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Assessing head injury risk and neuroprotective effect of ketone monoester supplementation in military airborne training.

Overview

Authors: Toshiya Miyatsu1, Jeremy McAdam1, Zachary A. Graham1, Arash Mahyari1, Konstantinos Mitsopoulos1, Andrew Dorsey1, Meredith Yeager1, Art Finch1, Eric Alsop2, Elizabeth Hutchins2, Brooke Lovell2, Krystine Garcia‐Mansfield3,4, Bessie Meechoovet2, Joanna Palada2, Ritin Sharma2, Kendall Van Keuren‐Jensen2, Patrick Pirrotte3,4, Marcas Bamman1, Timothy Broderick1, Morley Stone1
ORCID iDs: Toshiya Miyatsu
  1. Healthspan, Resilience and Performance Research, Florida Institute for Human and Machine Cognition Pensacola Florida USA
  2. Bioinnovation and Genome Sciences Division Translational Genomics Research Institute Phoenix Arizona USA
  3. Early Detection and Prevention Division Translational Genomics Research Institute Phoenix Arizona USA
  4. Integrated Mass Spectrometry Shared Resource, City of Hope National Medical Center Duarte California USA
Journal: Physiological reports, volume 14, issue 6, article e70818
Dates: received 14 October 2025; accepted 27 February 2026; published online 19 March 2026; in print March 2026
Type: Research article · Language: English
License: CC BY
Identifiers: DOI 10.14814/phy2.70818 · PMID 41852147 · PMCID PMC13097624 · OpenAlex W7139000015
Open access: gold, a free copy (OpenAlex)
Status: data only
Categories: behavior only (modality), human (organism), traumatic brain injury (population), clinical / translational (subfield)
Methods: Machine learning, Statistics
Keywords: ketone monoester supplementation, mild traumatic brain injury, military airborne training, neuroprotection, subconcussive head impact
MeSH: Brain Concussion*, Craniocerebral Trauma*, Ketones*, Military Personnel*, Neuroprotective Agents*, Adult, Biomarkers, Dietary Supplements, Double-Blind Method, Female, Humans, Male, Young Adult (* major topic)
Topic: High Altitude and Hypoxia (Genetics, Biochemistry, Genetics and Molecular Biology), according to OpenAlex
Citations: not cited yet (Europe PMC); 52 references in the paper

Abstract

Warfighters face significant risk of mild traumatic brain injury (mTBI) during operations and training. We performed a double‐blind, randomized, placebo‐controlled trial to: (1) determine head strike (HS) incidence, during US Army Basic Airborne Course's Improved Swing Landing Trainer (ISLT) training, (2) test protective efficacy of ketone monoester (KME) supplementation, and (3) assess blood‐based mTBI biomarker signatures. We enrolled 354 active‐duty male and female service members randomized 1:1 to placebo (PLA) or KME; n = 318 completed ISLT and assessments (PLA = 157, 142 M/15F; KME = 161, 144 M/18F). N = 112 (35.2%; 35.7% in PLA, 34.8% in KME) experienced HS, defined as whiplash or helmet‐to‐ground impact. Assessments included the Automated Neuropsychological Assessment Metric (ANAM‐4), SWAY balance testing, and plasma biomarkers. One ANAM‐4 measure (Simple Reaction Time‐Repeat; p = 0.024) and one SWAY measure (Single Leg Right; p = 0.014) demonstrated significant HS × Time × Treatment interactions, with performance decrements in HS + PLA not observed in HS + KME. Several HS × Time interactions were observed for ANAM‐4 and SWAY variables, indicating HS‐induced cognitive and balance decline. No relevant blood‐based biomarker patterns were associated with HS or KME. Predictive modeling identified variables associated with HS risk with moderate accuracy. In conclusion, ISLT resulted in ~32% head injury incidence and KME supplementation showed limited protection of cognitive and balance without corresponding biomarker changes.

Reproduced under the paper's license (CC BY), from the paper cited above.

Code

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Data

Datasets cited

Data availability statement

The exploratory multi‐omics methods, analysis outputs, and discussion from this study have been deposited in Figshare and are publicly available at https://figshare.com/s/4f7b64b39fbf7e0e5f2d. (DOI: 10.6084/m9.figshare.31021216 (https://doi.org/10.6084/m9.figshare.31021216)). They are provided as a permanent public record and represent exploratory analyses that were not subjected to formal peer review as part of the primary manuscript. Additional data supporting the findings of this study, including de‐identified individual‐level data not contained in the Figshare repository, are available from the corresponding author upon reasonable request and subject to institutional review board (IRB), ethical, and data‐use agreement approvals.

Reproduced under the paper's license (CC BY), from the paper cited above.

Versions

The history of this record: each version stored by the harvester or made by a correction of its authors or of the maintainers of its code, and what changed in its facts. The texts of the paper (its abstract, its availability statements) are not part of it; versions that changed only those are not listed.

Version 1, 30 September 2026: the first record

Recorded: type, language, journal, volume, issue, pages, dates, 20 authors, 5 keywords, 13 MeSH terms, 2 funders, 49 references.

Cite

This paper

Miyatsu, T., McAdam, J., Graham, Z. A., Mahyari, A., Mitsopoulos, K., Dorsey, A., Yeager, M., Finch, A., Alsop, E., Hutchins, E., Lovell, B., Garcia‐Mansfield, K., Meechoovet, B., Palada, J., Sharma, R., Van Keuren‐Jensen, K., Pirrotte, P., Bamman, M., Broderick, T., & Stone, M. (2026). Assessing head injury risk and neuroprotective effect of ketone monoester supplementation in military airborne training. Physiological reports, 14(6), e70818. https://doi.org/10.14814/phy2.70818

BibTeX

@article{miyatsu2026assessing,
author = {Miyatsu, Toshiya and McAdam, Jeremy and Graham, Zachary A. and Mahyari, Arash and Mitsopoulos, Konstantinos and Dorsey, Andrew and Yeager, Meredith and Finch, Art and Alsop, Eric and Hutchins, Elizabeth and Lovell, Brooke and Garcia‐Mansfield, Krystine and Meechoovet, Bessie and Palada, Joanna and Sharma, Ritin and Van Keuren‐Jensen, Kendall and Pirrotte, Patrick and Bamman, Marcas and Broderick, Timothy and Stone, Morley},
title = {{Assessing head injury risk and neuroprotective effect of ketone monoester supplementation in military airborne training}},
journal = {Physiological reports},
year = {2026},
month = mar,
volume = {14},
number = {6},
pages = {e70818},
publisher = {Wiley},
issn = {2051-817X},
doi = {10.14814/phy2.70818},
url = {https://doi.org/10.14814/phy2.70818},
pmid = {41852147},
pmcid = {PMC13097624}
}

RIS

TY - JOUR
AU - Miyatsu, Toshiya
AU - McAdam, Jeremy
AU - Graham, Zachary A.
AU - Mahyari, Arash
AU - Mitsopoulos, Konstantinos
AU - Dorsey, Andrew
AU - Yeager, Meredith
AU - Finch, Art
AU - Alsop, Eric
AU - Hutchins, Elizabeth
AU - Lovell, Brooke
AU - Garcia‐Mansfield, Krystine
AU - Meechoovet, Bessie
AU - Palada, Joanna
AU - Sharma, Ritin
AU - Van Keuren‐Jensen, Kendall
AU - Pirrotte, Patrick
AU - Bamman, Marcas
AU - Broderick, Timothy
AU - Stone, Morley
TI - Assessing head injury risk and neuroprotective effect of ketone monoester supplementation in military airborne training
T2 - Physiological reports
J2 - Physiol Rep
PY - 2026
DA - 2026/03/01
VL - 14
IS - 6
SP - e70818
SN - 2051-817X
PB - Wiley
DO - 10.14814/phy2.70818
UR - https://doi.org/10.14814/phy2.70818
LA - en
ER -

CSL-JSON

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