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PubMed2003

The refeeding syndrome and hypophosphatemia.

The refeeding syndrome is an underappreciated entity characterized by acute electrolyte derangements--notably hypophosphatemia--that occur during nutritional repletion of patients with significant suboptimal caloric intake. Adverse effects of hypophosphatemia include cardiac failure, muscle weakness, immune dysfunction, and death. Hypokalemia and hypomagnesemia commonly complicate refeeding syndrome as well; however, this report briefly reviews the clinical manifestations of refeeding-induced hypophosphatemia.

Aged↗

PubMed2002

IGF-I, IGF-I-binding proteins and GH-binding protein in malnourished elderly patients with inflammation receiving refeeding therapy.

OBJECTIVE: To investigate the mechanisms determining the success or failure of refeeding therapy in malnourished elderly patients with inflammation by studying changes in plasma IGF-I, GH-binding protein (GHBP) and IGF-binding protein (IGFBP) levels and IGFBP-3 proteolysis. DESIGN AND METHODS: We studied 15 severely malnourished hospitalized elderly patients. Weight, food intake, plasma albumin, transthyretin, C-reactive protein (CRP), orosomucoid, interleukin-6 (IL-6), IGF-I, intact and proteolytically degraded IGFBP-3 and GHBP levels were determined on admission and during refeeding therapy designed to increase food intake to 40 kcal/kg body weight per day (15% protein). RESULTS: Plasma IGF-I, IGFBP-3 and GHBP levels were significantly low for age on admission in all malnourished elderly patients. They increased in nine patients as nutritional status improved (albuminemia >30 g/l; transthyretinemia >200 mg/l or weight gain >5% of initial body weight) and levels of inflammation markers decreased (group 1). In contrast, plasma IGF-I, IGFBP-3 and GHBP levels remained low in six patients in whom nutritional status failed to improve and levels of inflammation markers increased (group 2). IGF-I showed greater variations than IGFBP-3 or GHBP with respect to nutritional status. High plasma CRP and IL-6 levels were associated with high levels of IGFBP-3 proteolysis. CONCLUSION: Efficient refeeding therapy was associated with a significant increase in IGF-I plasma levels. In patients with severe and persistent inflammation, high levels of proteolysis of IGFBP-3 may have contributed to the low plasma IGF-I levels, persistence of hypercatabolism and lack of improvement in nutritional status.

Aged↗

PubMed1986

The effects of fasting and refeeding on the thyroid follicles of young and aged mice--morphometric analysis.

The population movements of thyroid follicles in young and aged mice subjected to acute fasting and refeeding were analyzed by a morphometric method. After fasting for three days, the size distribution of thyroid follicles from young mice did not change, while the follicles from aged mice became significantly bigger than in the control group. Subsequent refeeding for four days caused a decrement in follicular sizes in both young and aged thyroid. The activity of follicular epithelia was decreased by fasting, but accelerated by refeeding. The equation describing the relationship between epithelial cell numbers and follicle diameters from a young control mouse agreed well with the theoretical one, especially in small follicles. However, the equation for an aged mouse differed from the theoretical one. This suggests that the older the mouse, the greater the deviation of the constituent factor, e.g. that of follicle size or cell number in thyroid. The extent of deviation would be one of the characteristics of aging in multicellular organisms.

Aging↗

PubMed1991

Effect of starvation and refeeding on the circadian rhythms of hematological and clinico-biochemical values, and water intake of rats.

We investigated the effect of starvation for 24 hr and subsequent refeeding for 12 hr on the circadian rhythms of 39 hematological and clinico-biochemical parameters, and water intake of F344 rats. The rats scarcely drank any water during the starvation period, but subsequently their intake of water were normal, even in the light period. During starvation, 12 parameters such as serum levels of alkaline phosphatase activity and PaCO2 decreased with time-related and time-related increases of 8 parameters such as the erythrocyte count and cholinesterase activity. During refeeding for 12 hr, almost all these biochemical parameters were normalized, but none of the hematological values except the leukocyte count returned to normal levels. Starvation and refeeding had little affect on the circadian rhythms of others.

Alkaline Phosphatase↗

PubMed1990

Differential regulation of two glucose transporters in rat liver by fasting and refeeding and by diabetes and insulin treatment.

Two species of glucose transporter (GT) are present in the liver: the erythroid/brain GT and the newly characterized liver GT. No information is available regarding the functional role of these two species or whether their expression is regulated concordantly in states in which hepatic glucose uptake or output are markedly altered. In this study, we analyzed the effect of fasting and refeeding and streptozocin-induced diabetes and subsequent insulin treatment on the expression of the erythroid/brain and liver GT polypeptides and their mRNAs in rat liver. The erythroid/brain GT mRNA in livers of control rats corresponded to 1-3% of the amount of liver GT mRNA. After a 4-day fast, its level increased approximately 3-fold and represented 8-10% of the liver GT mRNA, whereas the corresponding protein increased 4-fold. In livers from diabetic rats, levels of the erythroid/brain GT mRNA increased up to 2.4-fold and gradually returned to normal with chronic insulin treatment. Levels of the corresponding protein were minimally altered. Levels of immunoreactive liver GTs were not significantly changed by 2 days of fasting, 7 or 14 days of diabetes, or subsequent insulin treatment for 3, 5, or 7 days but increased up to 75% with refeeding for 3-48 h. Liver GT mRNA levels minimally decreased in diabetic or insulin-treated rats, decreased 45% after a 2-day fast, and increased up to 5-fold on refeeding for 24 h.(ABSTRACT TRUNCATED AT 250 WORDS)

Animal Feed↗

PubMed1996

Responses of leptin to short-term fasting and refeeding in humans: a link with ketogenesis but not ketones themselves.

We investigated the response of leptin to short-term fasting and refeeding in humans. A mild decline in subcutaneous adipocyte ob gene mRNA and a marked fall in serum leptin were observed after 36 and 60 h of fasting. The dynamics of the leptin decline and rise were further substantiated in a 6-day study consisting of a 36-h baseline period, followed by 36-h fast, and a subsequent refeeding with normal diet. Leptin began a steady decline from the baseline values after 12 h of fasting, reaching a nadir at 36 h. The subsequent restoration of normal food intake was associated with a prompt leptin rise and a return to baseline values 24 h later. When responses of leptin to fasting and refeeding were compared with that of glucose, insulin, fatty acids, and ketones, a reverse relationship between leptin and beta-OH-butyrate was found. Consequently, we tested whether the reciprocal responses represented a causal relationship between leptin and beta-OH-butyrate. Small amounts of infused glucose equal to the estimated contribution of gluconeogenesis, which was sufficient to prevent rise in ketogenesis, also prevented a fall in leptin. The infusion of beta-OH-butyrate to produce hyperketonemia of the same magnitude as after a 36-h fast had no effect on leptin. The study indicates that one of the adaptive physiological responses to fasting is a fall in serum leptin. Although the mediator that brings about this effect remains unknown, it appears to be neither insulin nor ketones.

3-Hydroxybutyric Acid↗

PubMed2003

Effect of short-term fasting and refeeding on transcriptional regulation of metabolic genes in human skeletal muscle.

During short-term fasting, substrate utilization in skeletal muscle shifts from predominantly carbohydrate to fat as a means of conserving glucose. To examine the potential influence of short-term fasting and refeeding on transcriptional regulation in skeletal muscle, muscle biopsies were obtained from nine male subjects at rest, after 20 h of fasting, and 1 h after consuming either a high-carbohydrate (CHO trial) or a low-carbohydrate (FAT trial) meal. Fasting induced an increase in transcription of the pyruvate dehydrogenase kinase 4 (PDK4) (10-fold), lipoprotein lipase (LPL) ( approximately 2-fold), uncoupling protein 3 (UCP3) ( approximately 5-fold), and carnitine palmitoyltransferase I (CPT I) ( approximately 2.5-fold) genes. Surprisingly, transcription of PDK4 and LPL increased further in response to refeeding (both trials) to more than 50-fold and 6- to 10-fold, respectively, over prefasting levels. However, responses varied among subjects with two subjects in particular displaying far greater activation of PDK4 (>100-fold) and LPL (>20-fold) than the other subjects (mean approximately 8-fold and approximately 2-fold, respectively). Transcription of UCP3 decreased to basal levels after the CHO meal but remained elevated after the FAT meal, whereas CPT I remained elevated after both refeeding meals. The present findings demonstrate that short-term fasting/refeeding in humans alters the transcription of several genes in skeletal muscle related to lipid metabolism. Marked heterogeneity in the transcriptional response to the fasting/refeeding protocol suggests that individual differences in genetic profile may play an important role in adaptive molecular responses to metabolic challenges.

Adult↗

PubMed1992

Effects of undernutrition and refeeding on weights of body parts and chemical components of growing Moroccan lambs.

Forty-four intact, male lambs (20 Timahdit and 24 D'man) were used to assess the effects of 22% (from approximately 25 to approximately 20 kg) and 31% (from approximately 25 to approximately 17 kg) live weight loss and the subsequent refeeding to initial BW on changes in body components. Body composition was determined using a serial slaughter technique at 17, 20, and 25 kg live weight during normal growth, weight loss, and refeeding phases. Reduction in live weight from 25 to 20 kg was associated with greater loss of visceral organs (30%) and internal fat (75%) than carcass loss (19%). Further body weight loss (from 20 to 17 kg) involved carcasses to a greater extent than internal organs. The composition of BW loss consisted of 53% water, 28% fat, and 15% protein. Refeeding was associated with a rapid increase in organ weights and less fat regeneration. Although total internal organs recovered only 90% of their original weight, liver and kidneys regained all their weight. At the same slaughter weight, carcass and noncarcass components of refed lambs were leaner because of lower fat content in these components.

Adipose Tissue↗

PubMed1999

Effects of underfeeding and refeeding on weight and cellularity of splanchnic organs in ewes.

We assessed the effects of a long and severe period of underfeeding, followed by a rapid refeeding with a high-concentrate diet, on weight, protein mass, and cellularity of the splanchnic organs in adult ewes. Twenty-four ewes, allocated to four groups of six, were fed a forage diet (50% regrowth of natural grassland hay and 50% wheat straw) either at maintenance (groups M and MO) or at 40% maintenance (groups U and UO) for 78 d. Groups M and U were then slaughtered, and groups MO and UO were subsequently overfed a high-concentrate diet (52% hay, 20% barley, 16% rapeseed meal, 4% fish meal, and 8% Megalac) at 236% maintenance for 26 d before being slaughtered. During the experiment, feed was adjusted to maintain feed supply at a constant percentage of animal requirements. After slaughter, fresh weight, dry weight, and protein mass of the reticulorumen, omasum, abomasum, small intestine, large intestine, and liver were measured. Cellularity was assessed from nucleic acids and protein contents for both ruminal mucosa and muscular-serosa layers, jejunum, and liver. The concentrations of ubiquitin and cathepsin D mRNA were measured in ruminal mucosa and muscular-serosa layers and in jejunum. Underfeeding decreased protein mass of splanchnic organs, especially in liver (-29%) and reticulorumen (-39%). Refeeding previously underfed animals increased protein mass of liver (+102%) and small intestine (+59%). No carry-over effect of the previous level of intake (UO vs. MO) was observed on the protein mass of splanchnic tissues after 26 d of refeeding. Variations in liver mass were mainly due to hypertrophy, as determined by the protein:DNA ratio, whereas variations in small intestinal mass were mainly due to hyperplasia, as determined by the amount of DNA. By contrast, changes in rumen mass associated with increasing ME intake seemed to be related to hypertrophy in the muscular-serosal component and hyperplasia in the epithelial component. The concentrations of ubiquitin and cathepsin D mRNA in the rumen and jejunum were not modified by feeding level, demonstrating that the expression of these genes for proteolytic enzymes was unchanged under these conditions.

Animal Feed↗

PubMed1982

Tissue glycogen levels in dams and fetuses as affected by fasting and refeeding pregnant sows.

Nineteen Landrace sows mated to Landrace boars were randomly assigned, on d 91 of pregnancy, to three groups: (1) control (six sows)--fed standard 13% protein corn-soybean meal gestation diet at 1.82 kg/d to d 112 of pregnancy; (2) 4-d fast (seven sows)--fed standard gestation diet to d 94 of pregnancy, fasted from d 95 to 98 of pregnancy and then refed a semipurified fat-free diet ad libitum until d 112 of pregnancy, and (3) 8-d fast (six sows)--treated the same as groups 2, except that the fast began on d 91 and extended through d 98 of pregnancy. The fat-free diet consisted of dextrose and soybean meal and was fortified with minerals and vitamins. On d 112 of pregnancy, all fetuses were removed by Caesarean section and determinations were made of fetal body and liver weights, fetal liver and gastrocnemius muscle glycogen concentrations, and maternal uterus and peritoneal adipose tissue glycogen levels. Sows in groups 2 and 3 consumed more (P less than .01) average daily feed during the refeeding period than did the control sows. Fasting and refeeding failed to affect maternal or fetal tissue glycogen concentration, or fetal body or liver weight. Average sow tissue glycogen concentrations were .23 and 3.0 mg/g tissue for peritoneal adipose tissue and uterus, respectively. Average fetal liver and gastrocnemius muscle glycogen concentrations were, 87 and 62 mg/g tissue, respectively. Average fetal body and liver weights were 1,287 and 39.5 g/fetus, respectively. We conclude that fasting followed by refeeding of a fat-free diet to pregnant sows during late gestation does not increase maternal or fetal tissue glycogen content and appears to be of no value in enhancing pig survival in early postnatal life.

Animal Feed↗

PubMed1991

Adipocyte dynamics in hypothalamic obese mice during food deprivation and refeeding.

Effect of hypothalamic lesions on regulation of body weight and fat cell dynamics in obese mice were examined during refeeding after prolonged food deprivation. Obese mice, which were treated with monosodium glutamate for 5 postnatal days and had ventromedial nuclear lesions in the hypothalamus, were used. When adult obese mice were given a glucose electrolyte solution for 20-40 days, the body weight dropped to about 45% of their pre-treatment weight. After reinstituted feeding of normal mouse food ad libitum, their body weight and adipose tissue weight returned to pre-starvation level. Tritiated thymidine autoradiography revealed that cell proliferation occurred in the early stages of refeeding and some fat cells were renewed in the epididymal adipose tissue. Fat cell renewal was found more active in the experimental group than in the control. Thereafter, fat cell size increased gradually via fat storage. These obese mice were found to have the capacity to regulate their body weight and adipose tissue not only through fat storage but also by increasing number of fat cells, in order to replace the cells which were lost during starvation. Therefore, ventromedial nuclear lesion in the hypothalamus does not influence the regulatory mechanism of adipose tissue during starvation and refeeding.

Adipose Tissue↗

PubMed2004

Suppression of myofibrillar protein degradation after refeeding in young and adult mice.

A diet containing adequate amounts of protein rapidly suppresses myofibrillar protein degradation after refeeding in young rats and mice. However, it is unclear whether this suppression is seen in adult animals. This study was undertaken to compare dietary protein-induced suppression of myofibrillar protein degradation in young and adult mice. Reductions in rates of myofibrillar protein degradation measured by N-methylhistidine (MeHis) released from the isolated extensor digitorum longus muscle were found at 4 to 7 h after refeeding in both young (7-wk-old) and adult (8-mo-old) mice, indicating that the response time of feeding-induced suppression of myofibrillar protein degradation was the same. When young (8-wk-old) mice were fed a 20% casein diet (20C) for 1 h after 18 h starvation, the rate of myofibrillar protein degradation was significantly decreased at 4 h after refeeding; however, mice fed a 10% casein diet (10C), 5% casein diet (5C), or protein-free diet (0C) did not show suppression of myofibrillar protein degradation. Adult (8-mo-old) mice fed 20C or 10C showed a reduction in the rate of MeHis release. The plasma concentration of leucine in young mice was only higher when they were fed 20C. Adult mice fed 20C or 10C showed higher plasma concentrations of leucine. These results suggest that postprandial suppression of myofibrillar protein degradation occurs in adult mice as in young mice, but the adult mice respond to a lower amount of dietary casein compared to the young mice.

Animals↗

PubMed1986

Age and thyroid hormone as factors in the responses of BHE rats to starvation-refeeding.

The interacting effects of thyroid hormone, age, and duration of starvation on the enzyme and liver lipid responses of BHE rats to starvation-refeeding were studied. Rats were starved for 2, 4, or 7 days and refed a 65% glucose diet for 2 days. The rats were either 150 or 420 days of age and injected daily with either saline or 10 micrograms thyroxine/100 g body weight. Neither age nor duration of starvation affected the glucose-6-phosphate dehydrogenase or malic enzyme activity or liver lipid response to starvation-refeeding. However, thyroxine treatment potentiated the response to starvation-refeeding in the 420-day-old rats when the duration of starvation increased from 2 to 7 days.

Age Factors↗

PubMed1979

Adaptations of glycogen metabolism in rat epididymal adipose tissue during fasting and refeeding.

It is well documented that adipose tissue glycogen content decreases during fasting and increases above control during refeeding. We now present evidence that these fluctuations result from adaptations intrinsic to adipose tissue glycogen metabolism that persist in vitro: in response to insulin (1 milliunit/ml), [3H]glucose incorporation into rat fat pad glycogen was reduced to 10% of control after a 3-day fast; incorporation increased 6-fold over fed control on the 4th day of refeeding following a 3-day fast. We have characterized this adaptation with regard to alterations in glycogen synthase and phosphorylase activity. In addition, we found that incubation of fat pads from fasted rats with insulin (1 milliunit/ml) increased glucose-6-P content, indicating that glucose transport was not the rate-limiting step for glucose incorporation into glycogen in the presence of insulin. In contrast, feeding a fat-free diet resulted in dramatic increases in glycogen content of fat pads without a concomitant increase in glucose incorporation into glycogen in response to insulin (1 milliunit/ml). Thus, fasting and refeeding appeared to alter insulin action on adipose tissue glycogen metabolism more than this dietary manipulation.

Adipose Tissue↗

PubMed1975

The effect of starvation and refeeding on cell population kinetics in the rat small bowel mucosa.

Male rats were starved for a period of 96 hours. Measurements of crypt cell population showed a small reduction during starvation. The growth fraction remained constant, but the total number of proliferating cells per crypt fell as a consequence of the reduction in crypt population. Both labelling and mitotic indices fell throughout the starvation period. The cell cycle time (Tc), measured by a stathmokinetic technique using vincristine, was increased from 10-4 hours in control rats to 14-7 hours after 96 hours' starvation. Upon refeeding, the proliferative indices were observed to rise. After a small initial fluctuation, the growth fraction remained constant. The crypt population remained substantially unchanged. Sixteen hours after refeeding, the cell cycle time was reduced to 6-5 hours. The hypoproliferative response to starvation is mediated solely by an increase in cell cycle time, and the response to refeeding is interpreted in terms of a reduction in Tc. Changes in the size of the proliferating population are considered not to play an important role in either response, although it is not possible to exclude entirely the presence of resting cells in the proliferative compartment itself.

Animals↗

PubMed2001

Life-threatening refeeding syndrome in a severely malnourished anorexia nervosa patient.

Overzealous refeeding in chronically malnourished anorexia nervosa patients may cause life-threatening complications. We describe a 14-year-old girl with anorexia nervosa who had a decrease in body weight from 45 kg to 25.5 kg over an 18-month period. She received 40 kcal.kg-1.d-1 carbohydrate-rich nutrition via enteral and parenteral routes. Her serum phosphate concentration dropped from a baseline of 1.39 mmol/L (4.3 mg/dL) to 0.19 mmol/L (0.6 mg/dL) on Day 4 of refeeding. Concurrent with the development of hypophosphatemia, she became drowsy and developed generalized muscle weakness, impaired myocardial contractility, thrombocytopenia, and gastrointestinal bleeding. Fluid overload with pulmonary edema complicated her recovery from these adverse events. After intravenous phosphate supplementation and fluid restriction, the symptoms of refeeding syndrome gradually resolved within 2 weeks. In chronically malnourished anorexia nervosa patients, nutritional support should be instituted gradually to avoid rapid electrolyte shifts and fluid overload. Serum phosphate concentrations, fluid status, and blood cell counts should be closely monitored.

Adolescent↗

PubMed2002

Thyroid C cell function during fasting and refeeding of young and old rats.

Age-related alterations in the structure and function of many organs often become apparent under stimulation of their function. Although the ageing process affects the regulation of mineral homeostasis, the function of thyroid C-cells that secrete calcitonin (CT) under the conditions of fasting and refeeding, a way of dietary manipulation that reveal the existence of age-related changes of follicular thyroid cells, has not been characterized. Therefore, we investigated the number of C-cells and serum CT concentration in young (4 mo) and old (26 mo) male rats fasted for 48 hours, and then refed for 4 or 24 hours. We found significantly higher number of C-cells in thyroids of old vs young rats both under basal conditions, and after fasting/refeeding. Correspondingly, serum calcitonin level was higher in fed or fasted old rats vs young ones. However, in young rats refeeding decreased, whereas in old animals increased serum concentrations of calcitonin. Thus, the control of serum calcium concentration, that was well preserved in old rats, occurs at the expense of increased serum CT level both under basal conditions, and after refeeding. These observations suggest that C-cell function is altered in ageing.

Aging↗

PubMed1990

Apolipoprotein B messenger RNA editing in the rat liver. Modulation by fasting and refeeding a high carbohydrate diet.

Apolipoprotein B (apoB) mRNA is modified by a posttranscriptional editing reaction in which a single base (C to U) change in apoB100 mRNA modifies a glutamine (CAA) to a translational stop codon (UAA), producing apoB48 mRNA in mammalian intestine. Rat liver normally contains both edited and unedited apoB mRNAs and previous work (Davidson, N. O., Powell, L. M., Wallis, S. C., and Scott, J. (1988) J. Biol. Chem. 263, 13482-13485) has demonstrated that the introduction of a translational stop codon can be modulated by thyroid hormone. In the current study, hepatic lipogenesis was modulated in vivo by fasting and refeeding a high carbohydrate diet, a maneuver which produced a 30-fold increase in hepatic triglyceride content. In this setting, hepatic apoB100 synthesis became undetectable in animals subjected to 48 h fasting and subsequently refed a high carbohydrate diet for either 24 or 48 h. This change was accountable for by an increase in the proportion of edited apoB mRNA, as determined by primer extension analysis, from 37% UAA in fasted animals to 79 and 91% UAA at 24 and 48 h of refeeding, respectively. The effect of this regimen on the expression of other hepatic apolipoprotein genes was less dramatic. ApoA-I and apoA-IV gene expression was modulated over a 2-fold range, in contrast to the (6-14-fold) pretranslational changes induced by thyroid hormone administration. ApoCIII mRNA abundance was unaltered in the setting of either fasting and refeeding or thyroid hormone administration, while apoE gene expression demonstrated a pretranslational increase following prolonged fasting. Taken together the data provide evidence that apoB mRNA editing is modulated by alterations in hepatic lipogenesis which additionally produce effects on the expression of other hepatic apolipoprotein genes suggesting that they are not coordinately regulated in vivo.

Animals↗