{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T04:27:48Z","timestamp":1778041668770,"version":"3.51.4"},"reference-count":26,"publisher":"Walter de Gruyter GmbH","issue":"7","license":[{"start":{"date-parts":[[2023,5,11]],"date-time":"2023-05-11T00:00:00Z","timestamp":1683763200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100019707","name":"Connecticut Children\u2019s Medical Center","doi-asserted-by":"publisher","award":["Fellowship Scholar activity"],"award-info":[{"award-number":["Fellowship Scholar activity"]}],"id":[{"id":"10.13039\/100019707","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec id=\"j_jpem-2022-0589_abs_001\">\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Ketone production is a physiological phenomenon that occurs during beta-oxidation of free fatty acids. Distinguishing physiologic ketosis from pathologic over-production\/underutilization of ketones is critical as\u00a0part of the diagnostic evaluation of disorders of carbohydrate metabolism, but there is limited literature on normal ketone production with fasting. Our aim is to\u00a0measure fasting serum beta-hydroxybutyrate (BHB) concentrations in healthy children after an overnight fast.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpem-2022-0589_abs_002\">\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Children\u00a0\u226418 years of age were prospectively recruited from elective procedures through our surgery centers. Exclusion criteria included a history of diabetes, hypopituitarism, adrenal, metabolic or inflammatory disorders, dietary restrictions, trauma, or use of medications that might affect blood glucose. Serum glucose, cortisol, and BHB were assessed after an overnight fast.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpem-2022-0589_abs_003\">\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Data from 94 participants (mean 8.3\u00a0\u00b1\u00a05.7\u202fyears, 54\u202f% male, 46\u202f% female, were analyzed. Children\u00a0\u22643\u202fyears of age (19) have significantly higher mean (0.40\u00a0\u00b1\u00a00.06\u202fmmol\/L) and median (0.4, IQR 0.2\u20130.6\u202fmmol\/L) BHB concentrations compared to children &gt;3 years of age (75) with mean (0.21\u00a0\u00b1\u00a00.02\u202fmmol\/L) and median BHB (0.1, IQR 0.1\u20130.2\u202fmmol\/L) (p&lt;0.0001). Fasting BHB levels of &gt;1.0\u202fmmol\/L was rare (2\u202f%, N=2) and 74\u202f% (N=70) of participants had BHB levels &lt;0.3\u202fmmol\/L.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpem-2022-0589_abs_004\">\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>BHB concentrations are significantly higher in young children (\u22643 years of age) compared to older children. Fasting BHB levels &gt;1.0\u202fmmol\/L are rare within our population and therefore may identify a value above which there may a greater concern for pathologic ketotic hypoglycemia. It is imperative to establish the normative range in children to differentiate physiological from pathological ketotic hypoglycemia.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1515\/jpem-2022-0589","type":"journal-article","created":{"date-parts":[[2023,5,10]],"date-time":"2023-05-10T17:26:32Z","timestamp":1683739592000},"page":"667-673","source":"Crossref","is-referenced-by-count":10,"title":["Fasting ketone levels vary by age: implications for differentiating physiologic from pathologic ketotic hypoglycemia"],"prefix":"10.1515","volume":"36","author":[{"given":"Komalben","family":"Parmar","sequence":"first","affiliation":[{"name":"Department of Pediatric Endocrinology , Connecticut Children Medical Center , Hartford , CT , USA"},{"name":"Department of Pediatrics , University of Connecticut School of Medicine , Farmington , CT , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maua","family":"Mosha","sequence":"additional","affiliation":[{"name":"Department of Research , Connecticut Children Medical Center , Hartford , CT , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David A.","family":"Weinstein","sequence":"additional","affiliation":[{"name":"Department of Pediatrics , University of Connecticut School of Medicine , Farmington , CT , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca","family":"Riba-Wolman","sequence":"additional","affiliation":[{"name":"Department of Pediatric Endocrinology , Connecticut Children Medical Center , Hartford , CT , USA"},{"name":"Department of Pediatrics , University of Connecticut School of Medicine , Farmington , CT , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2023,5,11]]},"reference":[{"key":"2023070813115018199_j_jpem-2022-0589_ref_001","doi-asserted-by":"crossref","unstructured":"Millar, R, Harding, A. Review article: accelerated starvation of childhood: have I judged ketones? EMA\u00a0\u2013 Emerg Med Australas 2019;31:314\u201320. https:\/\/doi.org\/10.1111\/1742-6723.13276.","DOI":"10.1111\/1742-6723.13276"},{"key":"2023070813115018199_j_jpem-2022-0589_ref_002","unstructured":"Vanelli, M, Mastrorilli, C, Fainardi, V, Iovane, B, Scarabello, C, Veronese, P, et al.. Clinical utility of beta-hydroxybutyrate measurement in the management of physiological ketosis at home in children under 5. Acta Biomed 2019;90:215\u201320. https:\/\/doi.org\/10.23750\/abm.v90i2.8260."},{"key":"2023070813115018199_j_jpem-2022-0589_ref_003","doi-asserted-by":"crossref","unstructured":"Adamkin, DH. Postnatal glucose homeostasis in late-preterm and term infants. 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