PMID: 9665093Jul 17, 1998Paper

Protein, fat, and carbohydrate requirements during starvation: anaplerosis and cataplerosis

The American Journal of Clinical Nutrition
O E OwenE K Dawson

Abstract

The purpose of this work was to clarify the essentiality of glucose production from amino acids in obese subjects undergoing prolonged starvation and to provide an explanation for death after the depletion of lean body mass when some body fat is still available to meet body energy requirements. Five obese subjects fasted for 21 d. Nitrogen balance studies were combined with measurements of blood metabolite and hormone concentrations, indirect calorimetry, determination of body-composition changes, and catheterization techniques. Phenylacetate was administered from day 19 to day 21 to remove glutamine from the body and to assess this perturbation on energy requirements, ammoniagenesis, ureagenesis, gluconeogenesis, and ketogenesis. The obese subjects lost body fat and fat-free mass in parallel and resting metabolic energy requirements per mass remained constant during starvation. Urinary nitrogen excretion reflected continuous demands for amino acid oxidation. Phenylacetate administration decreased blood glutamine concentrations, increased plasma epinephrine concentrations, and increased urinary nitrogen loss through phenylacetylglutamine excretion; urinary excretion rates of urea, ammonium, urate, creatinine, and ketone bodies ...Continue Reading

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