Metabolic and hormonal responses to nutritional ketosis across metabolic phenotypes and sex in adults. Metabolic and hormonal responses to nutritional ketosis across metabolic phenotypes and sex in adults Article Open access Published: 28 October 2026 Cite this article You have full access to this open access article Download PDF View saved research Metabolic and hormonal responses to nutritional ketosis across metabolic phenotypes and sex in adults Download PDF Abstract Ketogenic diets are increasingly used for weight management and metabolic improvement, but it remains unclear whether nutritional ketosis induces uniform adaptation across metabolic phenotypes and sex. This exploratory study examined phenotype- and sex-dependent responses to a 60-day ketogenic diet in adults with normal weight, overweight or obesity.
Participants were stratified into six metabolic phenotypeโsex groups and assessed at baseline, day 14, day 30 and day 60. Plasma biochemical and hormonal markers, appetite and perceived stress scores, and body composition were analyzed using repeated-measures models. During the ketogenic diet intervention, ฮฒ-hydroxybutyrate increased in all groups, confirming nutritional ketosis, but the response differed between groups and was most progressive in men with obesity.
Free fatty acids manifested in a heterogeneous manner, exhibiting distinct time-, phenotype-, and sex-dependent profiles. Glucose decreased after diet initiation, whereas insulin and HOMA-IR improved mainly in participants with overweight and obesity. Lipid profile changes were variable, while liver enzymes showed a sex-dependent temporal pattern.
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