This systematic review and meta-analysis searched 6 databases on 13 December 2021 for randomized and nonrandomized trials of exogenous ketones, and pooled effects with random-effects models. Forty-three trials including 586 participants were summarized. After ingestion, exogenous ketones increased blood beta-hydroxybutyrate by a mean difference of 1.73 mM and decreased mean blood glucose by 0.54 mM, and compared with placebo the changes were an increase of 1.98 mM and a decrease of 0.47 mM (all P < 0.001). Effects were significantly greater with ketone monoesters than with salts, and the abstract notes limited evidence on prolonged ketone supplementation.
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