Abstract
BackgroundAccurate and reliable monitoring of blood ketone and glucose levels is useful for athletes adhering to a ketogenic diet who want to verify that they are in a state of ketosis and, therefore, accruing performance adaptations. However, the cost of devices and testing materials may prohibit their use. More affordable field testing systems are available, but their accuracy and reliability remain in question. The objectives of this study were to evaluate the agreement between a previously validated ketone and glucose meter (Meter 1 – Precision Xtra) and a more affordable meter that has not been validated (Meter 2 – Keto-Mojo), and also to assess the diagnostic performance of Meter 2 for identifying nutritional ketosis.MethodsThirteen participants (7 females and 6 males; 21.6 ± 3.0 years old) visited the laboratory three times in this randomized, double-blind cross-over design study. Ketone and glucose levels were measured with Meter 1 and Meter 2 twice before and twice after ingestion of a racemic ketone, natural ketone, or maltodextrin supplement. Intraclass correlation coefficient (ICC) estimates and their 95% confidence intervals were calculated to evaluate interrater reliability for Meter 1 and Meter 2. Bland-Altman plots were constructed to visually assess the agreement between devices. Area under the ROC curve analysis was performed to evaluate the diagnostic ability of Meter 2 to detect nutritional ketosis at a threshold ketone level of 0.5 mM as identified by Meter 1.ResultsReliability between the meters was excellent for measuring ketones (ICC = .968; .942–.981) and good for measuring glucose (ICC = .809; .642–.893), though the Bland-Altman plot revealed substantial differences in agreement for measuring glucose. Area under the ROC curve (Area = 0.913; 0.828–0.998) was excellent for diagnosing nutritional ketosis.ConclusionsBoth Meter 1 and Meter 2 displayed excellent agreement between each other for ketone measurement. Meter 2 also displayed an excellent level of accuracy for diagnosing nutritional ketosis at a threshold value of 0.5 mM, making it an effective and affordable alternative to more expensive testing devices.
Highlights
The ketogenic diet (KD) is a nutritional approach in which daily carbohydrate intake is restricted, commonly to < 50 g/day or 5% of energy intake [1,2,3]
Free fatty acid (FFA) are converted to acetyl-CoA and to ketone bodies (KB), most notably in the form of βhydroxybutyrate (BHB), which can be used by tissues of the body as an alternative fuel source to glucose [5]
Prolonged adherence to the KD forces the body to adapt to these changes in substrate availability and shift to a state of ketosis in which most energy is derived from ketones rather than from glycogen [4]
Summary
The ketogenic diet (KD) is a nutritional approach in which daily carbohydrate intake is restricted, commonly to < 50 g/day or 5% of energy intake [1,2,3]. Chronic daily restriction of carbohydrates limits the use of glucose as a substrate and necessitates the use of free fatty acids (FFAs) for energy. Prolonged adherence to the KD forces the body to adapt to these changes in substrate availability and shift to a state of ketosis in which most energy is derived from ketones (via FFAs) rather than from glycogen [4]. Accurate and reliable monitoring of blood ketone and glucose levels is useful for athletes adhering to a ketogenic diet who want to verify that they are in a state of ketosis and, accruing performance adaptations. The objectives of this study were to evaluate the agreement between a previously validated ketone and glucose meter (Meter 1 – Precision Xtra) and a more affordable meter that has not been validated (Meter 2 – Keto-Mojo), and to assess the diagnostic performance of Meter 2 for identifying nutritional ketosis
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