X. Zheng, H. Gong, R. Zhang, J. Wang, G. Cai and X. Chen (2025). Higher dietary ketogenic ratio is associated with accelerated biological aging among US adults: analysis from NHANES 2005-2018. Nutrition research (New York, N.Y.), 143, 56-65. https://doi.org/10.1016/j.nutres.2025.09.010

PubMed 41108793

[Abstract]
Ketogenic diet (KD) is widely prescribed for weight management in obese individuals, yet their potential impact on biological aging remains unclear. Using cross-sectional data from the National Health and Nutrition Examination Survey (NHANES, 2005-2018) to test the hypothesis that KD may accelerate biological aging, biological aging was assessed through 4 indices: biological age acceleration (BioAgeAccel), phenotypic age acceleration (PhenoAgeAccel), homeostatic dysregulation (HD) and serum Klotho concentrations. Weighted multivariable linear regression and restricted cubic spline analyses were performed to evaluate the effects of KD on biological aging. Subgroup and interaction analyses were performed to assess the consistency of these associations across populations. Among the 22,026 included adults, fully adjusted models revealed that each 1-unit increase in dietary ketogenic ratio (DKR) corresponded to a 5.65-year increase in BioAgeAccel (P < .001), a 0.88-year increase in PhenoAgeAccel (P < .05), and a 67.67 pg/mL decrease in Klotho concentrations (P < .05). Restricted cubic spline (RCS) revealed a linear positive association between BioAgeAccel and DKR (P for overall < .001, P for nonlinear = .257), a positive association with potential nonlinearity between PhenoAgeAccel and DKR (P for overall = .001, P for nonlinear = .089, Inflection point = .371), a positive association with nonlinearity (P for overall = .016, P for overall = .002, Inflection point = .371) between HD and DKR, and a negative association with a nonlinear trend (P for overall = .002, P for nonlinear = .053, Inflection point = .374) between Klotho and DKR. Subgroup and interaction analyses confirmed the consistency of these associations across populations. Higher DKR values are positively correlated with accelerated biological aging, particularly when DKR exceeds 0.371. This is the first population-based study to demonstrate this association.