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Paul TJ, Stokken G. Acute Cardiomyopathy in a Prisoner on a Hunger Strike. Cureus 2024; 16:e51949. [PMID: 38333476 PMCID: PMC10852349 DOI: 10.7759/cureus.51949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
Chronic starvation and its associated metabolic derangements are known to have dangerous cardiovascular implications in the long term, but less is known about the cardiovascular consequences of acute starvation, such as in the context of a hunger strike. This case describes a patient who presented with signs and symptoms of acute coronary syndrome which began two weeks into a hunger strike and was ultimately found to have stress cardiomyopathy with complete resolution on subsequent imaging.
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Affiliation(s)
- Tenes J Paul
- Cardiovascular Medicine, University of Massachusetts Chan Medical School, Worcester, USA
| | - Glenn Stokken
- Cardiovascular Medicine, University of Massachusetts Chan Medical School, Worcester, USA
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2
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van Kempen TATG, Hulshof TG, Gerrits WJJ, Zijlstra RT. Review: The amazing gain-to-feed ratio of newly weaned piglets: sign of efficiency or deficiency? Animal 2023; 17:100987. [PMID: 37820408 DOI: 10.1016/j.animal.2023.100987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 08/31/2023] [Accepted: 09/07/2023] [Indexed: 10/13/2023] Open
Abstract
Shortly after weaning, piglets generally eat dry feed poorly; but nevertheless, a phenomenal gain-to-feed ratio is achieved as they gain about as much weight as they eat (150-200 g/d). The high gain-to-feed ratio, though, cannot be explained by their nutrient intake or nutrient repartitioning. Analyses based on tissue composition and bio-electrical impedance data showed that newly weaned piglets lose fat, maintain protein, and gain large amounts of water because of edema. This edema, which may well contribute up to one kg of BW, seems to be triggered by refeeding syndrome. Refeeding syndrome in adult humans occurs when subjects fast for an extended period of time (weeks) that results in downshifts in metabolic activity and concomitant shedding of phosphate (PO4), magnesium (Mg), and potassium (K) in urine. If food is abruptly reintroduced, thus, resulting in strong insulin spikes, metabolism is triggered but hampered by a lack of PO4, Mg, K, and thiamine, causing hypophosphatemia, metabolic stress, and edema. In piglets, the same process appears to happen immediately after weaning but in hours rather than weeks, possibly linked to their high metabolic rate. Refeeding syndrome can be lethal in humans but does not appear to be directly lethal in piglets. Our attempts to prevent it through altered diet composition and/or controlled feeding programs have not resulted in better performance at the end of the nursery phase. A practical ramification of weaning-induced edema is that growth and gain-to-feed ratio data immediately after weaning should be interpreted with caution. In addition, diets arguably should be formulated to not strongly trigger insulin release, while high lysine levels are not needed as the gain is not based on protein accretion.
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Affiliation(s)
- Theo A T G van Kempen
- Department of Animal Science, North Carolina State University, Raleigh, NC 27695-7621, USA.
| | | | - Walter J J Gerrits
- Animal Nutrition Group, Department of Animal Science, Wageningen University & Research, Wageningen 6700AH, the Netherlands
| | - Ruurd T Zijlstra
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Alberta, Canada
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3
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Hao Y, Fu Y, Sun L, Yu Y, Min X, Wei Q, Huang S, Zhao S, Wang L, Wang Y, Li Y, Zheng X, Zhang C, Xu H, Wang X, Lee GD. A novel fasting regimen revealed protein reservation and complement C3 down-regulation after 14-day's continual dietary deprivation. Front Endocrinol (Lausanne) 2023; 14:1150547. [PMID: 37484967 PMCID: PMC10359884 DOI: 10.3389/fendo.2023.1150547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/02/2023] [Indexed: 07/25/2023] Open
Abstract
Objectives The aim is to evaluate the effect of a novel 14-day fasting regimen on the balance between skeletal muscle and adipose tissue composition which might associate with inflammatory factors. Our analysis includes basic physical examinations, clinical laboratory analysis, bioelectrical impedance and biochemical analytic assessments of healthy volunteers. Methods Eight healthy subjects were randomly selected from a pool of volunteers to undergo a continual dietary deprivation (CDD) regimen. Individuals were assigned to take Flexible Abrosia (FA, prebiotic combination) plus appropriate mineral supplement of potassium and magnesium at 3 mealtime every day to prevent potential injury from starved intestinal flora and avoid spasms of smooth muscle due to hunger. Physical and medical examinations were conducted and blood samples were collected at following timepoints: before CDD as self-control (0D), day 7 and day 14 during fasting, and 7-21days and/or 2~3mo after refeeding. Results The combination of FA and mineral supplements significantly decreased self-reported physical response of starvation, with tolerable hunger-mediated sensations experienced during CDD. Bioelectrical and biochemical results indicated significant reduction in both muscle lean and fat mass on day 7. Meanwhile, markers related to fat composition consistently decreased during and after CDD. In addition, most biochemical marker levels, including serum proteins, reached their inflection points at the 7th day of CDD as compared to the control measurements. Levels of these factors started to show a relative plateau, or reversed direction upon the 14th day of CDD. The exceptions of above factors were myostatin and complement protein C3, which remained at lower concentrations in the blood throughout CDD, and were unable to fully recover toward baseline levels even after 3 months' refeeding. Conclusion Our results indicated that human subjects undergoing prolonged dietary restriction were well protected by FA and mineral ions from gut injury or physical discomfort of starvation. Most factors showed a relative plateau response at the end of 14D-CDD. The muscle tissues were well preserved during prolonged fasting, and an improved protein/lipid ratio was observed. Upon refeeding, constant lower levels of myostatin and complement C3 were maintained after CDD implies a long-term beneficial effect in dealing with anti-aging and inflammation.
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Affiliation(s)
- Yaqian Hao
- The First Affiliated Hospital of Henan University, Kaifeng, Henan, China
| | - Yu Fu
- The First Affiliated Hospital of Henan University, Kaifeng, Henan, China
| | - Liangliang Sun
- The First Affiliated Hospital of Henan University, Kaifeng, Henan, China
| | - Yaying Yu
- The First Affiliated Hospital of Henan University, Kaifeng, Henan, China
| | - Xia Min
- College of National Security, University of National Defense, Beijing, China
| | - Qiannan Wei
- The First Affiliated Hospital of Henan University, Kaifeng, Henan, China
| | - Shuangjian Huang
- The First Affiliated Hospital of Henan University, Kaifeng, Henan, China
| | - Sen Zhao
- The First Affiliated Hospital of Henan University, Kaifeng, Henan, China
| | - Li Wang
- The First Affiliated Hospital of Henan University, Kaifeng, Henan, China
| | - YuanYuan Wang
- The First Affiliated Hospital of Henan University, Kaifeng, Henan, China
| | - Yangyang Li
- The First Affiliated Hospital of Henan University, Kaifeng, Henan, China
| | - Xia Zheng
- The First Affiliated Hospital of Henan University, Kaifeng, Henan, China
| | - Chenlu Zhang
- The First Affiliated Hospital of Henan University, Kaifeng, Henan, China
| | - Hongxia Xu
- The First Affiliated Hospital of Henan University, Kaifeng, Henan, China
| | - Xiaoxue Wang
- The First Affiliated Hospital of Henan University, Kaifeng, Henan, China
- Institute on Aging and Disease of Henan University, Kaifeng, Henan, China
| | - Garrick D. Lee
- The First Affiliated Hospital of Henan University, Kaifeng, Henan, China
- Institute on Aging and Disease of Henan University, Kaifeng, Henan, China
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Roberge G, Samson C, Le Gal G, Calabrino A. Prolonged Fasting as a Cause of Deep Vein Thrombosis: A Case Report. TH OPEN 2023; 7:e94-e96. [PMID: 37091135 PMCID: PMC10118710 DOI: 10.1055/s-0043-57225] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/21/2023] [Indexed: 04/25/2023] Open
Abstract
Background Intermittent fasting is becoming more popular as health benefits are described in recent literature. Various forms of fasting exist, one of them involving a zero-calorie diet and drinking only water. However, the safety of water-only fasting is still not well established. We report a case of a man who developed a lower limb deep vein thrombosis at the end of a 2-week water-only fasting and characterized by an initial period of 5 days of no food and no water intake. We reviewed literature regarding potential links between fasting and venous thromboembolism (VTE). Clinical Approach We believe that fasting can induce important dehydration, leading to hypercoagulability and then contribute to the development of a venous thrombosis. The patient was treated with apixaban for 3 months as is recommended in patients with a provoked event caused by a transient risk factor. No thrombotic recurrence was observed during the 6-month follow-up. Conclusion The public needs to be aware of the potential life-threatening complications associated with important dehydration in the setting of medically unsupervised fasting, and these might include VTE. Whether a VTE with dehydration as the only identified risk factor should be approached as a low recurrence risk situation or not still needs to be clarified.
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Affiliation(s)
- Guillaume Roberge
- Centre d'Excellence des Maladies Vasculaires, Centre Hospitalier Universitaire de Québec, Université Laval, Hôpital Saint-François d'Assise, Québec, Canada
- Address for correspondence Guillaume Roberge, MD, DRCPSC Centre d'Excellence des Maladies Vasculaires, Centre Hospitalier Universitaire de Québec, Université Laval10, rue de l'Espinay, Québec, Canada G1L 3L5
| | | | - Grégoire Le Gal
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Anthony Calabrino
- Centre d'Excellence des Maladies Vasculaires, Centre Hospitalier Universitaire de Québec, Université Laval, Hôpital Saint-François d'Assise, Québec, Canada
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Khan J, Pernicova I, Nisar K, Korbonits M. Mechanisms of ageing: growth hormone, dietary restriction, and metformin. Lancet Diabetes Endocrinol 2023; 11:261-281. [PMID: 36848915 DOI: 10.1016/s2213-8587(23)00001-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 03/01/2023]
Abstract
Tackling the mechanisms underlying ageing is desirable to help to extend the duration and improve the quality of life. Life extension has been achieved in animal models by suppressing the growth hormone-insulin-like growth factor 1 (IGF-1) axis and also via dietary restriction. Metformin has become the focus of increased interest as a possible anti-ageing drug. There is some overlap in the postulated mechanisms of how these three approaches could produce anti-ageing effects, with convergence on common downstream pathways. In this Review, we draw on evidence from both animal models and human studies to assess the effects of suppression of the growth hormone-IGF-1 axis, dietary restriction, and metformin on ageing.
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Affiliation(s)
- Jansher Khan
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ida Pernicova
- Endocrinology and Metabolic Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Kiran Nisar
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Márta Korbonits
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
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6
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Rao HR, Barron MA, Biswas A, Branson HM, Mitton GD, Naqvi A. Malnutrition in a child with T-cell ALL leading to superior mesenteric artery syndrome and Wernicke's encephalopathy. Pediatr Blood Cancer 2022; 69:e29651. [PMID: 35441467 DOI: 10.1002/pbc.29651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/24/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Harini R Rao
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Mary A Barron
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Asthik Biswas
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada.,Department of Medical Imaging, University of Toronto, Canada
| | - Helen M Branson
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada.,Department of Medical Imaging, University of Toronto, Canada
| | - Gregory D Mitton
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada.,Department of Medical Imaging, University of Toronto, Canada
| | - Ahmed Naqvi
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada
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7
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Visioli F, Mucignat-Caretta C, Anile F, Panaite SA. Traditional and Medical Applications of Fasting. Nutrients 2022; 14:nu14030433. [PMID: 35276792 PMCID: PMC8838777 DOI: 10.3390/nu14030433] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/06/2022] [Accepted: 01/17/2022] [Indexed: 02/07/2023] Open
Abstract
Fasting has been practiced for millennia, for religious, ethical, or health reasons. It is also commonplace among different species, from humans, to animals, to lower eukaryotes. Research on fasting is gaining traction based on recent studies that show its role in many adaptive cellular responses such as the reduction of oxidative damage and inflammation, increase of energy metabolism, and in boosting cellular protection. In this expert review, we recount the historical evolution of fasting and we critically analyze its current medical applications, including benefits and caveats. Based on the available data, we conclude that the manipulation of dietary intake, in the form of calorie restriction, intermittent fasting, dietary restriction with the exclusion of some nutrients, prolonged fasting, and so forth, is anthropologically engraved in human culture possibly because of its positive health effects. Indeed, many studies show that fasting ameliorates many biochemical parameters related to cardiovascular and cancer risk, and neurodegeneration. Mechanistic studies are plentiful, but largely limited to cell cultures or laboratory animals. Understandably, there are no controlled trials of any form of fasting that gauge the effects on [any cause] mortality. Physicians should be aware that misinformation is pervasive and that their patients often adopt dietary regimens that are far from being clinically validated. Moreover, doctors are often unaware of their patients’ religious or traditional fasting and of its potential health effects. Based on current evidence, no long-term fasting should be undertaken without medical supervision until future research will hopefully help shed further light on fasting and its effects on human health.
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Affiliation(s)
- Francesco Visioli
- Department of Molecular Medicine, University of Padova, Viale G. Colombo, 335121 Padova, Italy; (C.M.-C.); (F.A.)
- IMDEA-Food, 28049 Madrid, Spain
- Correspondence: ; Tel.: +390498276107
| | - Carla Mucignat-Caretta
- Department of Molecular Medicine, University of Padova, Viale G. Colombo, 335121 Padova, Italy; (C.M.-C.); (F.A.)
| | - Francesca Anile
- Department of Molecular Medicine, University of Padova, Viale G. Colombo, 335121 Padova, Italy; (C.M.-C.); (F.A.)
| | - Stefan-Alexandru Panaite
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, School of Hygiene and Preventive Medicine, University of Padova, 35121 Padova, Italy;
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8
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He S, Ryu J, Liu J, Luo H, Lv Y, Langlais PR, Wen J, Dong F, Sun Z, Xia W, Lynch JL, Duggirala R, Nicholson BJ, Zang M, Shi Y, Zhang F, Liu F, Bai J, Dong LQ. LRG1 is an adipokine that mediates obesity-induced hepatosteatosis and insulin resistance. J Clin Invest 2021; 131:148545. [PMID: 34730111 DOI: 10.1172/jci148545] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 10/27/2021] [Indexed: 11/17/2022] Open
Abstract
Dysregulation in adipokine biosynthesis and function contributes to obesity-induced metabolic diseases. However, the identities and functions of many of the obesity-induced secretory molecules remain unknown. Here, we report the identification of leucine-rich alpha-2-glycoprotein 1 (LRG1) as an obesity-associated adipokine that exacerbates high fat diet-induced hepatosteatosis and insulin resistance. Serum levels of LRG1 were markedly elevated in obese humans and mice compared to their respective controls. LRG1 deficiency in mice greatly alleviated diet-induced hepatosteatosis, obesity, and insulin resistance. Mechanistically, LRG1 bound with high selectivity to the liver and promoted hepatosteatosis by increasing de novo lipogenesis and suppressing fatty acid β-oxidation. LRG1 also inhibited hepatic insulin signaling by down-regulating insulin receptor substrates 1 and 2. Our study identified LRG1 as a key molecule that mediates the crosstalk between adipocytes and hepatocytes in diet-induced hepatosteatosis and insulin resistance. Suppressing LRG1 expression and function may be a promising strategy for the treatment of obesity-related metabolic diseases.
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Affiliation(s)
- Sijia He
- Department of Pharmacology, University of Texas Health at San Antonio, San Antonio, United States of America
| | - Jiyoon Ryu
- Department of Cell Systems & Anatomy, University of Texas Health at San Antonio, San Antonio, United States of America
| | - Juanhong Liu
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hairong Luo
- Department of Metabolism and Endocrinology Clinical Research Center for Met, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ying Lv
- Novo Nordisk Research Centre China, Novo Nordisk Research Centre China, Beijing, China
| | - Paul R Langlais
- Department of Medicine, University of Arizona, Tucson, United States of America
| | - Jie Wen
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Feng Dong
- Department of Biochemistry and Structural Biology, University of Texas Health at San Antonio, San Antonio, United States of America
| | - Zhe Sun
- Novo Nordisk Research Centre China, Novo Nordisk Research Centre China, Beijing, China
| | - Wenjuan Xia
- Novo Nordisk Research Centre China, Novo Nordisk Research Centre China, Beijing, China
| | - Jane L Lynch
- Department of Pediatrics, University of Texas Health at San Antonio, San Antonio, United States of America
| | - Ravindranath Duggirala
- Department of Human Genetics and South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley, McAllen, United States of America
| | - Bruce J Nicholson
- Department of Biochemistry and Structural Biology, University of Texas Health at San Antonio, San Antonio, United States of America
| | - Mengwei Zang
- Department of Molecular Medicine, University of Texas Health at San Antonio, San Antonio, United States of America
| | - Yuguang Shi
- Department of Pharmacology, University of Texas Health at San Antonio, San Antonio, United States of America
| | - Fang Zhang
- Novo Nordisk Research Centre China, Novo Nordisk Research Centre China, Beijing, China
| | - Feng Liu
- Department of Pharmacology, University of Texas Health at San Antonio, San Antonio, United States of America
| | - Juli Bai
- Department of Pharmacology, University of Texas Health at San Antonio, San Antonio, United States of America
| | - Lily Q Dong
- Department of Cellular and Structural Biology, University of Texas Health at San Antonio, San Antonio, United States of America
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Effect of repeated bouts of fasting and refeeding on body composition and proteolysis gene expression in skeletal muscles and liver of C57BL/6J mice. Biologia (Bratisl) 2021. [DOI: 10.1007/s11756-021-00873-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Leptin treatment prevents impaired hypoglycemic counterregulation induced by exposure to severe caloric restriction or exposure to recurrent hypoglycemia. Auton Neurosci 2021; 235:102853. [PMID: 34358845 DOI: 10.1016/j.autneu.2021.102853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 06/06/2021] [Accepted: 07/07/2021] [Indexed: 02/07/2023]
Abstract
Hypoglycemia-associated autonomic failure (HAAF) is a maladaptive failure in glucose counterregulation in persons with diabetes (PWD) that is caused by recurrent exposure to hypoglycemia. The adipokine leptin is known to regulate glucose homeostasis, and leptin levels fall following exposure to recurrent hypoglycemia. Yet, little is known regarding how reduced leptin levels influence glucose counterregulation, or if low leptin levels are involved in the development of HAAF. The purpose of this study was to determine the effect of hypoleptinemia on the neuroendocrine responses to hypoglycemia. We utilized two separate experimental paradigms known to induce a hypoleptinemic state: 60% caloric restriction (CR) in mice and three days of recurrent hypoglycemia (3dRH) in rats. A sub-set of animals were also treated with leptin (0.5-1.0 μg/g) during the CR or 3dRH periods. Neuroendocrine responses to hypoglycemia were assessed 60 min following an IP insulin injection on the terminal day of the paradigms. CR mice displayed defects in hypoglycemic counterregulation, indicated by significantly lower glucagon levels relative to controls, 13.5 pmol/L (SD 10.7) versus 64.7 pmol/L (SD 45) (p = 0.002). 3dRH rats displayed reduced epinephrine levels relative to controls, 1900 pg/mL (SD 1052) versus 3670 pg/mL (SD 780) (p = 0.030). Remarkably, leptin treatment during either paradigm completely reversed this effect by normalizing glucagon levels in CR mice, 78.0 pmol/L (SD 47.3) (p = 0.764), and epinephrine levels in 3dRH rats, 2910 pg/mL (SD 1680) (p = 0.522). These findings suggest that hypoleptinemia may be a key signaling event driving the development of HAAF and that leptin treatment may prevent the development of HAAF in PWD.
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11
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A Systematic Review of the Role of Thiamine Supplementation in Treatment of Refeeding Syndrome. TOP CLIN NUTR 2021. [DOI: 10.1097/tin.0000000000000235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Jordao AA, Canale A, Brunaldi M, Zucoloto S. Hepatic ballooning degeneration: a new feature of the refeeding syndrome in rats. Clin Exp Hepatol 2020; 6:327-334. [PMID: 33511280 PMCID: PMC7816639 DOI: 10.5114/ceh.2020.102151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/21/2020] [Indexed: 11/17/2022] Open
Abstract
AIM OF THE STUDY Hepatic changes have been described during the refeeding syndrome due to increase in enzymes and hepatomegaly; however, they have not been properly described. Thus, the objective of this study was to investigate the hepatic histological characteristics and biochemical markers of hepatic steatosis in Wistar rats with refeeding syndrome. MATERIAL AND METHODS Thirty male Wistar rats were allocated to one of three groups: C, F or R. The animals from group C received an AIN-93 diet for 96 hours, and were then sacrificed. Animals allocated to group F were fasted for 48 hours and sacrificed. Animals from group R were also fasted for 48 hours, but were refed for another 48 hours, with AIN-93. The liver, blood and epididymal and retroperitoneal fats were collected. RESULTS Data obtained in groups F and R show the changes observed in refeeding syndrome, during starvation and refeeding. The serum glucose, magnesium, potassium and phosphorus, in group F, decreased. There was no evidence of hepatic steatosis. Hypophosphatemia, hypomagnesemia and hypokalemia were also observed in group R, confirming refeeding syndrome. The main histological characteristic, in this group, was the extensive presence of ballooning degeneration. This is the first article that has detected such change in liver structure, due to refeeding syndrome. The possible causes are: retention of sodium, causing whole body edema; and/or dysfunction of the sodium/potassium pump of the hepatocytes, as a result of hypophosphatemia. CONCLUSIONS This is the first description of an animal model of hepatic severe ballooning degeneration induced due to refeeding syndrome.
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Affiliation(s)
- Alceu Afonso Jordao
- Faculty of Medicine of Ribeirão Preto, University of Sao Paulo (USP), Brazil
| | - Amanda Canale
- Faculty of Medicine of Ribeirão Preto, University of Sao Paulo (USP), Brazil
| | - Mariângela Brunaldi
- Faculty of Medicine of Ribeirão Preto, University of Sao Paulo (USP), Brazil
| | - Sergio Zucoloto
- Faculty of Medicine of Ribeirão Preto, University of Sao Paulo (USP), Brazil
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da Silva JSV, Seres DS, Sabino K, Adams SC, Berdahl GJ, Citty SW, Cober MP, Evans DC, Greaves JR, Gura KM, Michalski A, Plogsted S, Sacks GS, Tucker AM, Worthington P, Walker RN, Ayers P. ASPEN Consensus Recommendations for Refeeding Syndrome. Nutr Clin Pract 2020; 35:178-195. [DOI: 10.1002/ncp.10474] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
| | - David S. Seres
- Columbia University Irving Medical Center New York New York USA
| | - Kim Sabino
- Saint Francis Hospital and Medical Center Hartford Connecticut USA
| | | | - Gideon J. Berdahl
- School of Pharmacy, University of Mississippi Jackson Mississippi USA
| | | | - M. Petrea Cober
- Akron Children's Hospital Akron Ohio USA
- Northeast Ohio Medical University Rootstown Ohio USA
| | - David C. Evans
- Ohio Health Trauma and Surgical Services Columbus Ohio USA
| | - June R. Greaves
- Coram CVS Speciality Infusion Services Northbrook Illinois USA
| | | | - Austin Michalski
- Patient Food and Nutrition ServicesMichigan Medicine Ann Arbor Michigan USA
| | - Stephen Plogsted
- Nutrition Support ServiceNationwide Children's Hospital Columbus Ohio USA
| | - Gordon S. Sacks
- Medical AffairsFresenius Kabi USA LLC Lake Zurich Illinois USA
| | - Anne M. Tucker
- Critical Care and Nutrition SupportUniversity of Texas M D Anderson Cancer Center Houston Texas USA
| | | | - Renee N. Walker
- Michael E. DeBakey Veterans Affairs Medical Center Houston Texas USA
| | - Phil Ayers
- Clinical Pharmacy ServicesMississippi Baptist Medical Center Jackson Mississippi USA
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Evaluation of dietary patterns and haematological profile of apparently healthy officers of the Central Prisons in the Ho municipality. A cross sectional study. SCIENTIFIC AFRICAN 2020. [DOI: 10.1016/j.sciaf.2020.e00284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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15
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Johnson HM, Stanfield E, Campbell GJ, Eberl EE, Cooney GJ, Bell-Anderson KS. Glucose mediates insulin sensitivity via a hepatoportal mechanism in high-fat-fed rats. J Endocrinol 2019; 241:189-199. [PMID: 30939450 DOI: 10.1530/joe-18-0566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/02/2019] [Indexed: 11/08/2022]
Abstract
Poor nutrition plays a fundamental role in the development of insulin resistance, an underlying characteristic of type 2 diabetes. We have previously shown that high-fat diet-induced insulin resistance in rats can be ameliorated by a single glucose meal, but the mechanisms for this observation remain unresolved. To determine if this phenomenon is mediated by gut or hepatoportal factors, male Wistar rats were fed a high-fat diet for 3 weeks before receiving one of five interventions: high-fat meal, glucose gavage, high-glucose meal, systemic glucose infusion or portal glucose infusion. Insulin sensitivity was assessed the following day in conscious animals by a hyperinsulinaemic-euglycaemic clamp. An oral glucose load consistently improved insulin sensitivity in high-fat-fed rats, establishing the reproducibility of this model. A systemic infusion of a glucose load did not affect insulin sensitivity, indicating that the physiological response to oral glucose was not due solely to increased glucose turnover or withdrawal of dietary lipid. A portal infusion of glucose produced the largest improvement in insulin sensitivity, implicating a role for the hepatoportal region rather than the gastrointestinal tract in mediating the effect of glucose to improve lipid-induced insulin resistance. These results further deepen our understanding of the mechanism of glucose-mediated regulation of insulin sensitivity and provide new insight into the role of nutrition in whole body metabolism.
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Affiliation(s)
- Holly M Johnson
- The University of Sydney, Charles Perkins Centre, School of Life and Environmental Sciences, Sydney, New South Wales, Australia
| | - Erin Stanfield
- The University of Sydney, Charles Perkins Centre, School of Life and Environmental Sciences, Sydney, New South Wales, Australia
| | - Grace J Campbell
- The University of Sydney, Charles Perkins Centre, School of Life and Environmental Sciences, Sydney, New South Wales, Australia
| | - Erica E Eberl
- The University of Sydney, Charles Perkins Centre, School of Life and Environmental Sciences, Sydney, New South Wales, Australia
| | - Gregory J Cooney
- The University of Sydney, Charles Perkins Centre, School of Medical Sciences, Sydney, New South Wales, Australia
| | - Kim S Bell-Anderson
- The University of Sydney, Charles Perkins Centre, School of Life and Environmental Sciences, Sydney, New South Wales, Australia
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16
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Lessan N, Ali T. Energy Metabolism and Intermittent Fasting: The Ramadan Perspective. Nutrients 2019; 11:nu11051192. [PMID: 31137899 PMCID: PMC6566767 DOI: 10.3390/nu11051192] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/06/2019] [Accepted: 05/09/2019] [Indexed: 01/06/2023] Open
Abstract
Intermittent fasting (IF) has been gaining popularity as a means of losing weight. The Ramadan fast (RF) is a form of IF practiced by millions of adult Muslims globally for a whole lunar month every year. It entails a major shift from normal eating patterns to exclusive nocturnal eating. RF is a state of intermittent liver glycogen depletion and repletion. The earlier (morning) part of the fasting day is marked by dominance of carbohydrate as the main fuel, but lipid becomes more important towards the afternoon and as the time for breaking the fast at sunset (iftar) gets closer. The practice of observing Ramadan fasting is accompanied by changes in sleeping and activity patterns, as well as circadian rhythms of hormones including cortisol, insulin, leptin, ghrelin, growth hormone, prolactin, sex hormones, and adiponectin. Few studies have investigated energy expenditure in the context of RF including resting metabolic rate (RMR) and total energy expenditure (TEE) and found no significant changes with RF. Changes in activity and sleeping patterns however do occur and are different from non-Ramadan days. Weight changes in the context of Ramadan fast are variable and typically modest with wise inter-individual variation. As well as its direct relevance to many religious observers, understanding intermittent fasting may have implications on weight loss strategies with even broader potential implications. This review examines current knowledge on different aspects of energy balance in RF, as a common model to learn from and also map out strategies for healthier outcomes in such settings.
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Affiliation(s)
- Nader Lessan
- Imperial College London Diabetes Center (ICLDC), Abu Dhabi, UAE.
| | - Tomader Ali
- Imperial College London Diabetes Center (ICLDC), Abu Dhabi, UAE.
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17
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Abstract
Exacerbation of liver enzymes after the initiation of feeding in malnourished patients is caused by refeeding syndrome or persistent starvation. There are no definite clinical markers for distinguishing between the two conditions. We herein report a 63-year-old woman with starvation-induced liver enzyme elevation. Her body weight was inversely associated with the liver enzyme levels after refeeding, which was a different course from refeeding syndrome. Normalization of liver enzymes ensued as the caloric intake increased and weight gain progressed. Daily changes in body weight can be a useful clinical marker for distinguishing between refeeding syndrome and starvation-induced liver enzyme elevation.
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Affiliation(s)
- Hiroaki Nishioka
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, Japan
| | - Aisa Yoshizaki
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, Japan
| | - Yukihiro Imai
- Department of Pathology, Kobe City Medical Center General Hospital, Japan
| | - Naoki Higashibeppu
- Department of Anesthesia and Critical Care, Kobe City Medical Center General Hospital, Japan
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18
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Moriya A, Fukuwatari T, Shibata K. A Suitable Diet for Recovery from Starvation Is a High-Fat Diet, but Not a High-Protein Diet, in Rats. J Nutr Sci Vitaminol (Tokyo) 2019; 64:412-424. [PMID: 30606964 DOI: 10.3177/jnsv.64.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The present study aims to determine the most suitable dietary balance of energy-producing nutrients for recovery from starvation. Rats were fed their standard high- carbohydrate diet (HCD, carbohydrate energy : protein energy : fat energy=71 : 18 : 11) for 7 d and then deprived of food for 3 d (short-term starvation) or 8 d (long-term starvation). The starved rats were then fed the HCD, a high-protein diet (HPD, 31 : 57 : 12), or a high-fat diet (HFD, 34 : 14 : 52) for 8 d. Rats had ad libitum access to drinking water throughout the experimental period, including the starvation period. The reference group was allowed free access to the HCD throughout the experimental period. Characteristically, increased drinking, increased urea nitrogen in the plasma and urine, and hypertrophy of the kidneys, were observed in the HPD group. Furthermore, the recovery of plasma glucose level was insufficient in this group. Therefore, administration of a HPD was contraindicated in recovery from starvation. The recovery of body weight after starvation was excellent in the HFD group. No effect on the metabolism of B-group vitamins involved in energy metabolism was found with the administration of any diet. The effects of HCD and HFD administration on recovery from starvation were investigated in further detail. No adverse effects were observed on the tissue to body weight mass ratios or biochemical parameters in blood in the HFD group. From the above findings, it is hypothesized that a HFD is most suitable for quickly reversing the influence of starvation.
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Affiliation(s)
- Aya Moriya
- Department of Nutrition, School of Human Cultures, The University of Shiga Prefecture
| | - Tsutomu Fukuwatari
- Department of Nutrition, School of Human Cultures, The University of Shiga Prefecture
| | - Katsumi Shibata
- Department of Nutrition, School of Human Cultures, The University of Shiga Prefecture.,Department of Clinical Nutrition and Dietetics, Faculty of Clinical Nutrition and Dietetics, Konan Women's University
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19
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Manno FA. Monk on fire: The meditative mind of a burning monk. COGENT PSYCHOLOGY 2019. [DOI: 10.1080/23311908.2019.1678556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Francis A.M. Manno
- School of Biomedical Engineering, Faculty of Engineering, University of Sydney, Sydney, New South Wales, Australia
- Department of Biomedical Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, China
- Department of Physics, City University of Hong Kong, Kowloon, Hong Kong SAR, China
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20
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Abstract
Aminotransferase elevations have been described in patients with anorexia nervosa. Hypothesized etiologies have included ischemic hepatitis, refeeding-induced transaminitis, and the process of autophagy. Supervised enteral nutrition is the mainstay of treatment for severe anorexia, but an increase in aminotransferase levels after initiation of enteral feeding presents clinicians with a diagnostic dilemma. We present a 31-year-old woman with anorexia nervosa (body mass index [BMI] of 13.5 kg/m2) who experienced a worsening of aminotransferase elevations even after the initiation of enteral feeding. Despite nutritional supplementation, the patient's weight continued to fall for 6 days. Peak aminotransferase concentrations correlated with the patient's lowest weight and improved only after an increase in BMI was eventually achieved. Secondary causes of severe transaminitis were investigated, and after no cause was found, a liver biopsy was performed. Pathology was consistent with liver injury secondary to severe malnutrition rather than from refeeding syndrome. This case highlights malnutrition as an important cause of aminotransferase elevations and underscores the need for judicious early weight restoration in patients with anorexia and abnormal liver chemistry.
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21
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Vootla VR, Daniel M. Abnormal Liver Function Tests in an Anorexia Nervosa Patient and an Atypical Manifestation of Refeeding Syndrome. Case Rep Gastroenterol 2015; 9:261-5. [PMID: 26351414 PMCID: PMC4560322 DOI: 10.1159/000437321] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Refeeding syndrome is defined as electrolyte and fluid abnormalities that occur in significantly malnourished patients when they are refed orally, enterally, or parenterally. The principal manifestations include hypophosphatemia, hypokalemia, vitamin deficiencies, volume overload and edema. This can affect multiple organ systems, such as the cardiovascular, pulmonary, or neurological systems, secondary to the above-mentioned abnormalities. Rarely, patients may develop gastrointestinal symptoms and show abnormal liver function test results. We report the case of a 52-year-old woman with anorexia nervosa who developed refeeding syndrome and simultaneous elevations of liver function test results, which normalized upon the resolution of the refeeding syndrome.
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Affiliation(s)
- Vamshidhar R Vootla
- Division of Gastroenterology, Bronx Lebanon Hospital Center, Bronx, N.Y., USA
| | - Myrta Daniel
- Division of Gastroenterology, Bronx Lebanon Hospital Center, Bronx, N.Y., USA
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22
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Management of Excessive Weight Loss Following Laparoscopic Roux-en-Y Gastric Bypass: Clinical Algorithm and Surgical Techniques. Obes Surg 2015; 26:5-11. [DOI: 10.1007/s11695-015-1775-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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23
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Golden MH. Nutritional and other types of oedema, albumin, complex carbohydrates and the interstitium - a response to Malcolm Coulthard's hypothesis: Oedema in kwashiorkor is caused by hypo-albuminaemia. Paediatr Int Child Health 2015; 35:90-109. [PMID: 25844980 DOI: 10.1179/2046905515y.0000000010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The various types of oedema in man are considered in relation to Starling's hypothesis of fluid movement from capillaries, with the main emphasis on nutritional oedema and the nephrotic syndrome in children. It is concluded that each condition has sufficient anomalous findings to render Starling's hypothesis untenable. The finding that the endothelial glycocalyx is key to control of fluid movement from and into the capillaries calls for complete revision of our understanding of oedema formation. The factors so far known to affect the function of the glycocalyx are reviewed. As these depend upon sulphated proteoglycans and other glycosaminoglycans, the argument is advanced that the same abnormalities will extend to the interstitial space and that kwashiorkor is fundamentally related to a defect in sulphur metabolism which can explain all the clinical features of the condition, including the formation of oedema.
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Key Words
- Albumin,
- Aldosterone,
- Angiotensin,
- Beriberi,
- Edema,
- Epidemic dropsy,
- Famine oedema,
- Glycocalyx,
- Glycosaminoglycans,
- Heart failure,
- Hunger oedema,
- Kwashiorkor,
- Malnutrition,
- Nephrotic syndrome,
- Oedema,
- Potassium deficiency,
- Pre-eclampsia,
- Protein-energy malnutrition,
- Proteoglycans,
- Renin,
- Salt,
- Severe acute malnutrition
- Vitamin E deficiency,
- War oedema,
- Water,
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24
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Müller TD, Nogueiras R, Andermann ML, Andrews ZB, Anker SD, Argente J, Batterham RL, Benoit SC, Bowers CY, Broglio F, Casanueva FF, D'Alessio D, Depoortere I, Geliebter A, Ghigo E, Cole PA, Cowley M, Cummings DE, Dagher A, Diano S, Dickson SL, Diéguez C, Granata R, Grill HJ, Grove K, Habegger KM, Heppner K, Heiman ML, Holsen L, Holst B, Inui A, Jansson JO, Kirchner H, Korbonits M, Laferrère B, LeRoux CW, Lopez M, Morin S, Nakazato M, Nass R, Perez-Tilve D, Pfluger PT, Schwartz TW, Seeley RJ, Sleeman M, Sun Y, Sussel L, Tong J, Thorner MO, van der Lely AJ, van der Ploeg LHT, Zigman JM, Kojima M, Kangawa K, Smith RG, Horvath T, Tschöp MH. Ghrelin. Mol Metab 2015; 4:437-60. [PMID: 26042199 PMCID: PMC4443295 DOI: 10.1016/j.molmet.2015.03.005] [Citation(s) in RCA: 712] [Impact Index Per Article: 79.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/11/2015] [Accepted: 03/11/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The gastrointestinal peptide hormone ghrelin was discovered in 1999 as the endogenous ligand of the growth hormone secretagogue receptor. Increasing evidence supports more complicated and nuanced roles for the hormone, which go beyond the regulation of systemic energy metabolism. SCOPE OF REVIEW In this review, we discuss the diverse biological functions of ghrelin, the regulation of its secretion, and address questions that still remain 15 years after its discovery. MAJOR CONCLUSIONS In recent years, ghrelin has been found to have a plethora of central and peripheral actions in distinct areas including learning and memory, gut motility and gastric acid secretion, sleep/wake rhythm, reward seeking behavior, taste sensation and glucose metabolism.
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Affiliation(s)
- T D Müller
- Institute for Diabetes and Obesity, Helmholtz Zentrum München, München, Germany
| | - R Nogueiras
- Department of Physiology, Centro de Investigación en Medicina Molecular y Enfermedades Crónicas, University of Santiago de Compostela (CIMUS)-Instituto de Investigación Sanitaria (IDIS)-CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Santiago de Compostela, Spain
| | - M L Andermann
- Division of Endocrinology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Z B Andrews
- Department of Physiology, Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
| | - S D Anker
- Applied Cachexia Research, Department of Cardiology, Charité Universitätsmedizin Berlin, Germany
| | - J Argente
- Department of Pediatrics and Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación La Princesa, Madrid, Spain ; Department of Pediatrics, Universidad Autónoma de Madrid and CIBER Fisiopatología de la obesidad y nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - R L Batterham
- Centre for Obesity Research, University College London, London, United Kingdom
| | - S C Benoit
- Metabolic Disease Institute, Division of Endocrinology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - C Y Bowers
- Tulane University Health Sciences Center, Endocrinology and Metabolism Section, Peptide Research Section, New Orleans, LA, USA
| | - F Broglio
- Division of Endocrinology, Diabetes and Metabolism, Dept. of Medical Sciences, University of Torino, Torino, Italy
| | - F F Casanueva
- Department of Medicine, Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago (CHUS), CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, Santiago de Compostela, Spain
| | - D D'Alessio
- Duke Molecular Physiology Institute, Duke University, Durham, NC, USA
| | - I Depoortere
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - A Geliebter
- New York Obesity Nutrition Research Center, Department of Medicine, St Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - E Ghigo
- Department of Pharmacology & Molecular Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - P A Cole
- Monash Obesity & Diabetes Institute, Monash University, Clayton, Victoria, Australia
| | - M Cowley
- Department of Physiology, Faculty of Medicine, Monash University, Melbourne, Victoria, Australia ; Monash Obesity & Diabetes Institute, Monash University, Clayton, Victoria, Australia
| | - D E Cummings
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - A Dagher
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - S Diano
- Dept of Neurobiology, Yale University School of Medicine, New Haven, CT, USA
| | - S L Dickson
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - C Diéguez
- Department of Physiology, School of Medicine, Instituto de Investigacion Sanitaria (IDIS), University of Santiago de Compostela, Spain
| | - R Granata
- Division of Endocrinology, Diabetes and Metabolism, Dept. of Medical Sciences, University of Torino, Torino, Italy
| | - H J Grill
- Department of Psychology, Institute of Diabetes, Obesity and Metabolism, University of Pennsylvania, Philadelphia, PA, USA
| | - K Grove
- Department of Diabetes, Obesity and Metabolism, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA
| | - K M Habegger
- Comprehensive Diabetes Center, University of Alabama School of Medicine, Birmingham, AL, USA
| | - K Heppner
- Division of Diabetes, Obesity, and Metabolism, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR 97006, USA
| | - M L Heiman
- NuMe Health, 1441 Canal Street, New Orleans, LA 70112, USA
| | - L Holsen
- Departments of Psychiatry and Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - B Holst
- Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen N, Denmark
| | - A Inui
- Department of Psychosomatic Internal Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - J O Jansson
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - H Kirchner
- Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - M Korbonits
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London, Queen Mary University of London, London, UK
| | - B Laferrère
- New York Obesity Research Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - C W LeRoux
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Ireland
| | - M Lopez
- Department of Physiology, Centro de Investigación en Medicina Molecular y Enfermedades Crónicas, University of Santiago de Compostela (CIMUS)-Instituto de Investigación Sanitaria (IDIS)-CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Santiago de Compostela, Spain
| | - S Morin
- Institute for Diabetes and Obesity, Helmholtz Zentrum München, München, Germany
| | - M Nakazato
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
| | - R Nass
- Division of Endocrinology and Metabolism, University of Virginia, Charlottesville, VA, USA
| | - D Perez-Tilve
- Department of Internal Medicine, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - P T Pfluger
- Institute for Diabetes and Obesity, Helmholtz Zentrum München, München, Germany
| | - T W Schwartz
- Department of Neuroscience and Pharmacology, Laboratory for Molecular Pharmacology, The Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | - R J Seeley
- Department of Surgery, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - M Sleeman
- Department of Physiology, Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Y Sun
- Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - L Sussel
- Department of Genetics and Development, Columbia University, New York, NY, USA
| | - J Tong
- Duke Molecular Physiology Institute, Duke University, Durham, NC, USA
| | - M O Thorner
- Division of Endocrinology and Metabolism, University of Virginia, Charlottesville, VA, USA
| | - A J van der Lely
- Department of Medicine, Erasmus University MC, Rotterdam, The Netherlands
| | | | - J M Zigman
- Departments of Internal Medicine and Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - M Kojima
- Molecular Genetics, Institute of Life Science, Kurume University, Kurume, Japan
| | - K Kangawa
- National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - R G Smith
- The Scripps Research Institute, Florida Department of Metabolism & Aging, Jupiter, FL, USA
| | - T Horvath
- Program in Integrative Cell Signaling and Neurobiology of Metabolism, Section of Comparative Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - M H Tschöp
- Institute for Diabetes and Obesity, Helmholtz Zentrum München, München, Germany ; Division of Metabolic Diseases, Department of Medicine, Technical University Munich, Munich, Germany
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25
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Šupak-Smolčić V, Antončić D, Ožanić D, Vladilo I, Bilić-Zulle L. Influence of a prolonged fasting and mild activity on routine laboratory tests. Clin Biochem 2015; 48:85-8. [DOI: 10.1016/j.clinbiochem.2014.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 10/15/2014] [Accepted: 10/16/2014] [Indexed: 01/06/2023]
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26
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Crook MA. Refeeding syndrome: Problems with definition and management. Nutrition 2014; 30:1448-55. [DOI: 10.1016/j.nut.2014.03.026] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 03/31/2014] [Indexed: 01/25/2023]
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27
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Abstract
Medical providers need to monitor growth at every visit. Weight status is influenced by genetics, medical conditions, socioeconomic status, and family environment. Screening for food security and psychosocial risk factors is an integral tool to identify families at risk for nutritional deficits and child maltreatment. Nutritional rehabilitation is best accomplished in an outpatient, multidisciplinary setting. Medical neglect should be considered in failure to thrive and obesity when there is a serious risk of harm from identified medical complications, additional or worsening medical complications occurring despite a multidisciplinary approach, and/or non-adherence with the treatment plan.
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Affiliation(s)
- Nancy S Harper
- Children's Physician Services of South Texas, Driscoll Children's Hospital, 3533 South Alameda, Corpus Christi, TX 78411, USA.
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28
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Chen LJ, Chen HL, Bair MJ, Wu CH, Lin IT, Lee YK, Chu CH. Refeeding syndrome in Southeastern Taiwan: Our experience with 11 cases. World J Gastroenterol 2014; 20:10525-10530. [PMID: 25132771 PMCID: PMC4130862 DOI: 10.3748/wjg.v20.i30.10525] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 03/13/2014] [Accepted: 05/05/2014] [Indexed: 02/07/2023] Open
Abstract
AIM: To present our experience with refeeding syndrome in southeastern Taiwan.
METHODS: We conducted a retrospective study during a 2-year period at the Mackay Memorial Hospital, Taitung Branch. We enrolled patients with very little or no nutrition intake for more than 10 d, a high risk group of refeeding syndrome, including those suffering from alcohol abuse, cancerous cachexia, chronic malnutrition, and prolonged starvation.
RESULTS: A total of 11 patients (7 males, 4 females) with nasogastric feeding were included as having refeeding syndrome. Most of them had the symptoms of diarrhea, lethargy, and leg edema. The initial nutritional supplement was found to be relatively high in calories (1355.1 ± 296.2 kcal/d), high in protein (47.3 ± 10.4 gm/d), low in vitamin B1 (2.0 ± 0.5 mg/d), low in potassium (1260.4 ± 297.7 mg/d), and low in phosphorus (660.1 ± 151.8 mg/d). Furthermore, hypophosphatemia (2.4 ± 0.9 mg/dL) was noted during follow-up. Based on the suggestions of a dietician and a gastroenterologist, the clinical disorders of diarrhea, malaise and leg edema were significantly improved. The level of phosphate was also increased (3.3 ± 0.6 mg/dL).
CONCLUSION: Refeeding syndrome is an overlooked and risky disorder that has some potentially fatal complications. Nasogastric feeding in nursing homes is an important risk factor for patients and deserves greater attention based on the initial results of this study.
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29
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Refractory hypoglycemia and subsequent cardiogenic shock in starvation and refeeding: report of three cases. Nutrition 2014; 30:1090-2. [PMID: 24927630 DOI: 10.1016/j.nut.2014.01.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 12/29/2013] [Accepted: 01/10/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Although starvation is associated with high in-hospital mortality, its related cardiac complications are not sufficiently understood. The aim of this study was to determine the clinical course and pathogenesis of cardiac complications in malnourished patients. METHODS We reviewed three cases of hypoglycemia and hypotriglyceridemia with cardiac complications in starvation. RESULTS This report concerns three patients, respectively suffering from anorexia nervosa, esophageal carcinoma, and Parkinson's disease. Their ages ranged from 18 to 70 y, body mass index was 11.5 ± 1.5 kg/m2 (mean ± SD), and the main symptom was coma. The average blood glucose level was 15.7 ± 7.8 mg/dL without any history of insulin use or diabetes mellitus. In all cases, hypoglycemia was refractory and repetitive so that continuous glucose administration was required to maintain euglycemia. Serum triglyceride and non-esterified fatty acid levels were also very low (7 ± 4 mg/dL and 10 ± 9.1 μEq/L, respectively). Levels of serum potassium, phosphate, and magnesium were almost normal at admission. The main cardiac complications included Takotsubo cardiomyopathy and cardiac arrest. All patients survived as a result of intensive treatment. CONCLUSIONS Repetitive severe hypoglycemia without known background causes should be viewed as an important sign. Once this occurs, the administration of a much higher caloric input than usual accompanied by intensive monitoring will be required to maintain appropriate glucose levels. The early identification of such patients seems to be essential to reduce the high risk for cardiac complications during starvation and refeeding.
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30
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Walmsley RS. Refeeding syndrome: screening, incidence, and treatment during parenteral nutrition. J Gastroenterol Hepatol 2013; 28 Suppl 4:113-7. [PMID: 24251716 DOI: 10.1111/jgh.12345] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2013] [Indexed: 12/13/2022]
Abstract
The possible deleterious effects of feeding after a period of prolonged starvation have been known for over 60 years. The resultant biochemical disturbance, symptoms, and signs have been termed the refeeding syndrome (RS). The key to the pathophysiology is the stimulation of insulin release resulting in anabolic activity. Depleted electrolyte and micronutrient stores are overwhelmed and cellular function disrupted. A concise definition of RS is not agreed and hampers interpretation of clinical data. Hypophosphatemia and appearance of tissue edema/pathological fluid shifts are the most often agreed diagnostic criteria. The characteristics of particular patient groups at risk have been recognized for some time, and there are guidelines from the National Institute for Clinical Excellence in the UK to aid recognition of individuals at high risk along with protocols for initiating nutrition. Using loose diagnostic criteria, RS appears to occur in 4% of cases of parenteral nutrition (PN) when case records were reviewed by experts in a large study into PN care in the UK. Disappointingly, prescribers recognized only 50% of at risk cases. Early data from a similar study in New Zealand appear to show a similar pattern. Prospective series looking at patients receiving nutrition support in institutions with Nutrition Support Teams have found an incidence of 1-5%. RS is still underrecognized. Patients receiving PN should be counted as being in a high-risk category and feeding protocols to avoid RS applied. Low rates of RS then occur and death from this cause be avoided.
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Affiliation(s)
- Russell S Walmsley
- North Shore Hospital, Auckland, New Zealand; Faculty of Medicine, University of Auckland, Auckland, New Zealand
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Levetan CS, Pierce SM. Distinctions between the islets of mice and men: implications for new therapies for type 1 and 2 diabetes. Endocr Pract 2013. [PMID: 23186955 DOI: 10.4158/ep12138.ra] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To elucidate why diabetes is so difficult to treat despite the present tools and pharmacologic armamentarium and to provide insights into emerging therapies by describing human and rodent data that demonstrates the ability to transform progenitor cells within the adult pancreas into new islets. METHODS A literature review focused on the distinctions between human and rodent islets. RESULTS We are beginning to elucidate important differences between the architecture and composition of the islets of Langerhans in humans and rodents. In contrast to rodent islets, human islets are more heterogeneous in cellular composition and have more prominent intra-islet vascularity, with smooth muscle-containing blood vessels that are not present in rodent islets. Some studies report that more than 70% of human beta cells have direct physical contact with other cell types, whereas others describe that smaller human islets possess features more typical of rodents, while larger islets exhibit greater vascularity and a cellular distribution distinct from centrally clustered beta cells surrounded by a mantle of alpha and delta cells found in rodents. CONCLUSIONS The differences between the islets of mice and men may influence why treatments hailed as reversing diabetes among rodents have not been successfully translated into humans. Increased understanding of the complexities within the human islet may yield unique insights into reversing diabetes in humans.
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Affiliation(s)
- Claresa S Levetan
- Division of Diabetes, Endocrinology and Metabolism, Chestnut Hill Hospital, Philadelphia, PA 19118, USA.
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Abstract
A 57-year-old woman presented to the hospital after a 40-day acaloric (water-only) fast, which was motivated by her Christian beliefs and Pentecostal affiliation. She exhibited hyponatremia on admission, and developed hypokalemia, hypophosphatemia and hypomagnesemia during refeeding. The authors are unaware of other published case reports describing medical and religious aspects of prolonged fasting by Christians for spiritual reasons. Nevertheless, this practice is advocated by some Pentecostal and non-Pentecostal sources, and may be more common than is widely recognized.
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Subjective experience of sensation in anorexia nervosa. Behav Res Ther 2013; 51:256-65. [PMID: 23523866 DOI: 10.1016/j.brat.2013.01.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 01/19/2013] [Accepted: 01/25/2013] [Indexed: 11/24/2022]
Abstract
The nature of disturbance in body experience in anorexia nervosa (AN) remains poorly operationalized despite its prognostic significance. We examined the relationship of subjective reports of sensitivity to and behavioral avoidance of sensory experience (e.g., to touch, motion) to body image disturbance and temperament in adult women currently diagnosed with AN (n = 20), women with a prior history of AN who were weight restored (n = 15), and healthy controls with no eating disorder history (n = 24). Levels of sensitivity to sensation and attempts to avoid sensory experience were significantly higher in both clinical groups relative to healthy controls. Sensory sensitivity was associated with body image disturbance (r(56) = .51, p < .0001), indicating that body image disturbance increased with increased global sensitivity to sensation. Sensory sensitivity was also negatively and significantly correlated with lowest BMI (r(2) = -.32, p < .001), but not current BMI (r(2) = .03, p = .18), and to the temperament feature of harm avoidance in both clinical groups. We discuss how intervention strategies that address sensitization and habituation to somatic experience via conditioning exercises may provide a new manner in which to address body image disturbance in AN.
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Rio A, Whelan K, Goff L, Reidlinger DP, Smeeton N. Occurrence of refeeding syndrome in adults started on artificial nutrition support: prospective cohort study. BMJ Open 2013; 3:e002173. [PMID: 23315514 PMCID: PMC3549252 DOI: 10.1136/bmjopen-2012-002173] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 11/19/2012] [Accepted: 12/11/2012] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Refeeding syndrome is a potentially life-threatening condition characterised by severe intracellular electrolyte shifts, acute circulatory fluid overload and organ failure. The initial symptoms are non-specific but early clinical features are severely low-serum electrolyte concentrations of potassium, phosphate or magnesium. Risk factors for the syndrome include starvation, chronic alcoholism, anorexia nervosa and surgical interventions that require lengthy periods of fasting. The causes of the refeeding syndrome are excess or unbalanced enteral, parenteral or oral nutritional intake. Prevention of the syndrome includes identification of individuals at risk, controlled hypocaloric nutritional intake and supplementary electrolyte replacement. OBJECTIVE To determine the occurrence of refeeding syndrome in adults commenced on artificial nutrition support. DESIGN Prospective cohort study. SETTING Large, single site university teaching hospital. Recruitment period 2007-2009. PARTICIPANTS 243 adults started on artificial nutrition support for the first time during that admission recruited from wards and intensive care. MAIN OUTCOME MEASURES PRIMARY OUTCOME occurrence of the refeeding syndrome. Secondary outcome: analysis of the risk factors which predict the refeeding syndrome. Tertiary outcome: mortality due to refeeding syndrome and all-cause mortality. RESULTS 133 participants had one or more of the following risk factors: body mass index <16-18.5≥(kg/m(2)), unintentional weight loss >15% in the preceding 3-6 months, very little or no nutritional intake >10 days, history of alcohol or drug abuse and low baseline levels of serum potassium, phosphate or magnesium prior to recruitment. Poor nutritional intake for more than 10 days, weight loss >15% prior to recruitment and low-serum magnesium level at baseline predicted the refeeding syndrome with a sensitivity of 66.7%: specificity was >80% apart from weight loss of >15% which was 59.1%. Baseline low-serum magnesium was an independent predictor of the refeeding syndrome (p=0.021). Three participants (2% 3/243) developed severe electrolyte shifts, acute circulatory fluid overload and disturbance to organ function following artificial nutrition support and were diagnosed with refeeding syndrome. There were no deaths attributable to the refeeding syndrome, but (5.3% 13/243) participants died during the feeding period and (28% 68/243) died during hospital admission. Death of these participants was due to cerebrovascular accident, traumatic injury, respiratory failure, organ failure or end-of-life causes. CONCLUSIONS Refeeding syndrome was a rare, survivable phenomenon that occurred during hypocaloric nutrition support in participants identified at risk. Independent predictors for refeeding syndrome were starvation and baseline low-serum magnesium concentration. Intravenous carbohydrate infusion prior to artificial nutrition support may have precipitated the onset of the syndrome.
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Affiliation(s)
- Alan Rio
- Department of Nutrition and Dietetics, King's College Hospital, London, UK
| | - Kevin Whelan
- Diabetes and Nutritional Sciences Division, King's College London, School of Medicine, London, UK
| | - Louise Goff
- Diabetes and Nutritional Sciences Division, King's College London, School of Medicine, London, UK
| | | | - Nigel Smeeton
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
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Abstract
We report the case of a 57-year-old woman with gastric carcinoid. The tumor was surgically removed and immunohistochemical investigation demonstrated a rare combination: ghrelin and serotonin in the cytoplasm of the tumor cells. The functional significance of simultaneous production of ghrelin and serotonin is not clear. It may be that an autocrine/paracrine interaction exists between these two different hormones.
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Guo H, Qin F, Li R. Clinical and laboratory observations during refeeding after starvation in patients. Eur J Intern Med 2012; 23:e164-5. [PMID: 22863444 DOI: 10.1016/j.ejim.2012.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 06/05/2012] [Accepted: 06/06/2012] [Indexed: 11/19/2022]
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Speakman JR, Westerterp KR. A mathematical model of weight loss under total starvation: evidence against the thrifty-gene hypothesis. Dis Model Mech 2012; 6:236-51. [PMID: 22864023 PMCID: PMC3529354 DOI: 10.1242/dmm.010009] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The thrifty-gene hypothesis (TGH) posits that the modern genetic predisposition to obesity stems from a historical past where famine selected for genes that promote efficient fat deposition. It has been previously argued that such a scenario is unfeasible because under such strong selection any gene favouring fat deposition would rapidly move to fixation. Hence, we should all be predisposed to obesity: which we are not. The genetic architecture of obesity that has been revealed by genome-wide association studies (GWAS), however, calls into question such an argument. Obesity is caused by mutations in many hundreds (maybe thousands) of genes, each with a very minor, independent and additive impact. Selection on such genes would probably be very weak because the individual advantages they would confer would be very small. Hence, the genetic architecture of the epidemic may indeed be compatible with, and hence support, the TGH. To evaluate whether this is correct, it is necessary to know the likely effects of the identified GWAS alleles on survival during starvation. This would allow definition of their advantage in famine conditions, and hence the likely selection pressure for such alleles to have spread over the time course of human evolution. We constructed a mathematical model of weight loss under total starvation using the established principles of energy balance. Using the model, we found that fatter individuals would indeed survive longer and, at a given body weight, females would survive longer than males, when totally starved. An allele causing deposition of an extra 80 g of fat would result in an extension of life under total starvation by about 1.1-1.6% in an individual with 10 kg of fat and by 0.25-0.27% in an individual carrying 32 kg of fat. A mutation causing a per allele effect of 0.25% would become completely fixed in a population with an effective size of 5 million individuals in 6000 selection events. Because there have probably been about 24,000 famine events since the evolution of hominins 4 million years ago, there has been ample time even for genes with only very minor impacts on adiposity to move to fixation. The observed polymorphic variation in the genes causing the predisposition to obesity is incompatible with the TGH, unless all these single nucleotide polymorphisms (SNPs) arose in the last 900,000 years, a requirement we know is incorrect. The TGH is further weakened by the observation of no link between the effect size of these SNPs and their prevalence, which would be anticipated under the TGH model of selection if all the SNPs had arisen in the last 900,000 years.
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Affiliation(s)
- John R Speakman
- Institute of Genetics and Developmental Biology, Key State Laboratory of Molecular Development, Chinese Academy of Sciences, Beijing, China.
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Lima-Oliveira G, Salvagno GL, Lippi G, Gelati M, Montagnana M, Danese E, Picheth G, Guidi GC. Influence of a regular, standardized meal on clinical chemistry analytes. Ann Lab Med 2012; 32:250-6. [PMID: 22779065 PMCID: PMC3384805 DOI: 10.3343/alm.2012.32.4.250] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 03/27/2012] [Accepted: 05/25/2012] [Indexed: 01/14/2023] Open
Abstract
Background Preanalytical variability, including biological variability and patient preparation, is an important source of variability in laboratory testing. In this study, we assessed whether a regular light meal might bias the results of routine clinical chemistry testing. Methods We studied 17 healthy volunteers who consumed light meals containing a standardized amount of carbohydrates, proteins, and lipids. We collected blood for routine clinical chemistry tests before the meal and 1, 2, and 4 hr thereafter. Results One hour after the meal, triglycerides (TG), albumin (ALB), uric acid (UA), phosphatase (ALP), Ca, Fe, and Na levels significantly increased, whereas blood urea nitrogen (BUN) and P levels decreased. TG, ALB, Ca, Na, P, and total protein (TP) levels varied significantly. Two hours after the meal, TG, ALB, Ca, Fe, and Na levels remained significantly high, whereas BUN, P, UA, and total bilirubin (BT) levels decreased. Clinically significant variations were recorded for TG, ALB, ALT, Ca, Fe, Na, P, BT, and direct bilirubin (BD) levels. Four hours after the meal, TG, ALB, Ca, Fe, Na, lactate dehydrogenase (LDH), P, Mg, and K levels significantly increased, whereas UA and BT levels decreased. Clinically significant variations were observed for TG, ALB, ALT, Ca, Na, Mg, K, C-reactive protein (CRP), AST, UA, and BT levels. Conclusions A significant variation in the clinical chemistry parameters after a regular meal shows that fasting time needs to be carefully considered when performing tests to prevent spurious results and reduce laboratory errors, especially in an emergency setting.
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Affiliation(s)
- Gabriel Lima-Oliveira
- Laboratory of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona, Italy.
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Dror Y, Almashanu S, Lubart E, Sela BA, Shimoni L, Segal R. The Impact of Refeeding on Blood Fatty Acids and Amino Acid Profiles in Elderly Patients. JPEN J Parenter Enteral Nutr 2012; 37:109-16. [DOI: 10.1177/0148607112443260] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Yosef Dror
- School of Nutrition, Faculty of Agriculture, The Hebrew University of Jerusalem, Rehovot, Tel-Hashomer, Israel
| | - Shlomo Almashanu
- Department of Community Genetics, Israeli Ministry of Health, Tel-Hashomer, Israel
| | - Emilia Lubart
- Geriatric Medical Center, Shmuel Harofeh, Beer Yaakov, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Ben-Ami Sela
- The Sackler Faculty of Medicine, Tel Aviv University, Israel
- Institute of Chemical Pathology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Liron Shimoni
- School of Nutrition, Faculty of Agriculture, The Hebrew University of Jerusalem, Rehovot, Tel-Hashomer, Israel
| | - Refael Segal
- Geriatric Medical Center, Shmuel Harofeh, Beer Yaakov, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, Israel
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Crocker DE, Ortiz RM, Houser DS, Webb PM, Costa DP. Hormone and metabolite changes associated with extended breeding fasts in male northern elephant seals (Mirounga angustirostris). Comp Biochem Physiol A Mol Integr Physiol 2012; 161:388-94. [DOI: 10.1016/j.cbpa.2011.12.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 12/16/2011] [Accepted: 12/20/2011] [Indexed: 11/30/2022]
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Laparoscopic reconversion of Roux-en-Y gastric bypass to original anatomy: technique and preliminary outcomes. Obes Surg 2012; 21:1289-95. [PMID: 20824511 DOI: 10.1007/s11695-010-0252-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass (RYGB) is one of the most common bariatric procedures performed. Dumping syndrome, intolerance to RYGB-induced restriction, and weight loss issues are possible problems bariatric surgeons are confronted with. This study reports the feasibility, safety, and outcomes of laparoscopic reconversion of RYGB to original anatomy (OA) as treatment of these complications. METHODS Between January 2005 and April 2008, eight patients benefited from laparoscopic reconversion of RYGB to OA. Reason was dumping syndrome without postprandial hypoglycemia (three), intolerance to RYGB-induced restriction (three), too much (one) and too little weight loss (one). Mean weight and body mass index (BMI) at RYGB were 104.7±19.3 kg and 38.7±6 kg/m(2), respectively. Four patients suffered of obesity co-morbidities. Mean time between RYGB and reconversion was 21±18.8 months. Mean weight, BMI, and % excess weight loss at reconversion was 66.8±21.7 kg, 20.1±7 kg/m(2), and 23.7±55%, respectively. The procedure involved dismantling both gastrojejunostomy and jejunojejunostomy, reanastomosing gastric pouch to gastric remnant, and proximal alimentary limb end to distal biliary limb end. RESULTS Mean operative time was 132.2±29.5 min. There were no conversions to open surgery and no early complications. Gastrogastrostomy was performed manually (four) and by linear stapler (four), and jejunojejunostomy by linear stapler (eight). Mean hospital stay was 7.7±3.5 days. After a mean follow-up of 18.3±9.2 months, two patients continued to further lose weight, two patients maintained the same weight, and four patients presented weight regain. Gastroesophageal reflux disease appeared in three patients. CONCLUSIONS Laparoscopic reconversion of RYGB to OA is feasible and safe. Dumping syndrome and intolerance to RYGB-induced restriction are resolved. The anatomy remains one of the aspects besides nutritional and psychological factors in cases of reconversion for weight issues.
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Zizzari P, Hassouna R, Grouselle D, Epelbaum J, Tolle V. Physiological roles of preproghrelin-derived peptides in GH secretion and feeding. Peptides 2011; 32:2274-82. [PMID: 21530598 DOI: 10.1016/j.peptides.2011.04.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 04/04/2011] [Accepted: 04/07/2011] [Indexed: 12/26/2022]
Abstract
Among the factors playing a crucial role in the regulation of energy metabolism, gastro-intestinal peptides are essential signals to maintain energy homeostasis as they relay to the central nervous system the informations about the nutritional status of the body. Among these factors, preproghrelin is a unique prohormone as it encodes ghrelin, a powerful GH secretagogue and the only orexigenic signal from the gastrointestinal tract and obestatin, a proposed functional ghrelin antagonist. These preproghrelin-derived peptides may contribute to balance energy intake, metabolism and body composition by regulating the activity of the GH/IGF-1 axis and appetite. Whereas the contribution of ghrelin has been well characterized, the role of the more recently identified obestatin, in this regulatory process is still controversial. In this chapter, we describe the contribution of these different preproghrelin-derived peptides and their receptors in the regulation of GH secretion and feeding. Data obtained from pharmacological approaches, mutant models and evaluation of the hormones in animal and human models are discussed.
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Affiliation(s)
- Philippe Zizzari
- UMR894 INSERM, Centre de Psychiatrie et Neurosciences, Université Paris Descartes, 2 ter rue d'Alésia, 75014 Paris, France
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Refeeding with a high-protein diet after a 48 h fast causes acute hepatocellular injury in mice. Br J Nutr 2011; 107:1435-44. [PMID: 21902856 DOI: 10.1017/s0007114511004521] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Elucidating the effects of refeeding a high-protein diet after fasting on disease development is of interest in relation to excessive protein ingestion and irregular eating habits in developed countries. The objective of the present study was to address the hepatic effects of refeeding a high-protein diet after fasting. Mice were fasted for 48 h and then refed with a test diet containing 3, 15, 35, 40, 45 or 50 % casein. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities and liver immediate-early gene expression levels were sequentially measured for the first 24 h after initiation of refeeding. Refeeding with a 50 % casein diet after 48 h of fasting led to a rapid (within 2-3 h) and abnormal elevation in serum ALT (P = 0·006) and AST (P = 0·001) activities and a marked increase in liver Finkel-Biskis-Jinkins (FBJ) osteosarcoma oncogene (P = 0·007) and nuclear receptor subfamily 4, group A, member 1 (P = 0·002) mRNA levels. In contrast, refeeding of the 3, 15 or 35 % casein diets produced no substantial increases in serum ALT and AST activities in mice. Refeeding of 40, 45 or 50 % casein increased serum ALT and AST activities in proportion to this dietary casein content. In mice refed the 3, 15 or 35, but not 50 %, casein diets, liver heat shock protein 72 transcript levels greatly increased. We conclude from these data that the consumption of a high-protein diet after fasting causes acute hepatocellular injury in healthy animals, and propose that careful attention should be paid to the use of such diets.
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Abstract
This review will summarize recent findings concerning the biological regulation of starvation as it relates to anorexia nervosa (AN), a serious eating disorder that mainly affects female adolescents and young adults. AN is generally viewed as a psychosomatic disorder mediated by obsessive concerns about weight, perfectionism and an overwhelming desire to be thin. By contrast, the thesis that will be developed here is that, AN is primarily a metabolic disorder caused by defective regulation of the starvation response, which leads to ambivalence towards food, decreased food consumption and characteristic psychopathology. We will trace the starvation response from yeast to man and describe the central role of insulin (and insulin-like growth factor-1 (IGF-1))/Akt/ F-box transcription factor (FOXO) signaling in this response. Akt is a serine/threonine kinase downstream of the insulin and IGF-1 receptors, whereas FOXO refers to the subfamily of Forkhead box O transcription factors, which are regulated by Akt. We will also discuss how initial bouts of caloric restriction may alter the production of neurotransmitters that regulate appetite and food-seeking behavior and thus, set in motion a vicious cycle. Finally, an integrated approach to treatment will be outlined that addresses the biological aspects of AN.
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Leptin and insulin growth factor 1: diagnostic markers of the refeeding syndrome and mortality. Br J Nutr 2011; 106:906-12. [DOI: 10.1017/s0007114511001097] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Refeeding syndrome is difficult to diagnose since the guidelines for identifying those at risk are largely based on subjective clinical parameters and there are no predictive biochemical markers. We examined the suitability of insulin-like growth factor 1 (IGF1) and leptin as markers to identify patients at risk of the refeeding syndrome before initiation of parenteral nutrition (PN). A total of thirty-five consecutive patients referred for commencement of PN were included. Serum leptin and IGF1 were measured before starting PN. Electrolytes, liver and renal function tests were conducted before and daily for 1 week after initiating PN. The primary outcome was a decrease in phosphate 12–36 h after initiating PN. ‘Refeeding index’ (RI) was defined as leptin × IGF1 divided by 2800 to produce a ratio of 1·0 in patients who are well nourished. RI had better sensitivity (78 %; 95 % CI 40, 97 %) and specificity (78 %; 95 % CI 40, 97 %) with a likelihood ratio of 3·4, at a cut-off value of 0·19 for predicting a ≥ 30 % decrease in phosphate concentration within 12–36 h after starting PN, compared with IGF1 or leptin alone. However, IGF1 was a better predictor of mortality than either leptin or the RI. The present study is the first to derive and test the ‘RI’, and find that it is a sensitive and specific predictor of the refeeding syndrome in hospitalised patients before starting PN.
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Sangiao-Alvarellos S, Helmling S, Vázquez MJ, Klussmann S, Cordido F. Ghrelin neutralization during fasting-refeeding cycle impairs the recuperation of body weight and alters hepatic energy metabolism. Mol Cell Endocrinol 2011; 335:177-88. [PMID: 21241769 DOI: 10.1016/j.mce.2011.01.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Revised: 01/09/2011] [Accepted: 01/11/2011] [Indexed: 02/05/2023]
Abstract
Ghrelin, a hormone whose levels increase during food deprivation, plays a pivotal role in the regulation of food intake, energy metabolism and storage, as well as in insulin sensitivity. Here, we investigated the effects of acyl-ghrelin neutralization with the acyl-ghrelin-binding compound NOX-B11(2) during the fasting-refeeding cycle. Our data demonstrate that ghrelin neutralization with NOX-B11(2) impairs recuperation of lost body weight after food deprivation. Analysis of enzymes involved in glucose and lipid metabolism in liver of fed, fasted and refed rats revealed that neutralization of acyl-ghrelin resulted in minor decreases in the enzymes of glycolytic and lipogenic pathways during fasting. However, during refeeding these enzymes as well as glycogen levels recovered more slowly when acyl-ghrelin was blocked. The high levels of ghrelin in response to food deprivation may contribute to an adequate decrease in hepatic glycolytic and lipogenic enzymes and aid in the recovery of body weight and energetic reserves once food becomes available after the fasting period.
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Affiliation(s)
- Susana Sangiao-Alvarellos
- Department of Medicine, School of Health Science, University of A Coruña, Campus de Oza, s/n, 15006, A Coruña, Spain.
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Abstract
Adequate nutrition during cancer plays a decisive role in several clinical outcome measures, such as treatment response, quality of life, and cost of care. However, the importance of nutrition in children and young adults with malignancies is still an underestimated topic within pediatric oncology. The importance of our work is to reinforce and indicate that malnutrition in children with cancer should not be accepted at any stage of the disease or tolerated as an inevitable process. Unique to our manuscript is the close collaboration, the exchange of knowledge and expertise between pediatric oncologists and a nutritional specialist, as well as the comprehension of the mechanisms during cancer cachexia and malnutrition. We provide a critical review of the current state of research and new knowledge related to nutritional management in childhood cancer.
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Affiliation(s)
- Jacqueline Bauer
- Department of Pediatrics, University Children's Hospital Münster, Münster, Germany.
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Influence of a light meal on routine haematological tests. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2010; 8:94-9. [PMID: 20383302 DOI: 10.2450/2009.0142-09] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Accepted: 11/09/2009] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Patient-related variables, such as physical exercise, stress and fasting status are important sources of variability in laboratory testing. However, no clear indications about fasting requirements exist for routine haematological tests, nor has the influence of meals been assessed. METHODS We studied 17 healthy volunteers who consumed a light meal containing a standardized amount of carbohydrates, protein and lipids. Blood was taken for routine haematological tests before the meal and 1, 2 and 4 hours thereafter. RESULTS One hour after the meal, neutrophil count and mean corpuscular haemoglobin (MHC) increased significantly, whereas lymphocyte and monocyte counts, red blood cell distribution width, haematocrit, and mean corpuscular volume decreased significantly. A clinically significant variation was only observed for lymphocytes. Two hours after the meal, a significant increase was observed for neutrophils and MCH, whereas lymphocytes, eosinophils, haemoglobin and haematocrit decreased significantly. Clinically significant variations were recorded for lymphocytes, red blood cells (RBC), haemoglobin, haematocrit and MCH. Four hours after the meal MCH was significantly increased, while lymphocytes, eosinophils, RBC, haemoglobin and haematocrit were significantly decreased. Clinically significant variations were recorded for neutrophils, eosinophils, RBC, hematocrit and MCH. CONCLUSION The significant variation of several haematological parameters after a light meal demonstrates that the fasting time needs to be carefully considered in order to interpret the results of haematological tests correctly.
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