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Decreased glucose oxidation during short-term starvation

  • J.A. Romijn
    Correspondence
    Address reprint requests to J.A. Romijn, MD, Department of Intensive Care, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
    Affiliations
    Department of Intensive Care, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.

    Department of Internal Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.

    Department of Endocrinology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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  • M.H. Godfried
    Affiliations
    Department of Intensive Care, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.

    Department of Internal Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.

    Department of Endocrinology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
    Search for articles by this author
  • M.J.T. Hommes
    Affiliations
    Department of Intensive Care, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.

    Department of Internal Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.

    Department of Endocrinology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
    Search for articles by this author
  • E. Endert
    Affiliations
    Department of Intensive Care, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.

    Department of Internal Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.

    Department of Endocrinology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
    Search for articles by this author
  • H.P. Sauerwein
    Affiliations
    Department of Intensive Care, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.

    Department of Internal Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.

    Department of Endocrinology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
    Search for articles by this author
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      Abstract

      Prolonged fasting (for days or weeks) decreases glucose production and oxidation. The effects of short-term starvation (ie, < 24 hours) on glucose metabolism are not known. To evaluate this issue, glucose oxidation and glucose turnover were measured after 16-hour and subsequently after 22-hour fasting. Glucose oxidation was calculated by indirect calorimetry in 12 healthy men (age 22 to 44 years); glucose turnover was measured by primed, continuous infusion of 3-3H-glucose in eight of these 12 volunteers. After 16-hour fasting net glucose oxidation was 0.59 ± 0.17 mg · kg−1 · min−1 and glucose tissue uptake 2.34 ± 0.12 mg · kg−1 · min−1. No correlation was found between net glucose oxidation and glucose tissue uptake. Prolonging fasting with an addtional 6 hours resulted in decreases of respiratory quotient (0.77 ± 0.01 v 0.72 ± 0.01) (P < .005), plasma glucose concentration (4.7 ± 0.1 v 4.6 ± 0.1 mmol/L) (P < .05), glucose tissue uptake (2.10 ± 0.12 mg · kg−1 · min−1)(P < .05), net glucose oxidation (0.09 ± 0.04 mg · kg−1 · min−1)(P < .005), and plasma insulin concentration (8 ± 1 v 6 ± 1 mU/L) (P < .005). Net glucose oxidation expressed as a percentage of glucose tissue uptake decreased from 22% ± 8% to 2% ± 1% (P < .05). There was no net glucose oxidation in seven of 12 controls after 22-hour fasting. Serum free fatty acid (FFA) concentration (364 ± 34 to 575 ± 48 μmol/L) (P < .005) and plasma ketone body concentration (104 ± 23 to 242 ± 38 μmol/L) (P < .005) increased between 16- and 22-hour fasting. After 16-hour fasting an inverse correlation was found between ketone body concentration and net glucose oxidation (P < .05) and between ketone body concentration and net glucose oxidation expressed as a percentage of glucose tissue uptake (P = .07). No significant correlation could be demonstrated between FFA and ketone body concentration and between FFA and net glucose oxidation. It is concluded that glucose oxidation decreases rapidly even within 1 day of starvation. This may be explained by physiological mechanisms like decreased insulin action and/or inhibition of glucose oxidation by ketone bodies, even in relatively low concentrations.
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