The fasting test in paediatrics: application to the diagnosis of pathological hypo- and hyperketotic states
Abstract
A 24-h fasting test was performed in 48 control children, in 9 hypoketotic patients with inherited defects of fatty acid oxidation and in 2 hyperketotic patients with inherited defects of ketolysis. The control group was then divided into three age groups on the basis of different adaptation to fasting. Concentrations of blood glucose, lactate, free fatty acids (FFA), 3-hydroxybutyrate, acetoacetate and carnitine were measured after 15 h, 20 h and 24 h of fasting. Significant negative correlations were found in the control group between plasma total ketone bodies (KB) and plasma glucose (P less than 0.001), plasma carnitine (P less than 0.005) and the amplitude of glycaemic response to glucagon at the end of the fast (P less than 0.01). FFA/KB ratio and the product of final fasting values of glucose and ketones were useful to differentiate between hypoketotic or hyperketotic patients and normal subjects. In children with a suspected or definite hyperketotic or hypoketotic disorder, a fasting test must only be performed in healthy patients, in good nutritional condition with non-diagnostic basal biochemical investigations. Carefully supervised fasting should be continued sufficiently to allow ketogenesis and ketolysis to become activated.
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Children under age 4 years may have a plasma glucose concentration below 70 mg/dL and hyperketonemia after overnight fasting because of limited fasting tolerance.
“however, children under age 4 years may have a PG concentration <70 mg/dL (3.9 mmol/L) and hyperketonemia after overnight fasting because of limited fasting tolerance.17,20,21”
From Recommendations from the Pediatric Endocrine Society for evaluation and management of persistent hypoglycemia in neonates, infants, and children (2015) · cites this paper as [20]
Mean plasma glucose concentration in the postabsorptive state in normal neonates after approximately 2 days of age and in infants and children does not differ from that in adults (70-100 mg/dL).
“Mean PG concentration in the postabsorptive state in normal neonates after ~2 days of age and in infants and children does not differ from that in adults (70–100 mg/dL [3.9–5.5 mmol/L])17,20,21”
From Recommendations from the Pediatric Endocrine Society for evaluation and management of persistent hypoglycemia in neonates, infants, and children (2015) · cites this paper as [20]
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- Authors
- Bonnefont, J. P., Specola, N. B., Vassault, A., Lombes, A., Ogier, H., de Klerk, J. B. C., Munnich, A., Coude, M., Paturneau-Jouas, M., & Saudubray, J. M.
- Affiliations
- Inserm (FR)
- Venue
- European Journal of Pediatrics
- Published
- 1990-12
- Volume
- 150
- Issue
- 2
- Pages
- 80-85
- ISSN
- 0340-6199 (ISSN-L)
- 1432-1076
- OpenAlex
- W1998858187
- Cited by
- 168
- References
- 22
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 7 · 2023: 1 · 2022: 9 · 2021: 7 · 2020: 2 · 2019: 5 · 2018: 3 · 2017: 6 · 2016: 12 · 2015: 8 · 2014: 11 · 2013: 5 · 2012: 1
- FWCI
- 2.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- European Journal of Pediatrics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Metabolism and Genetic Disorders
- Health Sciences › Medicine › Physiology › Diet and metabolism studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
- Keywords
- fasting test, inborn errors of fatty acid oxidation, ketone bodies, beta-hydroxybutyrate, acetoacetate, free fatty acids, plasma glucose, glucagon response, L-carnitine, children, ketogenesis, ketolysis
- MeSH terms
- Adolescent, Blood Glucose, Child, Child, Preschool, Fasting, Fatty Acids, Nonesterified, Female, Humans, Hydroxybutyrates, Hypoglycemia, Infant, Ketone Bodies, Lipid Metabolism, Inborn Errors, Male, 3-Hydroxybutyric Acid
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