Metabolism of substrates and micronutrients is altered by starvation and trauma.

During periods
of starvation, metabolic processes slow down to conserve energy and adapt to calorie
deprivation. After trauma, the body’s hormonal situation changes, increasing the demand for
energy, proteins, and micronutrients. If nutritional requirements are not recognized and met
during starvation or trauma, there may be a loss of body mass, body protein, and impairment or
loss of body functions.

In the biochemical sense, Starvation begins immediately after the absorption of a meal is
complete and is a marked feature of metabolism during sleep. In starvation our metabolic
processes decreases.

Summarize hormonal, metabolic changes and changes in the various organs (liver, muscle,
brain, adipose tissue) in the various phases listed below

Interprandial Phase between meals

Post Absorptive Phase overnight between 12 to 24 hours

Prolonged Fasting longer than 24 hours.

Prolonged Fasting
Points to Remember:

1. Circulating glucose concentrations do not drop below 3.5 mmol L−1 even in prolonged

starvation.
2. During starvation, the brain must be supplied with fuel in the form of glucose or ketone
bodies.
3. Carbohydrate reserves are depleted after 24 h of starvation.
4. In prolonged starvation, gluconeogenesis provides the glucose oxidised by the brain.
5. The major substrates for gluconeogenesis are amino acids derived from skeletal muscle
protein breakdown.
6. Circulating ketone body concentrations rise during prolonged starvation.
7. During starvation, most tissues utilise fatty acids and/or ketone bodies to spare glucose
for the brain.
8. Glucose utilisation by the brain is decreased during prolonged starvation as the brain
utilises ketone bodies as the major fuel.
9. High concentrations of ketone bodies result in significant excretion of ketones.
10. Urinary ketones are excreted as ammonium salts derived from the renal metabolism of
glutamine with the carbon skeleton being recovered through renal gluconeogenesis.
Correlate important clinical features with biochemical basis for Starvation

 Common less developed countries

 Diseases of the GI tract Malabsorption syndrome such as tropical sprue and coeliac
disease which affect the absorption of many nutrients
 Malabsorption of fat in pancreatitis or bile duct obstruction
 Damage to the intestinal mucosa due to food intolerance and allergy to gliadin a
component of the wheat protein gluten.
 Ingestion of gluten leads to atrophy of the intestinal mucosa with disappearance of the
villi
 Malabsorption and diarrhoea can occur as a result of infections .
 Prolonged infections can cause damage to intestinal mucosa leading to undernutrition.
 Infections can also fever thus lead to an increase in the metabolic rate and thus
undernutrition
 BMR can increase to as much as twice its normal value.
 Leading to weight loss

Anorexia nervosa
Protein Energy Malnutrition

Warburg effect and Metabolic Changes in Cancer patients

Is this phenomenon Cancer Specific?

No it is not. This is evident because this type of glycolysis is found in rapidly growing normal
cells as in embryonic cells also.

Why do cancer cells activate glycolysis despite the presence of Oxygen?

In a growing tumor, there is always the probability that a tumor can outgrow its oxygen supply.
This aerobic glycolysis would assure ATP synthesis when a tumor outgrows its oxygen supply.

Kwashiokor and Marasmaus

Watch this video:
https://www.youtube.com/watch?v=fwxFmUnoNZw

Metabolic response to Trauma:

 The metabolic response to starvation can be contrasted to trauma or disease:
 Metabolic rate drops during starvation, while in trauma patients it rises in proportion to
the trauma severity.
 Body fuels and body proteins are conserved during starvation, but are wasted during
trauma.
 Urinary nitrogen values fall with inadequate protein and calorie intake, but increase in
response to metabolic stress.
 Weight loss is slow in underfed patients but rapid in trauma patients.
 Changes in body composition with trauma usually occur two to three times faster than
during starvation.

 The response to trauma includes a breakdown of muscle tissue.

 This mechanism provides amino acids for gluconeogenesis and for synthesis of proteins
involved in immunologic response and tissue repair.
 However, this process can lead to a loss of body mass, most notably body protein.
 Prolonged metabolic stress without provision of adequate calories and protein leads to
impaired body functions and ultimately malnutrition.