{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:18:07Z","timestamp":1785421087121,"version":"3.56.0"},"reference-count":32,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Science and Technology Achievement Transformation Fund of West China Hospital, Sichuan University","award":["CGZH21006"],"award-info":[{"award-number":["CGZH21006"]}]},{"award":["CGZH21006"],"award-info":[{"award-number":["CGZH21006"]}],"id":[{"id":"https:\/\/ror.org\/011ashp19","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Rapid and accurate ketone detection is clinically valuable for both diabetic and non-diabetic individuals. Breath acetone represents an attractive non-invasive and real-time alternative for monitoring ketones. This study aimed to explore the correlation between breath acetone measured by proton transfer reaction time-of-flight mass spectrometry (PTR-TOF-MS) and ketone bodies in blood and urine in individuals with normoglycemia, prediabetes and diabetes. Methods: A total of 4000 participants were recruited. Urinary ketone levels, blood \u03b2-hydroxybutyrate (\u03b2HB) concentrations, and breath acetone (measured by PTR-TOF-MS) were assessed. Participants were classified into urine ketone-negative and urine ketone-positive groups. They were further divided according to the semiquantitative degree of urinary ketone (\u2212, +, ++, +++ and ++++). Spearman rank correlation analysis was performed to evaluate the relationship between breath acetone and blood \u03b2HB. Receiver operating characteristic (ROC) curve analysis was conducted to determine the preliminary thresholds of breath acetone for detecting blood \u03b2HB positivity. Multiple linear regression, including a quadratic term for blood \u03b2HB, was performed, and the inflection point of the curve was calculated. Results: Blood \u03b2HB and breath acetone were significantly higher in the urine ketone-positive group than in the urine ketone-negative group (p &lt; 0.001). A progressive elevation in blood \u03b2HB and exhaled breath acetone concentrations was observed with increasing urinary ketone levels (p &lt; 0.001). The Spearman rank correlation coefficient between breath acetone and blood \u03b2HB was 0.493, 0.522, 0.379, and 0.636 in the general population, normoglycemia, prediabetes, and diabetes groups, respectively (all p &lt; 0.001). The preliminary thresholds of breath acetone concentration for detecting blood \u03b2HB positivity were 2.37 ppmv in diabetes, 1.10 ppmv in prediabetes, and 2.05 ppmv in normoglycemia, respectively. Blood \u03b2HB exhibited a significant quadratic association with breath acetone in the general population, normoglycemia, and diabetes (B = \u22121.698, \u22121.409, and \u221216.070, respectively; p &lt; 0.001), with inflection points of the quadratic curves at 2.73 mmol\/L, 3.28 mmol\/L and 1.61 mmol\/L, respectively, whereas in prediabetes, the relationship did not significantly deviate from linearity. Conclusions: In normoglycemia and diabetes, breath acetone based on PTR-TOF-MS exhibited an inverted U-shaped relationship with blood \u03b2HB, while in prediabetes, breath acetone showed a linear positive correlation with blood \u03b2HB. In populations where blood \u03b2HB is below the quadratic inflection point, breath acetone measured by PTR-TOF-MS holds promise as a non-invasive ketone-monitoring tool.<\/jats:p>","DOI":"10.3390\/diagnostics16132043","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T16:56:55Z","timestamp":1782838615000},"page":"2043","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Correlation Between Breath Acetone and Ketone Bodies in Blood and Urine Among Individuals with Different Glycometabolic Statuses Based on PTR-TOF-MS"],"prefix":"10.3390","volume":"16","author":[{"given":"Ting","family":"Li","sequence":"first","affiliation":[{"name":"Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanting","family":"Yang","sequence":"additional","affiliation":[{"name":"Aliben Sci & Technol Co., Ltd., Chengdu 611930, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanlu","family":"Yue","sequence":"additional","affiliation":[{"name":"Aliben Sci & Technol Co., Ltd., Chengdu 611930, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Chen","sequence":"additional","affiliation":[{"name":"Aliben Sci & Technol Co., Ltd., Chengdu 611930, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Huang","sequence":"additional","affiliation":[{"name":"Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu 610041, China"},{"name":"State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu 610041, China"},{"name":"Research Laboratory for Prediction and Evaluation of Chronic Diseases in the Elderly, National Clinical Research Center for Geriatric Diseases, West China Hospital, Sichuan University, Chengdu 610041, China"},{"name":"General Practice Research Institute, West China Hospital, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9267-3437","authenticated-orcid":false,"given":"Fengming","family":"Luo","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu 610041, China"},{"name":"Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China"},{"name":"Department of Respiratory and Critical Care Medicine, Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1002\/(SICI)1520-7560(199911\/12)15:6<412::AID-DMRR72>3.0.CO;2-8","article-title":"Ketone bodies: A review of physiology, pathophysiology and application of monitoring to diabetes","volume":"15","author":"Laffel","year":"1999","journal-title":"Diabetes Metab. 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