Yoo Byung Min, Kim So Ra, Lee Byung-Wan
Department of Statistics and Data Science, Korea National Open University, Seoul 03087, Republic of Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.
Biomedicines. 2025 Jun 16;13(6):1484. doi: 10.3390/biomedicines13061484.
Ketone bodies (KBs), particularly β-hydroxybutyrate, are crucial metabolites that provide clean and efficient energy, especially during periods of low glucose availability. Ketogenesis is a promising therapeutic avenue for conditions such as obesity, metabolic syndrome, and diabetes. This review aims to summarize the current evidence on ketogenesis across different health conditions and therapeutic modalities, highlighting the potential to mitigate metabolic disorders and diabetes-related complications. By reducing inflammation and oxidative stress, increased KB production provides cardiovascular and neuroprotective benefits. Ketogenesis is enhanced under physiological conditions like pregnancy and fasting, as well as in pathophysiological states such as diabetes and heart failure. Various interventions, including the promotion of endogenous ketogenesis through diet and exercise, drug-induced ketogenesis via sodium-glucose cotransporter 2 inhibitors, and exogenous ketone supplementation, have demonstrated favorable effects on metabolic health. However, challenges remain, including risks such as pathological ketoacidosis and dyslipidemia. In specific populations, such as lean mass hyper-responders, laboratory lipid profiles might reflect the metabolic privilege. This review will assist in the future clarification of individual differences and optimized therapeutic approaches leveraging ketogenesis for the personalized management of metabolic disorders.
酮体（KBs），尤其是β-羟基丁酸，是至关重要的代谢产物，能提供清洁且高效的能量，特别是在葡萄糖供应不足的时期。生酮作用是治疗肥胖、代谢综合征和糖尿病等病症的一条有前景的治疗途径。本综述旨在总结不同健康状况和治疗方式下关于生酮作用的现有证据，强调减轻代谢紊乱和糖尿病相关并发症的潜力。通过减少炎症和氧化应激，增加酮体生成具有心血管和神经保护作用。在怀孕和禁食等生理状况下以及糖尿病和心力衰竭等病理生理状态下，生酮作用会增强。各种干预措施，包括通过饮食和运动促进内源性生酮作用、通过钠-葡萄糖协同转运蛋白2抑制剂诱导药物性生酮作用以及外源性补充酮体，已证明对代谢健康有有益影响。然而，挑战依然存在，包括病理性酮症酸中毒和血脂异常等风险。在特定人群中，如瘦体重高反应者，实验室血脂谱可能反映代谢优势。本综述将有助于未来阐明个体差异，并优化利用生酮作用进行代谢紊乱个性化管理的治疗方法。
