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The synthesis of the ketone bodies (ketogenesis) occurs in the mitochondria allowing this process to be intimately coupled to the rate of hepatic fatty acid oxidation

The pigmentation may be the result of an increase in the number of melanocytes in the basal cell layer of the oral epithelium, or of increased melanin biosynthesis by the melanocytes

This may indicate inadequate caloric intake, nutritional deficiencies, or an unrelated medical condition requiring investigation