Effects of Ketone Monoesters on Brain Function

Acute Effects of Ketone Monoester Supplementation on Brain Function in Older Men with Overweight

Disturbances in brain insulin-sensitivity are not only observed in obesity and type 2 diabetes (T2D), but also during brain aging and in dementia. Ketone monoester supplements may improve brain insulin-sensitivity, which can be quantified by measuring the gray-matter cerebral blood flow (CBF) response to intranasally administered insulin. We hypothesize that acute ketone monoester supplementation increases (regional) brain vascular function and insulin-sensitivity thereby improving cognitive performance and appetite control. The primary objective is to evaluate in older men the acute effect of ketone monoester supplementation on (regional) brain vascular function and insulin-sensitivity, as quantified by the non-invasive gold standard magnetic resonance imaging (MRI)-perfusion method Arterial Spin Labelling (ASL). The CBF response to intranasal insulin is a robust and sensitive physiological marker of brain insulin-sensitivity. Secondary objectives are to investigate effects on cognitive performance as assessed with a neuropsychological test battery, and appetite control as quantified by functional MRI (fMRI) with visual food cues.

Study Overview

• Status: Completed
• Conditions: Cerebral Blood Flow; Cognitive Performance; Appetite Control; Brain Vascular Function; Brain Insulin Sensitivity
• Intervention / Treatment: Dietary supplement: Ketone Monoester; Dietary supplement: Placebo

• Study Type: Interventional
• Enrollment (Actual): 18
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Netherlands
  • Limburg
    • Maastricht, Limburg, Netherlands
      • Maastricht University Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Men, aged between 60-75 years
• BMI between 25-30 kg/m2
• Fasting plasma glucose < 7.0 mmol/L
• Fasting serum TC < 8.0 mmol/L
• Fasting serum TAG < 4.5 mmol/L
• Systolic blood pressure < 160 mmHg and diastolic blood pressure < 100 mmHg
• Stable body weight (weight gain or loss < 3 kg in the past three months)
• Willingness to give up being a blood donor from 8 weeks before the start of the study, during the study and for 4 weeks after completion of the study
• No difficult venipuncture as evidenced during the screening visit

Exclusion Criteria:

• Women
• Left-handedness
• Following a low-carbohydrate diet or consuming nutritional ketone supplements
• Current smoker, or smoking cessation < 12 months
• Diabetic patients
• Familial hypercholesterolemia
• Abuse of drugs
• More than 3 alcoholic consumptions per day
• Use of products or dietary supplements known to interfere with the main outcomes as judged by the principal investigators
• Use medication to treat blood pressure, lipid or glucose metabolism, or neurological or mental disorders.
• Use of an investigational product within another biomedical intervention trial within the previous 1-month
• Severe medical conditions that might interfere with the study, such as epilepsy, asthma, kidney failure or renal insufficiency, chronic obstructive pulmonary disease, inflammatory bowel diseases, auto inflammatory diseases and rheumatoid arthritis
• Active cardiovascular disease like congestive heart failure or cardiovascular event, such as an acute myocardial infarction or cerebrovascular accident
• Contra-indications for MRI imaging (e.g. pacemaker, surgical clips/material in body, metal splinter in eye, claustrophobia).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Experimental; Ketone monoesters	Dietary supplement: Ketone Monoester; Ketone monoester supplement (395 mg/kg body mass)
Placebo Comparator: Placebo; Taste- and volume-matched placebo	Dietary supplement: Placebo; The placebo will be taste-matched to the active supplement for bitterness using denatonium benzoate and volume-matched with water

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Brain Vascular Function	Cerebral blood flow as quantified non-invasively by the MRI perfusion method Arterial Spin Labeling (ASL)	Change from placebo intervention at 30 minutes after supplement intake
Brain Insulin Sensitivity	Cerebral blood flow measurements before and after a nasal insulin spray as quantified non-invasively by the MRI perfusion method Arterial Spin Labeling (ASL)	Change from placebo intervention at 60 minutes after supplement intake

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Appetite-related brain reward activity	Blood oxygenation level-dependent (BOLD)-functional MRI (fMRI) response to food cues	Change from placebo intervention at 40 minutes after supplement intake
Cognitive Performance	Cambridge Neuropsychological Test Automated Battery (CANTAB)	Change from placebo intervention at 120 minutes after supplement intake
Brain Perfusion	Transcranial Doppler (TCD) ultrasound will be used to assess the velocity of blood flow through the middle cerebral artery (MCA)	Change from placebo intervention at 120 minutes after supplement intake
Blood pressure	Office blood pressure and heart rate	Change from placebo intervention at 90 minutes after supplement intake
Ketone metabolism	Circulating beta-hydroxybutyrate concentrations	During 120 minutes following supplement intake
Glucose metabolism	Circulating glucose and insulin concentrations	During 120 minutes following supplement intake
Markers related to low-grade systemic inflammation	Circulating high-sensitive C-reactive protein concentrations	During 120 minutes following supplement intake
Appetite hormones	Circulating ghrelin concentrations	During 120 minutes following supplement intake
Perceived hunger and satiety	Visual analogue scale (VAS) questionnaires	During 120 minutes following supplement intake
Anthropometric measurements	Weight, length, waist and hip circumference	Before supplement intake
Food intake	Food Frequency Questionnaire to assess food intake over the past month	Once 120 minutes following supplement intake

Collaborators and Investigators

• Sponsor: Maastricht University Medical Center
• Investigators: Principal Investigator: Peter J Joris, PhD, Maastricht University Medical Center

Study record dates

Study Major Dates

• Study Start (Actual): July 3, 2024
• Primary Completion (Actual): November 15, 2024
• Study Completion (Actual): November 15, 2024

Study Registration Dates

• First Submitted: April 29, 2024
• First Submitted That Met QC Criteria: April 29, 2024
• First Posted (Actual): May 1, 2024

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: February 19, 2025
• Last Verified: February 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Metabolic Diseases; Glucose Metabolism Disorders; Hyperinsulinism; Insulin Resistance
• Other Study ID Numbers: METC24-008

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No