Longitudinal Lipid Profile Variability Suggestive of a Lean Mass Hyper-Responder-like Pattern During Ketogenic Diet Adherence: A Case Report
DOI:
https://doi.org/10.70851/jfines.2026.3(3).404.413Keywords:
ketogenic diet, lean mass hyper-responder, lipid profile, nutritional ketosisAbstract
The ketogenic diet (KD) is widely used for weight loss and metabolic health improvement, and some individuals experience substantial increases in low-density lipoprotein (LDL) cholesterol, a pattern recently described in the context of the lean mass hyper-responder (LMHR) phenotype. This case report describes longitudinal changes in lipid profile, liver function, and metabolic parameters over 28 months of follow-up in an adult without known cardiovascular, diabetic, renal, hepatic, or endocrine disease, adhering to a KD initiated in January 2024. No pre-diet lipid values were available. Five laboratory assessments performed between June 2024 and May 2026 were analyzed. Total cholesterol ranged from 194 to 382 mg/dL and LDL cholesterol from 137.4 to 295.8 mg/dL, reflecting marked intra-individual variability rather than persistent elevation. Triglycerides remained low (23–99 mg/dL) throughout follow-up, and HDL cholesterol remained within a generally favorable range (44–76.2 mg/dL) but never reached the ≥80 mg/dL threshold formally required for the LMHR phenotype. A transient elevation of alanine aminotransferase (ALT; 132 U/L) and aspartate aminotransferase (AST; 74 U/L) was observed in January 2026, with subsequent resolution. Nutritional ketosis was objectively confirmed via capillary β-hydroxybutyrate monitoring (range 0.5–2.3 mmol/L) three times weekly throughout follow-up. Several parameters (HbA1c, free thyroxine, free testosterone) were measured only once and should not be interpreted as longitudinally stable. Consequently, the lipid pattern observed—marked LDL-C variability with persistently low triglycerides and high-normal HDL-C—is best described as an LMHR-like pattern rather than a confirmed LMHR phenotype, highlighting the need for further research to clarify the clinical implications of extreme LDL fluctuations in adults without known metabolic disease who do not fully meet strict phenotypic criteria.
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Copyright (c) 2026 Dr. Roberto García Sánchez, Samuel Pérez Bravo, Antonio Manuel León Mendoza, Dr. José Cristóbal Paniagua Marrero, Victoria Soler Anaya, Sonia Mederos Castellano, Dr. Ingrid Morales Pérez (Author)
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