Table 1.
Studies reporting the association between ketogenesis and MAFLD.
| Reference | Subjects | Independent Variable |
Dependent Variable |
Main Finding |
|---|---|---|---|---|
| Inokuchi et al. [50] | 20 NGT patients with obesity | NAFLD by computed tomography | Fasting plasma total ketone, βHB | Low fasting total ketone, βHB in NAFLD |
| Croci et al. [51] | 15 lean healthy, 20 NAFLDsubjects with overweight or obesity | NAFLD by liver biopsy | Fasting plasma βHB | Low fasting plasma βHB in NAFLD |
| Männistö et al. [64] | 76 patients with obesity | Steatosis by 1H-MRS, NASH by liver biopsy | Fasting plasma βHB, acetoacetate | Increased ketone bodies in simple steatosis but decreased in NASH |
| Fletcher et al. [53] | 40 non-diabetic patients | NAFLD by 1H-MRS | Fasting plasma ketone, ketogenic pathway measured by 5 stable isotope tracers | Low fasting ketone and ketogenesis in NAFLD |
| Mey et al. [52] | 22 patients with obesity | NAFLD by 1H-MRS | Fasting plasma βHB | Low fasting plasma βHB in NAFLD |
| Kim et al. [62] | 153,076 nondiabetic subjects | Fasting ketonuria | Steatosis by ultrasound Fibrosis by NFS and FIB-4 |
Low risk of NAFLD in subjects with ketonuria |
| Lim et al. [63] | 6022 nondiabetic NAFLD patients | Fasting ketonuria | Fibrosis by NFS and FIB-4 | Low risk of advanced fibrosis in subjects with ketonuria |
| Lee et al. [8] | 435 type 2 diabetic patients | Fasting plasma βHB | Non-invasive NAFLD indices | Low risk of NAFLD indices in subjects with intact ketogenesis |
| Kotronen et al. [60] | 58 nondiabetic patients | NAFLD by 1H-MRS | Fasting plasma βHB | Comparable between NAFLD and control |
| Sanyal et al. [57] | 6 NAFLD, 6 NASH, 6 lean healthy subjects | NAFLD by liver biopsy | Fasting plasma βHB | High fasting βHB in NAFLD and NASH |
| Chalasani et al. [59] | 37 nondiabetic patients | NASH by liver biopsy | Fasting plasma βHB | High fasting βHB in NASH |
| Bugianesi et al. [58] | 18 non-obese, non-diabetic patients | NAFLD by liver biopsy | Fasting plasma βHB | High fasting βHB in NAFLD |
| Post et al. [61] | 6297 general population | NAFLD by FLI score | Fasting ketone bodies, including total, βHB, acetoacetate, acetone | High fasting ketone bodies in NAFLD |
βHB, β-hydroxybutyrate; FIB-4, fibrosis-4 score; FLI, fatty liver index; 1H-MRS, proton magnetic resonance spectroscopy; NAFLD, non-alcoholic fatty liver disease; NASH, non-alcoholic steatohepatitis; NFS, NAFLD fibrosis score; NGT, normal glucose tolerance.