Metabolic profiles in children during fasting
Abstract
BACKGROUND: Hypoglycemia is one of the most common metabolic derangements in childhood. To establish the cause of hypoglycemia, fasting tolerance tests can be used. Currently available reference values for fasting tolerance tests have limitations in their use in daily practice. OBJECTIVE: The aim of this study was to determine the reference values of metabolites involved in glucose homeostasis during fasting in healthy children. METHODS: This study included a retrospective analysis of 488 fasting tests. All tests of patients (n = 321) with disorders, including metabolic and endocrine disorders, were excluded, as were tests performed in children who were over- or underweight. RESULTS: In 167 fasting tests performed in the study, hypoglycemia was reached in 52 (31%) tests. On the basis of the time until hypoglycemia was reached, 3 age groups could be defined: (1) children aged 0 to 24 months (median 15 months) (n = 49); (2) children aged 25 to 84 months (median 45 months) (n = 79); (3) and children aged 85 to 216 months (median 106 months) (n = 39). In all groups, a significant increase in ketone body levels and a significant decrease in glucose levels in plasma were observed during fasting. Younger children had a faster increase in ketone body levels and a faster decrease in glucose levels in plasma than older children. CONCLUSIONS: Reference values of the metabolites involved in glucose homeostasis during fasting in children were generated. Those values can be used to determine whether a child has a normal fasting response. For high-risk children, guidelines concerning maximum fasting time and dietary intervention during illness are of the utmost importance.
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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 [21]
Fasting hyperketonemia develops at a similar plasma glucose concentration in infants, children, and adults.
“fasting hyperketonemia develops at a similar PG concentration in infants, children, and adults21,22”
From Recommendations from the Pediatric Endocrine Society for evaluation and management of persistent hypoglycemia in neonates, infants, and children (2015) · cites this paper as [21]
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 [21]
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Huh, J., Koo, J. M., Kim, M.-J., Choi, H., Park, H.-J., Rim, G., & Hwang, W. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13123593 · Cited by 1 · see citing works
“…stress response to surgical stimuli by stabilizing hemodynamic parameters and reducing the release of stress hormones such as cortisol [21–23] Consequently, patients who are adequately hydrated preoperatively require less anesthetic and analgesic medication to achieve the same depth of…”
BackgroundLasio, M. L. D., Zaitsev, M. A., Hobert, J. A., Biase, I. D., Pasquali, M., & Yuzyuk, T. N. (2025) · Molecular Genetics and Metabolism · doi:10.1016/j.ymgme.2025.109160 · Cited by 1 · see citing works
Anesthesia Considerations for Facial Deformity Repair in Lesser Developed Countries
Gevirtz, C. M. (2014) · Springer eBooks · doi:10.1007/978-3-319-09423-6_17 · Cited by 1 · see citing works
Le dépistage et la prise en charge des nouveau-nés à risque d’hypoglycémie
Narvey, M. R., & Marks, S. D. (2019) · Paediatrics & Child Health · doi:10.1093/pch/pxz135 · Cited by 1 · see citing works
Hove, J. L. K. V. (2015) · Springer eBooks · doi:10.1007/978-3-319-14621-8_26 · Cited by 2 · see citing works
Shiohama, T., Fujii, K., Kosaki, R., Watanabe, Y. J. Á., Uchida, T., Hagiwara, S., Kinoshita, K., Sugita, K., Aoki, Y., & Shimojo, N. (2022) · American Journal of Medical Genetics Part A · doi:10.1002/ajmg.a.62926 · Cited by 1 · see citing works
“On the other hand, patients with malnutritional status such as acute fasting (Wolfsdorf et al., 1982; van Veen et al., 2011), chronic malnutrition (Monde et al., 2010; Drachmann et al., 2021), and anorexia nervosa (Pirke et al., 1985) typically show ketotic hypoglycemia, unlike in the current…”
BackgroundSchlune, A., Kummer, S., & Meißner, T. (2014) · Monatsschrift Kinderheilkunde · doi:10.1007/s00112-014-3218-2 · Cited by 1 · see citing works
Hypoglycemia in Infants and Children
(2020) · American Academy of PediatricsItasca, IL eBooks · doi:10.1542/9781610023610-31
The Path From Hormone Abnormality to Hypoglycemia
Steinkrauss, L. J. (2016) · Journal of Pediatric Nursing · doi:10.1016/j.pedn.2016.06.001
Not sweet enough: Hypoglycaemia in children
Bretton, L. (2016) · Emergency Medicine Australasia · doi:10.1111/1742-6723.12698
Svitlyk, Y. O., Harbar, M. O., & Svitlyk, H. V. (2018) · EMERGENCY MEDICINE · doi:10.22141/2224-0586.3.90.2018.129488
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Fasting Status, Aspiration Risk, and Sedation Outcomes
Bhatt, M. (2021) · Springer eBooks · doi:10.1007/978-3-030-58406-1_35
Raine, J., MBChB, J. W. G., Vliet, G. V., MB, B. J. I. W., & Deladoëy, J. (2019) · doi:10.1002/9781119386230.ch2
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“It often develops during fasting in children and mostly in neonates for they have limited glucose stores, high glucose demand and defective glucose production [4, 5].”
BackgroundCetonemia y glicemia en niños con 3 diferentes líquidos claros una hora antes de cirugía
Ruiz, A. F. M., Mejía, A. T., & Arango, F. (2023) · Revista Chilena de Anestesia · doi:10.25237/revchilanestv52n7-07
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Fasting Status, Aspiration Risk, and Sedation Outcomes
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A Retrospective Study on Preoperative Fasting in Pediatric Population in a Tertiary Center
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Research Progress of Preoperative Oral Carbohydrate
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- Authors
- van Veen, M. R., van Hasselt, P. M., de Sain-van der Velden, M. G. M., Verhoeven, N., Hofstede, F. C., de Koning, T. J., & Visser, G.
- Affiliations
- Department of Metabolic and Endocrine Diseases, Wilhelmina Children's Hospital Utrecht, University Medical Center, Utrecht, the Netherlands
- University Medical Center Utrecht (NL)
- Corresponding author
- Visser, Gepke
- Venue
- PEDIATRICS
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2011-04-01
- Volume
- 127
- Issue
- 4
- Pages
- e1021-e1027
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- OpenAlex
- W2144420785
- Cited by
- 86
- References
- 18
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 6 · 2023: 9 · 2022: 11 · 2021: 10 · 2020: 4 · 2019: 9 · 2018: 3 · 2017: 5 · 2016: 5 · 2015: 4 · 2014: 7 · 2013: 4 · 2012: 2
- FWCI
- 2.50
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- PEDIATRICS (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Metabolism and Genetic Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
- Keywords
- hypoglycemia, reference values, children, glucose homeostasis, ketone bodies, plasma glucose, age differences, fasting response
- MeSH terms
- Adolescent, Age Factors, Blood Glucose, Child, Child, Preschool, Energy Metabolism, Fasting, Female, Humans, Hypoglycemia, Infant, Infant, Newborn, Ketone Bodies, Male, Reference Values, Retrospective Studies
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