Subclinical ketosis is defined as a preclinical stage of ketosis. The peak prevalence of subclinical ketosis occurs during the fourth week of lactation. Herd-related factors, breed, parity, and season are other important determinants. Subclinical ketosis can be revealed by determining levels of plasma glucose, plasma NEFA and blood, and milk or urine ketone body concentration. There are theoretical and practical advantages of using milk ketone bodies. Most authors are agreed on approximate lower and upper borderlines for subclinical ketosis. The risk of an outbreak of clinical symptoms has been evaluated by some authors. Most authors have found significant negative relationships between energy balance and ketone body concentration. Some disagreement may be attributable to the fact that the diets used in different experiments can have different glucogenic potential, even if the energy content is the same. This affects the relationship between energy balance and ketone body concentration, as the ketone body level is influenced by both the energy balance and plasma glucose. Feeding silage with high butyric acid content increases the risk of subclinical ketosis. There are indications that cows with the highest milk yield directly after calving are at greatest risk for developing ketosis. Increased ketone body level secondarily reduces milk production, a decrease that has been quantified by some authors. Subclinical ketosis causes delayed reproductive functions return to normal after calving, increased intervals from calving to first and last service, and an increased frequency of ovarian cysts. The routine determination of milk acetone levels in control programs can be used to evaluate the status of individual cows, to indicate the energy feeding in early lactation at a herd level, and to evaluate sires for breeding. The heritability and the tendency toward a positive genetic correlation between milk acetone and milk yield have also been discussed, as have aspects of nutritional prevention. Factors such as energy- and protein-rich roughage, tasty high-energy concentrates, suitable feeding during the dry period, and division of the concentrates into at least four meals are considered to be important.