{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T15:32:53Z","timestamp":1791559973079,"version":"4.3.4"},"reference-count":35,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2021,9,2]],"date-time":"2021-09-02T00:00:00Z","timestamp":1630540800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100011264","name":"FP7 People: Marie-Curie Actions","doi-asserted-by":"publisher","award":["FP7-MC-CIG 303795"],"award-info":[{"award-number":["FP7-MC-CIG 303795"]}],"id":[{"id":"10.13039\/100011264","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000833","name":"Rosetrees Trust","doi-asserted-by":"publisher","award":["M209"],"award-info":[{"award-number":["M209"]}],"id":[{"id":"10.13039\/501100000833","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>There is increasing interest in the use of a ketogenic diet for various adult disorders; however, the ability of adults to generate ketones is unknown. Our goal was to challenge the hypothesis that there would be no difference between adults and children regarding their ability to enter ketosis. Methods: Two populations were studied, both treated with identical very low-carbohydrate high-fat diets: a retrospective series of children with epilepsy or\/and metabolic disorders (2009\u20132016) and a prospective clinical trial of adults with glioblastoma. Dietary intake was assessed based upon written food diaries and 24-h dietary recall. Ketogenic ratio was calculated according to [grams of fat consumed]\/[grams of carbohydrate and protein consumed]. Ketone levels (\u03b2-hydroxybutyrate) were measured in blood and\/or urine. Results: A total of 168 encounters amongst 28 individuals were analyzed. Amongst both children and adults, ketone levels correlated with nutritional ketogenic ratio; however, the absolute ketone levels in adults were approximately one quarter of those seen in children. This difference was highly significant in a multivariate linear regression model, p &lt; 0.0001. Conclusions: For diets with comparable ketogenic ratios, adults have lower blood ketone levels than children; consequently, high levels of nutritional ketosis are unobtainable in adults.<\/jats:p>","DOI":"10.3390\/nu13093093","type":"journal-article","created":{"date-parts":[[2021,9,2]],"date-time":"2021-09-02T23:05:12Z","timestamp":1630623912000},"page":"3093","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Dietary-Induced Ketogenesis: Adults Are Not Children"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0734-7536","authenticated-orcid":false,"given":"Keren","family":"Porper","sequence":"first","affiliation":[{"name":"Pediatric Neurology Institute, Edmond and Lily Safra Children\u2019s Hospital, Sheba Medical Center, Tel HaShomer, Ramat Gan 52621, Israel"},{"name":"Institute of Oncology, Sheba Medical Center, Tel HaShomer, Ramat Gan 52621, Israel"},{"name":"Sackler School of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leor","family":"Zach","sequence":"additional","affiliation":[{"name":"Sackler School of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel"},{"name":"Department of Radiation Oncology, Sheba Medical Center, Tel HaShomer, Ramat Gan 52621, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yael","family":"Shpatz","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Sheba Medical Center, Tel HaShomer, Ramat Gan 52621, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruria","family":"Ben-Zeev","sequence":"additional","affiliation":[{"name":"Pediatric Neurology Institute, Edmond and Lily Safra Children\u2019s Hospital, Sheba Medical Center, Tel HaShomer, Ramat Gan 52621, Israel"},{"name":"Sackler School of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michal","family":"Tzadok","sequence":"additional","affiliation":[{"name":"Pediatric Neurology Institute, Edmond and Lily Safra Children\u2019s Hospital, Sheba Medical Center, Tel HaShomer, Ramat Gan 52621, Israel"},{"name":"Sackler School of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisheva","family":"Jan","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Sheba Medical Center, Tel HaShomer, Ramat Gan 52621, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alisa","family":"Talianski","sequence":"additional","affiliation":[{"name":"Institute of Oncology, Sheba Medical Center, Tel HaShomer, Ramat Gan 52621, Israel"},{"name":"Sackler School of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin E.","family":"Champ","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Duke University, Durham, NC 27710, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zvi","family":"Symon","sequence":"additional","affiliation":[{"name":"Sackler School of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel"},{"name":"Department of Radiation Oncology, Sheba Medical Center, Tel HaShomer, Ramat Gan 52621, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yair","family":"Anikster","sequence":"additional","affiliation":[{"name":"Sackler School of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel"},{"name":"Metabolic Diseases Unit, Edmond and Lily Safra Children\u2019s Hospital, Sheba Medical Center, Tel HaShomer, Ramat Gan 52621, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9959-2485","authenticated-orcid":false,"given":"Yaacov R.","family":"Lawrence","sequence":"additional","affiliation":[{"name":"Sackler School of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel"},{"name":"Department of Radiation Oncology, Sheba Medical Center, Tel HaShomer, Ramat Gan 52621, Israel"},{"name":"Department of Radiation Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1111\/j.1528-1167.2008.01765.x","article-title":"Optimal clinical management of children receiving the ketogenic diet: Recommendations of the International Ketogenic Diet Study Group","volume":"50","author":"Kossoff","year":"2009","journal-title":"Epilepsia"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1016\/S1474-4422(08)70092-9","article-title":"The ketogenic diet for the treatment of childhood epilepsy: A randomised controlled trial","volume":"7","author":"Neal","year":"2008","journal-title":"Lancet Neurol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1111\/j.1469-8749.2007.00707.x","article-title":"GLUT1 deficiency syndrome\u20142007 update","volume":"49","author":"Klepper","year":"2007","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1655","DOI":"10.1212\/WNL.49.6.1655","article-title":"Outcome of pyruvate dehydrogenase deficiency treated with ketogenic diets: Studies in patients with identical mutations","volume":"49","author":"Wexler","year":"1997","journal-title":"Neurology"},{"key":"ref_5","first-page":"CD001903","article-title":"Ketogenic diets for drug-resistant epilepsy","volume":"6","author":"Bresnahan","year":"2020","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"122","DOI":"10.3389\/fnmol.2016.00122","article-title":"Tumor metabolism, the ketogenic diet and beta-hydroxybutyrate: Novel approaches to adjuvant brain tumor therapy","volume":"9","author":"Woolf","year":"2016","journal-title":"Front. Mol. Neurosci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/1743-7075-2-34","article-title":"A low-carbohydrate, ketogenic diet to treat type 2 diabetes","volume":"2","author":"Yancy","year":"2005","journal-title":"Nutr. Metab."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1177\/088307380001501203","article-title":"The Ketogenic Diet: Seizure Control Correlates Better with Serum \u03b2-Hydroxybutyrate Than with Urine Ketones","volume":"15","author":"Gilbert","year":"2000","journal-title":"J. Child Neurol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.seizure.2009.10.009","article-title":"Blood beta-hydroxybutyrate correlates better with seizure reduction due to ketogenic diet than do ketones in the urine","volume":"19","author":"Lambrechts","year":"2010","journal-title":"Seizure"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1007\/s11060-021-03786-8","article-title":"A Phase I clinical trial of dose-escalated metabolic therapy combined with concomitant radiation therapy in high-grade glioma","volume":"153","author":"Porper","year":"2021","journal-title":"J. Neuro-Oncol."},{"key":"ref_11","first-page":"89","article-title":"A Clinical Study of Epileptic Children Treated by Ketogenic Diet","volume":"196","author":"Talbot","year":"1927","journal-title":"N. Engl. J. Med."},{"key":"ref_12","unstructured":"Talbot, F. (1930). Treatment of Epilepsy, The Macmillan Co."},{"key":"ref_13","first-page":"12","article-title":"The Ketogenic and Atkins Diets Effect on Intractable Epilepsy: A Comparison","volume":"8","author":"Ghazavi","year":"2014","journal-title":"Iran. J. Child Neurol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"9","DOI":"10.4103\/2319-4170.107154","article-title":"Medium-chain Triglyceride Ketogenic Diet, An Effective Treatment for Drug-resistant Epilepsy and A Comparison with Other Ketogenic Diets","volume":"36","author":"Liu","year":"2013","journal-title":"Biomed. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1093\/ajcn\/44.5.630","article-title":"Thermic effect of medium-chain and long-chain triglycerides in man","volume":"44","author":"Seaton","year":"1986","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1111\/j.1528-1167.2007.01025.x","article-title":"Efficacy and Tolerability of the Ketogenic Diet According to Lipid: Nonlipid Ratios? Comparison of 3:1 with 4:1 Diet","volume":"48","author":"Seo","year":"2007","journal-title":"Epilepsia"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1016\/j.nut.2016.03.025","article-title":"Preliminary evaluation of a differential effect of an \u03b1-linolenate-rich supplement on ketogenesis and plasma \u03c9-3 fatty ac-ids in young and older adults","volume":"32","author":"Hennebelle","year":"2016","journal-title":"Nutrition"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1111\/j.1528-1167.2005.71204.x","article-title":"A Comparison of the Ability of a 4:1 Ketogenic Diet and a 6.3:1 Ketogenic Diet to Elevate Seizure Thresholds in Adult and Young Rats","volume":"46","author":"Nylen","year":"2005","journal-title":"Epilepsia"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/S0920-1211(98)00125-9","article-title":"Seizure resistance is dependent upon age and calorie restriction in rats fed a ketogenic diet","volume":"35","author":"Bough","year":"1999","journal-title":"Epilepsy Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2152","DOI":"10.1210\/endo-120-5-2152","article-title":"Age-related change in ketone body metabolism: Diminished glucagon effect on ketogenesis in adult rats","volume":"120","author":"Okuda","year":"1987","journal-title":"Endocrinology"},{"key":"ref_21","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. Res. Rev."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.plefa.2003.11.001","article-title":"Pathways and control of ketone body metabolism: On the fringe of lipid biochemistry","volume":"70","author":"Fukao","year":"2004","journal-title":"Prostaglandins Leukot. Essent. Fat. Acids"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1016\/j.nut.2006.04.010","article-title":"Fat oxidation and plasma removal capacity of an intravenous fat emulsion in elderly and young men","volume":"22","author":"Olivecrona","year":"2006","journal-title":"Nutrition"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1172\/JCI106264","article-title":"Hepatic metabolism of free fatty acids in normal and diabetic dogs","volume":"49","author":"Basso","year":"1970","journal-title":"J. Clin. Investig."},{"key":"ref_25","first-page":"329","article-title":"Hormonal control of ketone body metabolism in the normal and diabetes care","volume":"11","author":"Johonston","year":"1982","journal-title":"Clin. Endocrinol. Metab."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"E849","DOI":"10.1152\/ajpendo.00073.2005","article-title":"On the suppression of plasma nonesterified fatty acids by insulin during enhanced intravascular lipolysis in humans","volume":"289","author":"Carpentier","year":"2005","journal-title":"Am. J. Physiol.-Endocrinol. Metab."},{"key":"ref_27","first-page":"E659","article-title":"Impaired beta-adrenergic receptor-mediated regulation of gene expression in adipocytes from older rats","volume":"266","author":"Shilo","year":"1994","journal-title":"Am. J. Physiol. Content"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1111\/j.1651-2227.1976.tb04896.x","article-title":"Cerebral blood flow and exchange of oxygen, glucose, ketone bodies, lactate, pyruvate and amino acids in infants","volume":"65","author":"Settergren","year":"1976","journal-title":"Acta Paediatr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1042\/bj0720027","article-title":"The fatty acids of human milk from mothers on diets taken ad libitum","volume":"72","author":"Insull","year":"1959","journal-title":"Biochem. J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1042\/bj0380029","article-title":"Human-milk fat: 1. Component fatty acids","volume":"38","author":"Hilditch","year":"1944","journal-title":"Biochem. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1093\/ajcn\/45.2.399","article-title":"Storage of medium-chain triglycerides in adipose tissue of orally fed infants","volume":"45","author":"Lepage","year":"1987","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1186\/s12986-016-0136-4","article-title":"Monitoring for compliance with a ketogenic diet: What is the best time of day to test for urinary ketosis?","volume":"13","author":"Urbain","year":"2016","journal-title":"Nutr. Metab."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1016\/j.cell.2015.11.001","article-title":"Personalized Nutrition by Prediction of Glycemic Responses","volume":"163","author":"Zeevi","year":"2015","journal-title":"Cell"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"6670","DOI":"10.1038\/s41598-018-25190-5","article-title":"Ketogenic diet enhances neurovascular function with altered gut microbiome in young healthy mice","volume":"8","author":"Ma","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"6164","DOI":"10.3748\/wjg.v23.i33.6164","article-title":"Ketogenic diet poses a significant effect on imbalanced gut microbiota in infants with refractory epilepsy","volume":"23","author":"Xie","year":"2017","journal-title":"World J. Gastroenterol."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/9\/3093\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:55:04Z","timestamp":1760165704000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/9\/3093"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,2]]},"references-count":35,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,9]]}},"alternative-id":["nu13093093"],"URL":"https:\/\/doi.org\/10.3390\/nu13093093","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,2]]}}}