Parmar Komalben, Mosha Maua, Weinstein David A, Riba-Wolman Rebecca
Department of Pediatric Endocrinology, Connecticut Children Medical Center, Hartford, CT, USA.
Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA.
J Pediatr Endocrinol Metab. 2023 May 11;36(7):667-673. doi: 10.1515/jpem-2022-0589. Print 2023 Jul 26.
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 part of the diagnostic evaluation of disorders of carbohydrate metabolism, but there is limited literature on normal ketone production with fasting. Our aim is to measure fasting serum beta-hydroxybutyrate (BHB) concentrations in healthy children after an overnight fast.
Children ≤18 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.
Data from 94 participants (mean 8.3 ± 5.7 years, 54 % male, 46 % female, were analyzed. Children ≤3 years of age (19) have significantly higher mean (0.40 ± 0.06 mmol/L) and median (0.4, IQR 0.2-0.6 mmol/L) BHB concentrations compared to children >3 years of age (75) with mean (0.21 ± 0.02 mmol/L) and median BHB (0.1, IQR 0.1-0.2 mmol/L) (p<0.0001). Fasting BHB levels of >1.0 mmol/L was rare (2 %, N=2) and 74 % (N=70) of participants had BHB levels <0.3 mmol/L.
BHB concentrations are significantly higher in young children (≤3 years of age) compared to older children. Fasting BHB levels >1.0 mmol/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.
酮体生成是游离脂肪酸β氧化过程中发生的一种生理现象。区分生理性酮症与病理性酮体过度生成/利用不足对于碳水化合物代谢紊乱的诊断评估至关重要，但关于正常禁食状态下酮体生成的文献有限。我们的目的是测量健康儿童过夜禁食后的空腹血清β-羟基丁酸（BHB）浓度。
前瞻性地从我们手术中心的择期手术中招募18岁及以下儿童。排除标准包括糖尿病史、垂体功能减退、肾上腺、代谢或炎症性疾病、饮食限制、创伤或使用可能影响血糖的药物。过夜禁食后评估血清葡萄糖、皮质醇和BHB。
分析了94名参与者（平均8.3±5.7岁，54%为男性，46%为女性）的数据。与3岁以上儿童（75名）相比，3岁及以下儿童（19名）的平均BHB浓度（0.40±0.06毫摩尔/升）和中位数（0.4，四分位间距0.2 - 0.6毫摩尔/升）显著更高，3岁以上儿童的平均BHB浓度为（0.21±0.02毫摩尔/升），中位数BHB为（0.1，四分位间距0.1 - 0.2毫摩尔/升）（p<0.0001）。空腹BHB水平>1.0毫摩尔/升的情况很少见（2%，N = 2），74%（N = 70）的参与者BHB水平<0.3毫摩尔/升。
与大龄儿童相比，幼儿（3岁及以下）的BHB浓度显著更高。在我们的研究人群中，空腹BHB水平>1.0毫摩尔/升很少见，因此可能确定了一个数值，高于该数值可能更需关注病理性酮症性低血糖。必须确定儿童的正常范围，以区分生理性和病理性酮症性低血糖。
