This systematic review and meta-analysis included eight randomized controlled trials (80 participants, 77 men and three women) from 569 articles screened, comparing ketone monoesters or precursors with a nutritive or nonnutritive control on endurance performance. Overall there was no significant difference (Hedges g of 0.136, 95 percent CI -0.195 to 0.467, p = .419). Time to exhaustion (Hedges g of -0.002) and time trial (Hedges g of 0.057) subanalyses were also not significant. All studies reported increased blood ketones after ingestion, and monoesters appeared more effective than precursors at raising concentrations.
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