A ketogenic diet in combination with gemcitabine induces metabolic changes in KPC mice. (A) Schematic outline of the mechanistic study design. Female and male KPC mice were randomized to a control diet plus gemcitabine (CG) or to a ketogenic diet plus gemcitabine (KG) and euthanized after 2 months; n = 4 per sex/group. (B) Non-fasted blood β-hydroxybutyrate levels, (C) circulating levels of non-fasting glucose, (D) body weight, (E) lean mass, and (F) fat mass progression are shown at baseline, one and two months after diet plus gemcitabine initiation of KPC mice treated with CG or KG. (G) Gastrocnemius weight, (H) heart weight, and (I) serum leptin levels at euthanasia shown for CG- and KG-treated KPC mice. Values are expressed as mean ± SEM; * p < 0.05.