Ketogenic response to cotreatment with bezafibrate and medium chain triacylglycerols in healthy humans

• Bezafibrate (BEZA) mildly increases the ketogenic response to medium chain triacylglycerols (MCTs).
• The acetoacetate-to-β-hydroxybutyrate ratio is affected differently by BEZA plus MCT than by MCT alone.
• BEZA plus MCT does not increase peak ketone concentration compared with MCT alone.
• BEZA plus MCT does not affect daylong mean ketone concentration compared with MCT alone.

ObjectivesThe aim of this study was to compare the ketogenic effect of the peroxisome proliferator-activated receptor-α stimulator, bezafibrate (BEZA), alone or in combination with medium-chain triacylglycerols (MCTs) in healthy adults.MethodsEighteen healthy adults completed the study: 10 were given a therapeutic dose of BEZA (400 mg/d) for 8 wk followed by a further 4 wk of BEZA (400 mg/d) plus MCT (60 g/d). Eight other participants were given MCT alone (60 g/d) for 4 wk. All participants underwent identical metabolic study days: (a) pretreatment (the control), and after (b) BEZA combined with MCT (BEZA+MCT) or (c) an equal dose of MCT only. On the metabolic study days, a standard breakfast and lunch were given and blood samples were taken hourly to measure plasma ketones, glucose, and fatty acids.ResultsThe combination of BEZA+MCT increased ketones twofold during the metabolic study day. The addition of BEZA increased early ketogenic efficiency of MCT by 2.5-fold but did not result in higher peak or mean concentration of ketones during the metabolic study day. No other differences were seen in plasma metabolites or insulin during metabolic study days. On the final metabolic study day, MCT or BEZA+MCT had different effects on the plasma acetoacetate-to-β-hydroxybutyrate ratio compared with control.ConclusionsBEZA mildly potentiated the ketogenic action of MCT but did not increase peak plasma ketone concentration or overall ketone production during the metabolic study day.