Association between ketone body levels and chronic liver disease: Epidemiological studies and potential mechanisms

Chronic liver disease encompasses conditions such as metabolic dysfunction-associated steatotic liver disease, metabolic dysfunction-associated steatohepatitis, alcohol-related liver disease, and chronic viral hepatitis, being a major cause of cirrhosis and hepatocellular carcinoma. Ketone bodies, crucial hepatic energy substrates, may serve as biomarkers in CLD progression. This review investigated the association between chronic liver diseases and ketone body levels. Studies indicate that ketone body levels may serve as biomarkers for chronic liver diseases. Patients with metabolic dysfunction-associated steatotic liver disease have elevated ketone levels. However, findings are inconsistent in obese populations and metabolic dysfunction-associated steatohepatitis. The relationship between ketone body levels and other chronic liver diseases, such as alcohol-related liver disease and chronic viral hepatitis, remains unclear, necessitating further research. The review also discussed potential mechanisms linking ketone metabolism abnormalities to chronic liver disease pathogenesis. Understanding the role of ketone bodies in chronic liver disease is essential for developing targeted interventions, and future research should employ large-scale databases and causal inference methods to clarify these associations.