to develop user-friendly prototypes for performance testing in various clinical scenarios in which ketone testing is relevant in diabetes care (e.g., sick day management of T1DM, DKA diagnosis by school nurses, general practitioners, ambulance officers and emergency department staff, monitoring for DKA in type 2 diabetes and potentially T1DM users of sodium glucose transporter type 2 inhibitors).…”

“…Studies have found a significant relationship between the blood ketone body β-hydroxybutyrate and breath acetone exhaled during respiration in adults [ 7 – 11 ], and to some extent in young people [ 12 , 13 ], including responses to ketogenic diets and during episodes of DKA. Thus, the measurement of the breath acetone concentration provides a non-invasive method to measure the level of ketosis [ 8 ] ( Table 1 ), and if developed and validated for use in T1DM could help in prevention of severe DKA through early detection [ 10 ]. Non-invasive technologies are of particular interest for young patient groups, with studies reporting more fear and pain related to finger pricking and injections among younger children [ 14 , 15 ] and adolescents [ 16 ].…”

Activation of G protein-coupled receptors by ketone bodies: Clinical implication of the ketogenic diet in metabolic disorders

“…KB become the primary energy source by cells with mitochondria and, most importantly, by the brain. This significant rise in KB in course of KD it is known as “nutritional ketosis” ( 17 ), a condition in which plasma KB concentration physiologically increases (at least > 0.5 mM ( 18 )), resulting in a rather safe nutritional approach ( 19 ).…”