{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:11:58Z","timestamp":1760235118840,"version":"build-2065373602"},"reference-count":65,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2021,7,29]],"date-time":"2021-07-29T00:00:00Z","timestamp":1627516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008713","name":"Diabetes Australia Research Trust","doi-asserted-by":"publisher","award":["Y20G-FARM"],"award-info":[{"award-number":["Y20G-FARM"]}],"id":[{"id":"10.13039\/100008713","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>The sympathoadrenal counterregulatory response to hypoglycemia is critical for individuals with type 1 diabetes due to impaired ability to produce glucagon. Ketogenic diets (KD) are an increasingly popular diabetes management tool; however, the effects of KD on the sympathoadrenal response are largely unknown. Here, we determined the effects of KD-induced ketosis on the sympathoadrenal response to a single insulin-induced hypoglycemic challenge. We investigated how a 3 week KD feeding regimen affected the main components of the sympathoadrenal counterregulatory response: adrenal sympathetic nerve activity (ASNA), adrenal gland activity, plasma epinephrine, and brainstem glucose-responsive C1 neuronal activation in anesthetized, nondiabetic male Sprague-Dawley rats. Rats on KD had similar blood glucose (BG) levels and elevated ketone body \u03b2-hydroxybutyrate (BHB) levels compared to the control Chow diet group. All KD rats responded to hypoglycemia with a robust increase in ASNA, which was initiated at significantly lower BG levels compared to Chow-fed rats. The delay in hypoglycemia-induced ASNA increase was concurrent with rapid disappearance of BHB from cerebral and peripheral circulation. Adrenal gland activity paralleled epinephrine and ASNA response. Overall, KD-induced ketosis was associated with initiation of the sympathoadrenal response at lower blood glucose levels; however, the magnitude of the response was not diminished.<\/jats:p>","DOI":"10.3390\/nu13082627","type":"journal-article","created":{"date-parts":[[2021,7,29]],"date-time":"2021-07-29T21:21:21Z","timestamp":1627593681000},"page":"2627","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Slow but Steady\u2014The Responsiveness of Sympathoadrenal System to a Hypoglycemic Challenge in Ketogenic Diet-Fed Rats"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0873-8782","authenticated-orcid":false,"given":"Polina E.","family":"Nedoboy","sequence":"first","affiliation":[{"name":"The Heart Research Institute, Newtown, NSW 2042, Australia"},{"name":"Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7806-5718","authenticated-orcid":false,"given":"Myfanwy","family":"Cohen","sequence":"additional","affiliation":[{"name":"The Heart Research Institute, Newtown, NSW 2042, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa M.-J.","family":"Farnham","sequence":"additional","affiliation":[{"name":"The Heart Research Institute, Newtown, NSW 2042, Australia"},{"name":"Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1001\/jamainternmed.2014.136","article-title":"National Estimates of Insulin-Related Hypoglycemia and Errors Leading to Emergency Department Visits and Hospitalizations","volume":"174","author":"Geller","year":"2014","journal-title":"JAMA Intern. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1007\/s00125-005-0082-6","article-title":"Long-term mortality in a nationwide cohort of childhood-onset type 1 diabetic patients in Norway","volume":"49","author":"Skrivarhaug","year":"2006","journal-title":"Diabetologia"},{"key":"ref_3","first-page":"E149","article-title":"Glucose counterregulation: Prevention and correction of hypoglycemia in humans","volume":"264","author":"Cryer","year":"1993","journal-title":"Am. J. Physiol. Metab."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1111\/j.1749-6632.2010.05820.x","article-title":"Neuroendocrine responses to hypoglycemia","volume":"1212","author":"Tesfaye","year":"2010","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"4019","DOI":"10.1210\/en.2010-1458","article-title":"Minireview: The Value of Looking Backward: The Essential Role of the Hindbrain in Counterregulatory Responses to Glucose Deficit","volume":"152","author":"Ritter","year":"2011","journal-title":"Endocrinology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1111\/nyas.14214","article-title":"Hypoglycemia-associated autonomic failure, counterregulatory responses, and therapeutic options in type 1 diabetes","volume":"1454","author":"Rickels","year":"2019","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1210\/er.2018-00226","article-title":"Central Mechanisms of Glucose Sensing and Counterregulation in Defense of Hypoglycemia","volume":"40","author":"Stanley","year":"2019","journal-title":"Endocr. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"R215","DOI":"10.1152\/ajpregu.00531.2011","article-title":"The physiology and pathophysiology of the neural control of the counterregulatory response","volume":"302","author":"Beall","year":"2012","journal-title":"Am. J. Physiol. Integr. Comp. Physiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1172\/JCI105650","article-title":"Brain Metabolism during Fasting","volume":"46","author":"Owen","year":"1967","journal-title":"J. Clin. Investig."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.2337\/db08-1557","article-title":"Medium-Chain Fatty Acids Improve Cognitive Function in Intensively Treated Type 1 Diabetic Patients and Support in Vitro Synaptic Transmission during Acute Hypoglycemia","volume":"58","author":"Page","year":"2009","journal-title":"Diabetes"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.2337\/diab.43.11.1311","article-title":"Effect of hyperketonemia and hyperlacticacidemia on symptoms, cognitive dysfunction, and counterregulatory hormone responses during hypoglycemia in normal humans","volume":"43","author":"Veneman","year":"1994","journal-title":"Diabetes"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1016\/j.neulet.2005.05.038","article-title":"Ketogenic diet reduces hypoglycemia-induced neuronal death in young rats","volume":"385","author":"Yamada","year":"2005","journal-title":"Neurosci. Lett."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2757","DOI":"10.1172\/JCI107095","article-title":"Resistance to Symptomatic Insulin Reactions after Fasting","volume":"51","author":"Drenick","year":"1972","journal-title":"J. Clin. Investig."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1146\/annurev.nutr.26.061505.111258","article-title":"Fuel Metabolism in Starvation","volume":"26","author":"Cahill","year":"2006","journal-title":"Annu. Rev. Nutr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1007\/978-0-387-85998-9_45","article-title":"Ketones Suppress Brain Glucose Consumption","volume":"645","author":"LaManna","year":"2009","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2","DOI":"10.4103\/2319-4170.107152","article-title":"Dietary Therapies for Epilepsy","volume":"36","author":"Kossoff","year":"2013","journal-title":"Biomed. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e20173349","DOI":"10.1542\/peds.2017-3349","article-title":"Management of Type 1 Diabetes With a Very Low\u2013Carbohydrate Diet","volume":"141","author":"Lennerz","year":"2018","journal-title":"Pediatrics"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1111\/dme.13663","article-title":"The glycaemic benefits of a very-low-carbohydrate ketogenic diet in adults with Type 1 diabetes mellitus may be opposed by increased hypoglycaemia risk and dyslipidaemia","volume":"35","author":"Leow","year":"2018","journal-title":"Diabet. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.1111\/dme.14049","article-title":"Glycaemic stability of a cyclist with Type 1 diabetes: 4011 km in 20 days on a ketogenic diet","volume":"36","author":"Nolan","year":"2019","journal-title":"Diabet. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1210\/jcem-50-3-557","article-title":"Effect of ketone body infusion on plasma catecholamine and substrate concentrations during acute hypoglycemia in man","volume":"50","author":"Kehlet","year":"1980","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"107557","DOI":"10.1016\/j.jdiacomp.2020.107557","article-title":"Consuming a ketogenic diet leads to altered hypoglycemiccounter-regulation in mice","volume":"34","author":"Morrison","year":"2020","journal-title":"J. Diabetes Complicat."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"132","DOI":"10.2337\/dc16-1472","article-title":"Low-Carbohydrate Diet Impairs the Effect of Glucagon in the Treatment of Insulin-Induced Mild Hypoglycemia: A Randomized Crossover Study","volume":"40","author":"Ranjan","year":"2017","journal-title":"Diabetes Care"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.autneu.2017.12.004","article-title":"The effects of recurrent hypoglycaemia and opioid antagonists on the adrenal catecholamine synthetic capacity in a rat model of HAAF","volume":"210","author":"Senthilkumaran","year":"2018","journal-title":"Auton. Neurosci."},{"key":"ref_24","first-page":"E388","article-title":"Repetitive hypoglycemia reduces activation of glucose-responsive neurons in C1 and C3 medullary brain regions to subsequent hypoglycemia","volume":"317","author":"Kakall","year":"2019","journal-title":"Am. J. Physiol. Metab."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.2337\/diabetes.50.5.1119","article-title":"Effect of acute and antecedent hypoglycemia on sympathetic neural activity and catecholamine responsiveness in normal rats","volume":"50","author":"Sivitz","year":"2001","journal-title":"Diabetes"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"R1115","DOI":"10.1152\/ajpregu.00248.2018","article-title":"Activation of \u00b5-opioid receptors in the rostral ventrolateral medulla blocks the sympathetic counterregulatory response to glucoprivation","volume":"315","author":"Kakall","year":"2018","journal-title":"Am. J. Physiol. Integr. Comp. Physiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1895","DOI":"10.2337\/db13-1073","article-title":"Orexinergic Activation of Medullary Premotor Neurons Modulates the Adrenal Sympathoexcitation to Hypothalamic Glucoprivation","volume":"63","author":"Korim","year":"2014","journal-title":"Diabetes"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"H1360","DOI":"10.1152\/ajpheart.00181.2016","article-title":"Effects of various types of anesthesia on hemodynamics, cardiac function, and glucose and lipid metabolism in rats","volume":"311","author":"Sano","year":"2016","journal-title":"Am. J. Physiol. Circ. Physiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1779","DOI":"10.1016\/S0028-3908(97)00143-3","article-title":"Effects of anesthetics on Fos protein expression in autonomic brain nuclei related to cardiovascular regulation","volume":"36","author":"Rocha","year":"1997","journal-title":"Neuropharmacology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1016\/0306-4522(82)91138-1","article-title":"Co-storage of enkephalins and adrenaline in the bovine adrenal medulla","volume":"7","author":"Livett","year":"1982","journal-title":"Neuroscience"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2229","DOI":"10.1016\/0306-4522(80)90139-6","article-title":"Simultaneous demonstration of phenylethanolamine N-methyltransferase immunofluorescent and catecholamine fluorescent nerve cell bodies in the rat medulla oblongata","volume":"5","author":"Howe","year":"1980","journal-title":"Neuroscience"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.neuroscience.2016.01.012","article-title":"pSer40 tyrosine hydroxylase immunohistochemistry identifies the anatomical location of C1 neurons in rat RVLM that are activated by hypotension","volume":"317","author":"Nedoboy","year":"2016","journal-title":"Neuroscience"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"7963","DOI":"10.18632\/aging.103116","article-title":"Metabolic switching is impaired by aging and facilitated by ketosis independent of glycogen","volume":"12","author":"Hernandez","year":"2020","journal-title":"Aging"},{"key":"ref_34","first-page":"1307","article-title":"Ketosis Proportionately Spares Glucose Utilization in Brain","volume":"33","author":"Zhang","year":"2013","journal-title":"Br. J. Pharmacol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1002\/cne.1097","article-title":"Immunotoxic destruction of distinct catecholamine subgroups produces selective impairment of glucoregulatory responses and neuronal activation","volume":"432","author":"Ritter","year":"2001","journal-title":"J. Comp. Neurol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.plefa.2003.07.006","article-title":"Brain uptake and metabolism of ketone bodies in animal models","volume":"70","author":"Nehlig","year":"2004","journal-title":"Prostaglandins Leukot. Essent. Fat. Acids"},{"key":"ref_37","first-page":"E746","article-title":"Changes in cerebral blood flow and carbohydrate metabolism during acute hyperketonemia","volume":"270","author":"Hasselbalch","year":"1996","journal-title":"Am. J. Physiol. Metab."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1007\/s10545-005-5518-0","article-title":"Cerebral ketone body metabolism","volume":"28","author":"Morris","year":"2005","journal-title":"J. Inherit. Metab. Dis."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.plefa.2003.09.007","article-title":"The therapeutic implications of ketone bodies: The effects of ketone bodies in pathological conditions: Ketosis, ketogenic diet, redox states, insulin resistance, and mitochondrial metabolism","volume":"70","author":"Veech","year":"2004","journal-title":"Prostaglandins Leukot. Essent. Fat. Acids"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"DeFronzo, R.A., and Ferrannini, E. (2016). Regulation of Intermediary Metabolism during Fasting and Feeding. Endocrinology: Adult and Pediatric, Elsevier Inc.","DOI":"10.1016\/B978-0-323-18907-1.00035-4"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1210\/en.2017-00630","article-title":"Selective Pharmacogenetic Activation of Catecholamine Subgroups in the Ventrolateral Medulla Elicits Key Glucoregulatory Responses","volume":"159","author":"Li","year":"2018","journal-title":"Endocrinology"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1002\/cne.903480309","article-title":"Spatially and temporally differentiated patterns of c-fos expression in brainstem catecholaminergic cell groups induced by cardiovascular challenges in the rat","volume":"348","author":"Chan","year":"1994","journal-title":"J. Comp. Neurol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"3866","DOI":"10.1172\/JCI91921","article-title":"Recurrent hypoglycemia inhibits the counterregulatory response by suppressing adrenal activity","volume":"128","author":"Ma","year":"2018","journal-title":"J. Clin. Investig."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.expneurol.2007.12.029","article-title":"Antioxidant capacity contributes to protection of ketone bodies against oxidative damage induced during hypoglycemic conditions","volume":"211","author":"Haces","year":"2008","journal-title":"Exp. Neurol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1038\/jcbfm.2015.1","article-title":"Protection of hypoglycemia-induced neuronal death by beta-hydroxybutyrate involves the preservation of energy levels and decreased production of reactive oxygen species","volume":"35","author":"Montiel","year":"2015","journal-title":"J. Cereb. Blood Flow Metab."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e005066","DOI":"10.1161\/JAHA.116.005066","article-title":"Ketone Body Infusion With 3-Hydroxybutyrate Reduces Myocardial Glucose Uptake and Increases Blood Flow in Humans: A Positron Emission Tomography Study","volume":"6","author":"Gormsen","year":"2017","journal-title":"J. Am. Heart Assoc."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Kovacs, Z., D\u2019Agostino, D.P., Diamond, D., Kindy, M.S., Rogers, C., and Ari, C. (2019). Therapeutic Potential of Exogenous Ketone Supplement Induced Ketosis in the Treatment of Psychiatric Disorders: Review of Current Literature. Front. Psychiatry, 10.","DOI":"10.3389\/fpsyt.2019.00363"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1249\/JSR.0000000000000732","article-title":"Nutritional Ketosis with Ketogenic Diets or Exogenous Ketones: Features, Convergence, and Divergence","volume":"19","author":"Poff","year":"2020","journal-title":"Curr. Sports Med. Rep."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1042\/cs0810189","article-title":"Ketone infusion lowers hormonal responses to hypoglycaemia: Evidence for acute cerebral utilization of a non-glucose fuel","volume":"81","author":"Amiel","year":"1991","journal-title":"Clin. Sci."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1038\/sj.jcbfm.9600177","article-title":"Global cerebral blood flow and metabolism during acute hyperketonemia in the awake and anesthetized rat","volume":"26","author":"Linde","year":"2006","journal-title":"J. Cereb. Blood Flow Metab."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"829","DOI":"10.2337\/diabetes.46.5.829","article-title":"Importance of cerebral blood flow to the recognition of and physiological responses to hypoglycemia","volume":"46","author":"Thomas","year":"1997","journal-title":"Diabetes"},{"key":"ref_52","first-page":"E1607","article-title":"Diet-induced ketosis increases capillary density without altered blood flow in rat brain","volume":"292","author":"Puchowicz","year":"2007","journal-title":"Am. J. Physiol. Metab."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1016\/S0197-0186(00)00102-9","article-title":"Diet-induced ketosis increases monocarboxylate transporter (MCT1) levels in rat brain","volume":"38","author":"Leino","year":"2001","journal-title":"Neurochem. Int."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1113\/jphysiol.2007.138594","article-title":"Enhanced expression of three monocarboxylate transporter isoforms in the brain of obese mice","volume":"583","author":"Pierre","year":"2007","journal-title":"J. Physiol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1502","DOI":"10.1097\/00004647-200010000-00012","article-title":"Human brain beta-hydroxybutyrate and lactate increase in fasting-induced ketosis","volume":"20","author":"Pan","year":"2000","journal-title":"J. Cereb. Blood Flow Metab."},{"key":"ref_56","first-page":"E1161","article-title":"Blood-brain barrier permeability of glucose and ketone bodies during short-term starvation in humans","volume":"268","author":"Hasselbalch","year":"1995","journal-title":"Am. J. Physiol. Metab."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1262\/jrd.20214","article-title":"Food Deprivation Induces Monocarboxylate Transporter 2 Expression in the Brainstem of Female Rat","volume":"55","author":"Matsuyama","year":"2009","journal-title":"J. Reprod. Dev."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.eplepsyres.2016.06.009","article-title":"Fasting time duration modulates the onset of insulin-induced hypoglycemic seizures in mice","volume":"125","author":"Pitchaimani","year":"2016","journal-title":"Epilepsy Res."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Prins, M.L. (2008). Cerebral Metabolic Adaptation and Ketone Metabolism after Brain Injury. Br. J. Pharmacol., 28.","DOI":"10.1038\/sj.jcbfm.9600543"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"S62","DOI":"10.1007\/s001250051404","article-title":"Hypoglycaemia in diabetes mellitus--protecting the brain","volume":"40","author":"Amiel","year":"1997","journal-title":"Diabetologia"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1046\/j.1471-4159.2001.00575.x","article-title":"Measurement of beta-hydroxybutyrate in acute hyperketonemia in human brain","volume":"79","author":"Pan","year":"2001","journal-title":"J. Neurochem."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/0026-0495(94)90242-9","article-title":"Stimulatory influence of d(\u2212)3-hydroxybutyrate feeding on sympathetic nervous system activity in the rat","volume":"43","author":"Kolanowski","year":"1994","journal-title":"Metabolism"},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Kosinski, C., and Jornayvaz, F.R. (2017). Effects of Ketogenic Diets on Cardiovascular Risk Factors: Evidence from Animal and Human Studies. Nutrients, 9.","DOI":"10.3390\/nu9050517"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1161\/CIRCRESAHA.116.303604","article-title":"The Sympathetic Nervous System Alterations in Human Hypertension","volume":"116","author":"Grassi","year":"2015","journal-title":"Circ. Res."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/S1474-4422(17)30408-8","article-title":"Mechanisms of action for the medium-chain triglyceride ketogenic diet in neurological and metabolic disorders","volume":"17","author":"Augustin","year":"2018","journal-title":"Lancet Neurol."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/8\/2627\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:37:02Z","timestamp":1760164622000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/8\/2627"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,29]]},"references-count":65,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8]]}},"alternative-id":["nu13082627"],"URL":"https:\/\/doi.org\/10.3390\/nu13082627","relation":{},"ISSN":["2072-6643"],"issn-type":[{"type":"electronic","value":"2072-6643"}],"subject":[],"published":{"date-parts":[[2021,7,29]]}}}