Metabolic response to a ketogenic breakfast in the healthy elderly

Objective  To determine whether the metabolism of glucose or ketones differs in the healthy elderly compared to young or middle-aged adults during mild, short-term ketosis induced by a ketogenic breakfast. Design and participants  Healthy subjects in three age groups (23±1, 50±1 and 76±2 y old) were given a ketogenic meal and plasma -hydroxybutyrate, glucose, insulin, triacylglycerols, total cholesterol, non-esterified fatty acids and breath acetone were measured over the subsequent 6 h. Each subject completed the protocol twice in order to determine the oxidation of a tracer dose of both carbon-13 (¹³C) glucose and ¹³C- -hydroxybutyrate. The tracers were given separately in random order. Apolipoprotein E genotype was also determined in all subjects. Results  Plasma glucose decreased and -hydroxybutyrate, acetone and insulin increased similarly over 6 h in all three groups after the ketogenic meal. There was no significant change in cholesterol, triacylglycerols or non-esterified fatty acids over the 6 h. ¹³C-glucose and ¹³C- -hydroxybutyrate oxidation peaked at 2–3 h post-dose for all age groups. Cumulative ¹³C-glucose oxidation over 24 h was significantly higher in the elderly but only versus the middle-aged group. There was no difference in cumulative 13C- -hydroxybutyrate oxidation between the three groups. Apolipoprotein E ( 4) was associated with elevated fasting cholesterol but was unrelated to the other plasma metabolites. Conclusion  Elderly people in relatively good health have a similar capacity to produce ketones and to oxidize ¹³C- -hydroxybutyrate as middle-aged or young adults, but oxidize ¹³C-glucose a little more rapidly than healthy middle-aged adults.