{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T22:53:39Z","timestamp":1793141619575,"version":"4.5.0"},"reference-count":41,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,5,5]]},"abstract":"<jats:p xml:lang=\"en\">Ketogenic diets (KDs) are increasingly being adopted by adults with normal body mass index for health and performance\u2010related reasons. Accumulating evidence shows that this population is susceptible to large increases in low\u2010density lipoprotein cholesterol (LDL\u2010C) when consuming KDs, raising concerns about long\u2010term atherosclerotic cardiovascular disease (ASCVD) risk. This review synthesizes current evidence on KD\u2010induced LDL\u2010C elevations among individuals with normal body mass index, explores potential mechanisms underlying this phenotype, and discusses implications for ASCVD risk assessment and clinical management. Short\u2010term clinical trials in healthy individuals with normal body mass index consuming KDs report mean LDL\u2010C increases ranging from 18 to 70\u2009mg\/dL. Although it has been proposed that these LDL\u2010C elevations may be benign in otherwise metabolically healthy individuals, supporting evidence is lacking. Strong and consistent evidence supports LDL\u2010C as a causal, cumulative risk factor for ASCVD. However, the long\u2010term ASCVD consequences of KD\u2010induced LDL\u2010C elevation in lean individuals have not been directly studied. Limited coronary imaging data are available in this population, but they do not establish cardiovascular safety. Emerging case reports suggest that moderate carbohydrate reintroduction (50\u2013100\u2009g\/d) can substantially reverse KD\u2010induced LDL\u2010C elevations, with further reductions achievable using pharmacologic therapy. Clinicians should be prepared to manage patients who choose to follow KDs, especially those with extreme LDL\u2010C elevation. Regular lipid monitoring and patient\u2010centered risk communication are essential for individuals choosing to follow a KD, particularly those of normal body mass index who may otherwise appear at low ASCVD risk.<\/jats:p>","DOI":"10.1161\/jaha.125.048903","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T09:54:57Z","timestamp":1777370097000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Ketogenic Diets and Low\u2010Density Lipoprotein Cholesterol in Adults With Normal Weight: An Emerging Clinical Challenge"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6275-9405","authenticated-orcid":false,"given":"Zachary S.","family":"DiMattia","sequence":"first","affiliation":[{"name":"The Pennsylvania State University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3914-0353","authenticated-orcid":false,"given":"Kristina S.","family":"Petersen","sequence":"additional","affiliation":[{"name":"The Pennsylvania State University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.appet.2019.104324"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m4743"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1038\/ejcn.2013.116"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacl.2019.08.003"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacl.2020.10.005"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/cdn\/nzab144"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacl.2021.04.010"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajpc.2023.100495"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.3390\/nu15040962"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2025.1635489"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/nutrit\/nuad017"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajcnut.2024.01.009"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajcnut.2025.09.012"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx144"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.13985"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijms242115621"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1172\/jci.insight.128308"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.3945\/an.111.000422"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/nqz113"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacl.2025.03.009"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-2275(20)37178-9"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2024.02.024"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.3390\/nu14061135"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.3390\/nu13030814"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2018.10.013"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/132.7.1879"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc16-1958"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.numecd.2021.11.005"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2022.0912"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.3390\/metabo12050460"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(18)30135-X"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz174"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0055030"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacadv.2024.100924"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacadv.2025.101686"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacadv.2024.101109"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.64898\/2026.01.15.26343955"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacl.2020.12.005"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2019.09.014"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.2174\/0115701611370578250621183337"},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001029"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.125.048903","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T14:47:56Z","timestamp":1785250076000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.125.048903"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,5]]},"references-count":41,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,5,5]]}},"alternative-id":["10.1161\/JAHA.125.048903"],"URL":"https:\/\/doi.org\/10.1161\/jaha.125.048903","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,5]]},"assertion":[{"value":"2025-12-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e048903"}}