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. 2016 Nov 4;13:77.
doi: 10.1186/s12986-016-0136-4. eCollection 2016.

Monitoring for Compliance With a Ketogenic Diet: What Is the Best Time of Day to Test for Urinary Ketosis?

Free PMC article

Monitoring for Compliance With a Ketogenic Diet: What Is the Best Time of Day to Test for Urinary Ketosis?

Paul Urbain et al. Nutr Metab (Lond). .
Free PMC article


Background: The ketogenic diet (KD) is a very low-carbohydrate, high-fat and adequate-protein diet with no calorie limit that induces a metabolic condition called "physiological ketosis". It was first introduced to treat epilepsy in the 1920s and has become quite popular recently as weight-loss and performance-enhancing diet. Its therapeutic use in a range of diseases is under investigation. During KD interventions people are supposed to monitor compliance with the dietary regimen by daily urine testing for ketosis. However, there are no studies investigating the best time for testing.

Findings: Twelve healthy subjects (37 ± 11 years; BMI = 23.0 ± 2.5 kg/m2) were instructed to, during the sixth week of a KD and with stable ketosis, measure their urine (8×) and blood (18×) ketone concentration at regular intervals during a 24-h period. According to their 1-day food record, the subjects consumed on average a diet with 74.3 ± 4.0 %, 19.5 ± 3.5 %, and 6.2 ± 2.0 % of total energy intake from fat, protein and carbohydrate, respectively. The lowest blood ß-hydroxybutyrate (BHB) (0.33 ± 0.17 mmol/l) and urine acetoacetate (AA) (0.46 ± 0.54 mmol/l) concentrations were measured at 10:00, respectively. The highest BHB (0.70 ± 0.62 mmol/l) and AA concentrations were noted at 03:00, respectively. Via urine testing the highest levels of ketosis were found at 22:00 and 03:00 and the highest detection rates (>90 %) for ketosis were at 07:00, 22:00 and 03:00, respectively.

Conclusions: These results indicate that ketonuria in subjects with stable ketosis is highest and can be most reliably detected in the early morning and post-dinner urine. Recommendations can be given regarding precise time of the day for measuring ketone bodies in urine in future studies with KDs.

Keywords: Diet compliance; Ketogenic diet; Ketone bodies; Ketonuria; Ketosis; Urine testing.


Fig. 1
Fig. 1
Course of ketone bodies in blood and urine (mmol/l) during the 24-h period and energy intake. Blue bars represent the energy (kcal) and macronutrient compositions (% of energy intake) of the principal meals and snacks. Error bars represent 2 standard errors. Mean times for the principal meals were as follow: breakfast 07:40 ± 0:30; lunch 12:53 ± 0:30; dinner 19:08 ± 0:40. Mean deviations in time to full hour of blood and urine measurements were 3.6 ± 7.9 min and 2.9 ± 7.8 min, respectively
Fig. 2
Fig. 2
Course of urine ketone bodies (mmol/l) during the 24-h period and % of subjects with positive urine testing for ketosis via reagent strips (grey bars). Error bars represent 2 standard errors. Mean deviation in time to full hour of urine measurements was 2.9 ± 7.8 min

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