The estimated number of annual deaths attributable to obesity among US adults is approximately 280000 based on HRs from all subjects and 325000 based on HRs from only nonsmokers and never-smokers.

Expressing fat-free mass (FFM) and body fat mass (BFM) as percentages of body weight or by weight is unsatisfactory. For example, tall patients with protein-energy malnutrition (PEM) can exhibit values for FFM and BFM similar to those of shorter well-nourished individuals. To obviate such difficulties, we propose use of height-normalized indices, namely, a FFM index [FFM (kg)/height (m)2, or FFMI] and a BFM index [BFM (kg)/height (m)2, or BFMI]. We calculated these indices in a reference population of 124 healthy young men and in 32 nonobese young men (from the Minnesota Study) before, during, and after experimental semistarvation. When values for FFMI and BFMI falling below the reference cohort's 5th percentile cutoff point were used as a criterion for PEM, these indices, together with basal oxygen-consumption rate, diagnosed PEM in 27 of the 32 Minnesota Study subjects after 12 wk of semi-starvation. These findings indicate that FFMI and BFMI may be useful in nutritional assessment.

Induction of mild states of hyperketonemia may improve physical and cognitive performance. In this study, we determined the kinetic parameters, safety and tolerability of (R)-3-hydroxybutyl (R)-3-hydroxybutyrate, a ketone monoester administered in the form of a meal replacement drink to healthy human volunteers. Plasma levels of β-hydroxybutyrate and acetoacetate were elevated following administration of a single dose of the ketone monoester, whether at 140, 357, or 714 mg/kg body weight, while the intact ester was not detected. Maximum plasma levels of ketones were attained within 1–2 h, reaching 3.30 mM and 1.19 mM for β-hydroxybutyrate and acetoacetate, respectively, at the highest dose tested. The elimination half-life ranged from 0.8–3.1 h for β-hydroxybutyrate and 8–14 h for acetoacetate. The ketone monoester was also administered at 140, 357, and 714 mg/kg body weight, three times daily, over 5 days (equivalent to 0.42, 1.07, and 2.14 g/kg/d). The ketone ester was generally well-tolerated, although some gastrointestinal effects were reported, when large volumes of milk-based drink were consumed, at the highest ketone monoester dose. Together, these results suggest ingestion of (R)-3-hydroxybutyl (R)-3-hydroxybutyrate is a safe and simple method to elevate blood ketone levels, compared with the inconvenience of preparing and consuming a ketogenic diet.