Undernourishment and Its Effects - Revised Document

Undernourishment and Deficiency: Effects of Fasting

In humans, certain tissues can utilize glucose, fatty acids (FA), and ketone bodies indiscriminately,

while others rely primarily on glucose for energy. The nervous system, highly dependent on glucose,

adapts to use ketone bodies during prolonged fasting.

I. Body Energy Reserves

For individuals who are not obese, energy reserves are primarily stored as triglycerides in adipose

tissue, amounting to approximately 100,000 kcal. These reserves can be swiftly mobilized in

emergencies.

Carbohydrate reserves, both circulating glucose (about 80 kcal) and glycogen stored in the liver

(250 to 600 kcal), are limited. Muscle glycogen cannot be mobilized due to the absence of

glucose-6-phosphatase in muscle tissue. While the protein mass, potentially representing around

24,000 kcal through hepatic gluconeogenesis, is not considered an energy reserve due to its

structural and enzymatic roles.

II. Night Fasting

During fasting, the body utilizes its carbohydrate and lipid reserves, consuming glucose, FA, and

ketone bodies. Liver glycogenolysis provides a steady glucose supply. Increased lipolysis occurs at

night, though hepatic and circulating reserves are insufficient to meet the glucose needs of the

brain, central nervous system, renal medulla, red blood cells, and leukocytes for 8 to 12 hours.

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These needs are met by hepatic gluconeogenesis from proteins.

III. Short-term Fasting

Extending beyond 12 hours, fasting induces metabolic changes. Initially, the body supplies

glucose-dependent tissues with glucose from limited hepatic reserves by mainly converting proteins

to glucose (hepatic gluconeogenesis) and directing glucose consumption exclusively towards

glucose-dependent tissues. After 5 to 8 days, the body adapts by decreasing protein

gluconeogenesis, consuming lipid reserves, utilizing ketone bodies in the brain, and reducing overall

caloric expenditure.

Changes in Circulating Fuel and Hormonal Variations

Initially, blood glucose levels decrease, stabilizing around the third day. Free blood FA and glycerol,

indicating lipolysis, double in the first four days then stabilize. Ketone bodies increase, peaking

around the seventh to eighth day. Concurrently, serum alanine and glutaminemia decrease,

reflecting their hepatic and renal uptake. Hormonal changes include a reduction in insulin levels and

an increase in glucagon, promoting lipolysis and FA release.

Quantitative Aspects of Fuel Consumption

A typical 70 kg man, not undernourished and with a basal energy expenditure of 1,800 kcal,

consumes 75g of proteins, 160g of triglycerides, and 180g of glucose (mainly used by the nervous

system) after 24 hours of fasting. Non-glucose-dependent tissues use FA and ketone bodies derived

from adipose tissue triglycerides.

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Adaptations to Prolonged Fasting

Prolonged fasting necessitates a metabolic shift to reduce protein gluconeogenesis, utilize lipid

reserves, consume ketone bodies in the brain, and reduce caloric expenditure. This adaptation

ensures survival beyond the initial critical days.

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