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. 2019 Jun 6;4(11):e127737. doi: 10.1172/jci.insight.127737

Figure 2. Fasting ketosis is impaired in subjects with NAFLD.

Figure 2

Plasma (A) ketones and (B) NEFAs were measured during H-E clamp and after a 12- and 24-hour fast. Both ketone (control: n = 16, NAFLD: n = 21) and NEFA (control: n = 17, NAFLD: n = 22) concentrations were higher among those with fatty liver during an H-E clamp. In 12-hour-fasted subjects, plasma ketones were normal in those with NAFLD despite increased circulating NEFAs. After a 24-hour fast, plasma NEFA and ketone concentrations were ≈30% lower in NAFLD subjects compared with controls. There was a significant interaction term for both plasma ketones and NEFAs, indicating that control and NAFLD subjects respond differently to the transition from high to low insulin concentrations. (C) The lower plasma ketone concentrations among those with NAFLD at 24 hours of fasting were due to reduced plasma BHB, but not AcAc, concentrations. Significance was determined using 2-tailed Student’s t test for unpaired data and 2-way repeated-measures ANOVA when appropriate.