J Korean Med Sci.  2020 Aug;35(31):e273. 10.3346/jkms.2020.35.e273.

The Presence of Urinary Ketones according to Metabolic Status and Obesity

• Kim BR
• Seo JW
• Kim SM
• Kim KN
• Joo NS

• KMID: 2505199
• DOI: http://doi.org/10.3346/jkms.2020.35.e273

Abstract

Background
Recently, new concepts about obesity and normal weight subtypes with metabolic conditions are rising and ketone bodies are emerging as a significant indicator of metabolic health. This study aimed to find a relationship between ketonuria and those subtypes.
Methods
The data of 19,036 subjects were analyzed in this cross-sectional study (2013–2017 Korea National Health and Nutrition Examination Survey, KNHANES). Based on body mass index and adult treatment panel III with modification of waist circumference, individuals were categorized into 4 groups: metabolically healthy normal weight (MHNW), metabolically healthy obese (MHO), metabolically unhealthy normal weight (MUNW), and metabolically unhealthy obese (MUO). Individuals were divided into 2 groups, positive and negative ketonuria groups, and the metabolic parameters were compared.
Results
The metabolic indicators of the positive ketonuria group showed better results than those of the negative ketonuria group and the MHNW group showed the highest proportion of positive ketonuria. The MHNW group showed higher urinary ketones than the MUO group (odds ratio [OR], 0.391; 95% confidence interval [CI], 0.254–0.601) in men. In women, OR of having ketonuria was 0.698 (95% CI, 0.486–1.002) in the MHO group and 0.467 (95% CI, 0.226–0.966) in the MUNW group compared to the MHNW group, respectively.
Conclusion
Compared to the MHNW group, the MUO group showed lower presence of ketonuria in men, and tendency to have less ketonuria in women.

Keyword

Ketonuria; Metabolic Syndrome; Central Obesity

Figure

• 

  Fig. 1 Flowchart showing the selection and categorization of study subjects.KNHANES = Korean National Health and Nutrition Examination Survey, BMI = body mass index, HbA1c = glycated hemoglobin, OHA = oral hypoglycemic agent, SBP = systolic blood pressure, DBP = diastolic blood pressure, TG = triglyceride, HDL-C = high-density lipoprotein-cholesterol, MHNW = metabolically healthy normal weight, MHO = metabolically healthy obese, MUNW = metabolically unhealthy normal weight, MUO = metabolically unhealthy obese.aData from health interview, health examination and nutritional survey; bSubjects who did not meet the inclusion and exclusion criteria were not eliminated. Individuals who met all the inclusion and exclusion criteria were regarded as the analysis group.

• 

  Fig. 2 Proportion of ketonuria in each metabolic and obesity phenotype.P value < 0.001 both in men and women; P value is calculated by χ2 test under complex sample analysis.MHNW = metabolically healthy normal weight, MHO = metabolically healthy obese, MUNW = metabolically unhealthy normal weight, MUO = metabolically unhealthy obese.aValues are presented as unweighted number (weighted %).

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