Summary.A comparison of the metabolic and gastroentero-pancreatic hormonal responses of ten obese and eight lean subjects to 12 h and 36 h fasts has been made. Each subject was given a 50 g oral glucose tolerance test at the end of both 12 h and 36 h starvation. After the 12 h fast blood glucose and 3-hydroxybutyrate were similar in each group but blood glycerol was 30% higher in the obese subjects. Plasma insulin and vaso-active intestinal polypeptide were also higher in the obese subjects after 12 h starvation. After 36 h starvation in the lean subjects blood glucose was unchanged but on refeeding with 50 g oral glucose, glucose tolerance was impaired. In the same group blood glycerol and 3-hydroxybutyrate rose after 36 h starvation. Plasma glucagon, secretin and vaso-active intestinal polypeptide rose after 36 h starvation in the lean subjects but plasma insulin was unchanged. Refeeding with oral glucose suppressed the increased plasma glucagon, secretin and vaso-active intestinal polypeptide. After the 36 h fast in the obese subjects, blood glucose was unchanged, blood glycerol fell, but blood 3-hydroxybutyrate rose although to a reduced level in comparison with the lean subjects. In the obese group there was no change in plasma glucagon, secretin or vaso-active intestinal polypeptide after 36 h starvation, although plasma insulin fell. The results show different metabolic and gastro-entero-pancreatic hormonal responses to fasting in lean and obese human subjects and suggest an important metabolic role of glucagon, secretin and vaso-active intestinal polypeptide during starvation.Key words: Insulin, glucagon, secretin, vaso-active intestinal polypeptide, glucose, glycerol and 3-hydroxybutyrate.
* Now Endocrinology Fellow, University of Texas at DallasObesity and its consequences are a major cause of disability in the Western World, and in many obese patients dietary therapy may be ineffective. Of major interest and possible therapeutic relevance are the metabolic and hormonal abnormalities previously described during fasting in obesity, which suggest impaired lipolysis [1][2][3][4][5][6][7]28].Within the gastro-entero-pancreatic hormones there is a group with structural homology (glucagon, secretin and vaso-active intestinal polypeptide -VIP) all of which exhibit lipolytic actions in vitro [8-11, 22, 23]. To examine whether these hormones have metabolic roles in vivo and to determine whether there is an abnormal response of this group to fasting in obesity, the plasma glucagon, secretin, VIP and insulin responses together with the blood glucose, glycerol and 3-hydroxybutyrate responses to 36 h starvation have been measured in lean and obese subjects.
Subjects and MethodsTen obese subjects (two males and eight females, aged 21-51 years) all with a body mass index of 29 or greater [30] and eight lean controls (three males and five females, aged 17-41 years) were fasted overnight (12 h). A 50 g oral glucose tolerance test was then administered and peripheral venous blood samples were taken at 30 rain intervals...