title: Metabolic profiles in children during fasting.
abstract: BACKGROUND
  Hypoglycemia is one of the most common metabolic derangements in childhood. To establish the cause of hypoglycemia, fasting tolerance tests can be used. Currently available reference values for fasting tolerance tests have limitations in their use in daily practice.
  
  
  OBJECTIVE
  The aim of this study was to determine the reference values of metabolites involved in glucose homeostasis during fasting in healthy children.
  
  
  METHODS
  This study included a retrospective analysis of 488 fasting tests. All tests of patients (n = 321) with disorders, including metabolic and endocrine disorders, were excluded, as were tests performed in children who were over- or underweight.
  
  
  RESULTS
  In 167 fasting tests performed in the study, hypoglycemia was reached in 52 (31%) tests. On the basis of the time until hypoglycemia was reached, 3 age groups could be defined: (1) children aged 0 to 24 months (median 15 months) (n = 49); (2) children aged 25 to 84 months (median 45 months) (n = 79); (3) and children aged 85 to 216 months (median 106 months) (n = 39). In all groups, a significant increase in ketone body levels and a significant decrease in glucose levels in plasma were observed during fasting. Younger children had a faster increase in ketone body levels and a faster decrease in glucose levels in plasma than older children.
  
  
  CONCLUSIONS
  Reference values of the metabolites involved in glucose homeostasis during fasting in children were generated. Those values can be used to determine whether a child has a normal fasting response. For high-risk children, guidelines concerning maximum fasting time and dietary intervention during illness are of the utmost importance.
authors.affiliation: Department of Metabolic and Endocrine Diseases, Wilhelmina Children's Hospital Utrecht, University Medical Center, Utrecht, the Netherlands.
authors.forename: Merel R
authors.initials: MR
authors.lastname: van Veen
authors.forename: Peter M
authors.initials: PM
authors.lastname: van Hasselt
authors.forename: Monique G M
authors.initials: MG
authors.lastname: de Sain-van der Velden
authors.forename: Nanda
authors.initials: N
authors.lastname: Verhoeven
authors.forename: Floris C
authors.initials: FC
authors.lastname: Hofstede
authors.forename: Tom J
authors.initials: TJ
authors.lastname: de Koning
authors.forename: Gepke
authors.initials: G
authors.lastname: Visser
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D004734:Energy Metabolism / Q000502:physiology*; D005215:Fasting / Q000502:physiology*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology / Q000503:physiopathology; D007223:Infant; D007231:Infant, Newborn; D007657:Ketone Bodies / Q000097:blood; D008297:Male; D012016:Reference Values; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D007657:Ketone Bodies