Prolonged Periods Of Fasting Research Articles

A muscle-centric view of time-restricted feeding for older adults.

The practice of time-restricted feeding (TRF) has received fervent interest in recent years as a strategy to mitigate obesity and metabolic disease. We sought to review the implications of TRF for skeletal muscle health and function in aging. TRF has high adherence and can promote body weight loss in older populations. Body weight reductions favor fat mass in the young, however, there is also the potential for undesirable losses in lean mass. There is currently no evidence to support TRF for skeletal muscle function and metabolism in older persons, and only tentative findings in the young. With a narrow eating window of 6-8 h and a prolonged fasting period to minimize daily insulin exposure, TRF may contradict recommended dietary practices for optimizing skeletal muscle anabolism in older people. TRF might represent a promising intervention to address obesity and its associated metabolic diseases, however, at present there is insufficient evidence for optimizing skeletal muscle mass or health in older individuals. Further research is needed to: (1) ascertain the impact of TRF on body composition, skeletal muscle anabolism, and autophagy in aging, and; (2) delineate the potentially myoprotective roles of dietary protein and exercise within the framework of TRF in older persons.

Full compensatory growth before harvest and no impact on fish welfare in Atlantic salmon after an 8-week fasting period

Individually tagged Atlantic salmon postsmolts (≈1200 g, 46 cm) reared in triplicate indoor holding tanks were fasted for 8 weeks at 12 °C and subsequently refed for 5 weeks, whereafter they were transferred to triplicate sea cages in a common garden setup together with a continuously fed control group until harvest size of ≈6100 g and 73 cm. At the end of the fasting period fish had lost 7.3% mass and the condition factor had decreased from 1.23 to 1.06. Furthermore, fasted fish were 544 g lighter and 3.8 cm shorter than fed controls, corresponding to a size difference of 50%. Following refeeding, feed intake gradually increased and surpassed the feed intake of controls. As such, fasted fish eventually showed compensatory growth and at harvest weight and length were similar to controls. At harvest, males were larger than females, and immature fish were larger than maturing fish in both treatment groups. The proportion of maturing fish was 25% higher in the fed control group. During the fasting period fish behaviours were video monitored, but no aggressions were observed. After the 8-week fasting period, fish welfare was scored based on the salmon welfare index model. Only minor deviations were found and at similar regularities between fasted and control fish. To assess potential long-term impacts on welfare status, vertebral deformities were quantified with radiology at harvest. Occurrence of vertebral deformities were low and similar between treatments. In conclusion, this study shows that Atlantic salmon are highly flexible with regards to growth patterns in response to food availability, and that a prolonged fasting period neither cause signs of reduced welfare in the short or in the long term.

Impact of a Single 36 Hours Prolonged Fasting Period in Adults With Type 1 Diabetes - A Cross-Over Controlled Trial.

Prolonged fasting has shown beneficial effects in healthy individuals and in people with chronic diseases. In type 1 diabetes, the effect or even the feasibility of fasting is unclear. We aimed to assess the impact and safety of prolonged fasting in adults with type 1 diabetes. Glycemia was assessed during overnight fasting (12 hours) vs. prolonged fasting (36 hours) via an intermittently-scanned continuous glucose monitoring system. Anthropometric data, metabolic and hormonal markers were compared between both trial arms. After each fasting period, a 75 g oral glucose tolerance test was performed and plasma glucose levels and hormones were assessed. Data were compared via paired t-tests and mixed-model regressions (p ≤ 0.05). Twenty individuals with type 1 diabetes (7 females) with a mean ± SD age of 35 ± 11 years, body mass index (BMI) 24.8 ± 2.8 kg/m2 and HbA1c 54 ± 7 mmol/mol were included. Hypoglycemia/hour (70 mg/dL; <3.9 mmol/L) was similar in both trial arms (12 hrs: 0.07 ± 0.06 vs. 36 hrs: 0.05 ± 0.03, p=0.21). Glycemic excursions during the oral glucose tolerance test were not different after the two fasting periods. Beta-hydroxybutyrate levels were higher after prolonged fasting (p=0.0006). Our study showed that people with type 1 diabetes can safely perform a 36 hours fasting period with a low risk of hypoglycemia and ketoacidosis.Clinical Trial RegistrationDRKS.de, identifier DRKS00016148.

P94 Pre-Operative Fasting in Surgical Patients at Good Hope Hospital – Reducing incidents of unnecessary prolonged fasting periods in patients undergoing surgery

Patients are often fasted from food and liquid for unnecessarily long periods of time prior to surgery. There is often misunderstanding amongst patients and even members of staff as to what exactly is meant by the pre-operative fasting rules, specifically the meaning of ‘clear fluids’. Prolonged fluid fasting can result in significant distress to adult and children patients through feelings of thirst, hunger and anxiety. Prolonged fasting can also negatively affect insulin resistance and severe cases of hypoglycaemia and hypovolaemia.A questionnaire was handed out to elective surgical patients over a month period between September and October 2019. Data was then collated and compared to the 2011 ESA Guidelines standard where 100% of patients should be fasted appropriately. Results were presented and a poster was created which will be distributed at pre-operative assessment clinic and displayed in clinical areas and the day-case unit.68 responses to the questionnaire were collected. The results showed that 58% of patients received both written and verbal advice about pre-operative fasting. However, 42% of patients stated they received no information about being able to drink clear fluids until 2 hours prior to their operation and therefore fasted from fluids for longer than required.In conclusion there was still disparity between what exactly was meant by ‘clear fluids’ and many did not realise the list included coffee and tea without added milk. The next steps would be to implement clear posters outlining correct fasting rules and reinforce education to healthcare staff about this matter. Patients are often fasted from food and liquid for unnecessarily long periods of time prior to surgery. There is often misunderstanding amongst patients and even members of staff as to what exactly is meant by the pre-operative fasting rules, specifically the meaning of ‘clear fluids’. Prolonged fluid fasting can result in significant distress to adult and children patients through feelings of thirst, hunger and anxiety. Prolonged fasting can also negatively affect insulin resistance and severe cases of hypoglycaemia and hypovolaemia.

Ten days of complete fasting affected subjective sensations but not cognitive abilities in healthy adults.

People may be unable to obtain anything edible for days under some circumstances, but they must maintain their calmness and cognition to navigate solutions. Our aim was to study changes in subjective sensations and cognition in healthy adults during a 10-day complete fasting experiment. Thirteen healthy male volunteers voluntarily participated in the 22-day experiment comprising 4 phases: 3days of baseline consumption, 10days of complete fasting (only water ad libitum), 4days of calorie restriction, and a 5-day recovery period. The volunteers' subjective sensations, cognitive performance, and serum energy substances were measured at 6 time points. Across the 6 time points, the trajectories of subjective sensations in response to fasting were "U"- or " ∩ "-shaped curves instead of progressive discomfort or mood enhancement. A significant fasting time effect was found on depression-dejection (baseline: 16.85 ± 2.88; highest score on the third day of completing fasting: 17.69 ± 3.97, P = 0.04) and self-rated anxiety (baseline: 26.23 ± 4.75; highest score on the sixth day of completing fasting: 30.85 ± 5.58, P = 0.01), and the change curves were consistent with the inflection point of the energy substrates shifting from serum glucose to ketone. In addition, basic cognitive functions appeared to be unaffected during the 10-day fast. Our study showed strong influences on the sensations from the third to sixth days of the prolonged fasting period but no significant effects on basic cognitive abilities associated with the energy substance switch. These findings could contribute to the development and understanding of survival strategies in food-shortage emergencies or of intermittent fasting programmes.

An Analysis of Safety and Efficacy of Day-care Surgery in Children in a Tertiary Care Hospital in India.

Background:Advances in surgery and anesthesia have paved the way for the establishment of day-care surgery (DCS). Observations that children achieve better convalescence in the home environment along with significant economic advantages have led to this paradigm shift in clinical practice.Aims and Objectives:This study is aimed to evaluate the feasibility of performing various surgical procedures on day-care basis and assess parental satisfaction with DCS in children.Materials and Methods:In this prospective observational study, all children >3 months of age undergoing various elective surgical procedures as day-care cases in our institution were enrolled. Types of operations, complications, including any unplanned admissions and parental satisfaction, were recorded.Results:Between December 2015 and December 2018, a total of 654 day-care surgeries were performed in our institution by pediatric surgeons. The mean age was 5.5 years with M: F 5.5:1. Thirty different surgical procedures were successfully performed as DCS, the common procedures being inguinal herniotomy (31.5%), and orchidopexy (14.3%). Unplanned admissions were recorded in 2.29% (15/654) patients (scrotal edema-5, postoperative pain-8, and a long recovery from anesthesia-2). No major complications occurred; two minor complications during follow-up were superficial wound infection and drug reaction. Overall parental satisfaction was very high (100%)-preoperative prolonged fasting period and long waiting time in the preoperative room of afternoon shift patients (7.95% and 8.3%) were the reasons for their discontent.Conclusions:DCS in children is safe and effective with high parental satisfaction. It can substantially reduce the waiting list for several surgical procedures in children.

Dietary Allicin Improved the Survival and Growth of Large Yellow Croaker (Larimichthys crocea) Larvae via Promoting Intestinal Development, Alleviating Inflammation and Enhancing Appetite.

A 30-day feeding experiment was conducted to investigate effects of dietary allicin on survival, growth, antioxidant capacity, innate immunity and expression of inflammatory and appetite related genes in large yellow croaker larvae. Four iso-nitrogenous (53% crude protein) and iso-lipidic (19% crude lipid) diets were formulated via supplementing graded levels of allicin (0.0 (the control), 0.005, 0.01, and 0.02% dry diet, respectively). Results showed that, among dietary treatments, larvae fed the diet with 0.005% allicin had the highest survival rate (SR) (P < 0.05), while larvae fed the diet with 0.01% allicin had the highest specific growth rate (SGR) (P < 0.05). Activities of α-amylase in both pancreatic (PS) and intestine segments (IS) of larvae fed the diet with 0.01% allicin were significantly lower than that in the control (P < 0.05). On the other hand, the supplementation of 0.01% allicin in diets significantly increased activities of alkaline phosphatase (AKP) and leucine aminopeptidase (LAP) in the intestinal brush border membrane (BBM) of larvae than the control (P < 0.05), indicating the promoting roles of allicin on fish larval intestinal development. Moreover, compared to the control, both the nitric oxide (NO) content and the activity of nitric oxide synthase (NOS) were significantly up-regulated in larvae fed the diet with 0.005% allicin, and catalase (CAT) were significantly upregulated in larvae fed the diet with 0.02% allicin (P < 0.05). Transcriptional levels of pro-inflammatory genes including cyclooxygenase-2 (cox-2), interleukin-1β (il-1β) and interleukin-6 (il-6) significantly decreased with increasing allicin, compared to the control. The expression of appetite genes including npy, ghrelin and leptin significantly increased with the prolonged fasting period, and dietary allicin supplementation significantly increased the transcriptional level of neuropeptide Y (npy) at 0.01%, while increased the transcriptional level of leptin in larvae at 0.02% dosages (P < 0.05). These results showed that the supplementation of 0.005% – 0.01% allicin in diets could improve the survival and growth of large yellow croaker larvae probably by promoting intestinal development, alleviating inflammation and enhancing appetite.

Síndrome de Realimentación: Revisión de tema

El síndrome de realimentación (SR) se encuentra constituido por una serie de alteraciones metabólicas, producidas por el reinicio de la alimentación posterior a un periodo prolongado de ayuno. Durante el periodo de ayuno, el cuerpo entra en un estado de metabolismo catabólico; el cual posteriormente se convierte en un estado anabólico con la reintroducción de la alimentación. Dicho proceso explica las distintas alteraciones hidroelectrolíticas.&#x0D; La prevención constituye el pilar de tratamiento en este padecimiento, el NICE ha elaborado una serie de criterios para agrupar a las personas según el riesgo. Entre los pacientes con mayor riesgo se encuentran aquellos que presentan alguna patología oncológica, enfermedad crónica, trastornos alimenticios, entre otros. El SR requiere de un manejo precoz basado en un adecuado diagnóstico y la correcta administración tanto calórica como electrolítica según cada caso.

Do prolonged fasting periods influence the postprandial metabolic responses in turtles? What can Trachemys scripta elegans teach us about this?

The postprandial period is characterized by a modification of the gastrointestinal activity after food intake, accompanied by an increase in metabolic rate, secretion of acids, and absorption of nutrients. For ectothermic vertebrates, those changes are particularly prominent given the relatively low metabolic cost and the low frequency of food uptake. However, prolonged fasting periods decrease energy reserves and may compromise the upregulation of costly processes, such as the increase in metabolic rate after resuming the meal intake. Assuming that the main source of energy needed to support such events is provided from the animal's own body reserves, our aim with this study is to test the hypothesis that the longer the period of fasting, the smaller the metabolic rate increase during the postprandial period, since lesser energy reserves trigger these increases. For this, we measured the oxygen consumption rates (V̇O2 ) of red-eared slider turtles, Trachemys scripta elegans, submitted to different periods of fasting (47 and 102 days), before and after the ingestion of meals equivalent to 5% of their body masses. Despite the longer fasting period, which led to a reduction of 10.77% in the body mass of the turtles, there were no differences between the two experimental groups regarding maximum V̇O2 values after food intake (V̇O2 peak), postprandial metabolic scope, mean time to V̇O2 peak, and postprandial duration. Results indicate that 102 fasting days does not compromise aerobic metabolic increase during postprandial period and does not impair digestive process of the turtles, even with a loss of body mass.

Aralıklı Açlık Diyetleri ve Düşük Karbonhidratlı Diyetlerin Obezite Tedavisindeki Etkisi

Obezite, prevalansı giderek artan küresel bir sağlık sorunudur. Fazla kilolu ve obez bireyleri tedavi etmek için yeni diyet stratejileri oluşturulmuştur ve bu diyet stratejileri popüler ve yaygın hale gelmiştir. Bu diyetler arasında “aralıklı açlık diyetleri” ve “düşük karbonhidratlı diyetler (DKD)” bulunmaktadır. Birçok aralıklı açlık diyeti varyasyonu açlık döngülerinin uzunluğu ve sıklığı bakımından farklılık gösterir. Alternatif gün açlık diyetleri (dönüşümlü açlık), zaman kısıtlı beslenme, dini oruç olarak sınıflandırılabilir. Düşük karbonhidratlı diyetlerin ortak bir tanımı bulunmamaktadır. Bazı DKD’lerde enerji alımına bağlı, bazılarında ise enerji alımından bağımsız olarak karbonhidrat alım miktarı kısıtlanmaktadır. Alternatif gün açlık diyetlerinin ve zaman sınırlı beslenmenin vücut ağırlığı kaybında olumlu etkileri olduğu öne sürülmektedir, ancak, açlık süresinin uzaması diyete uyumu azaltabilir. Ramazan orucunda ise genellikle bir aylık süreçte kaybedilen vücut ağırlığı geri kazanılmaktadır. Düşük karbonhidratlı diyetlerin vücut ağırlığı kaybı üzerine olumlu etkileri olsa da düşük yağlı diyetlerin etkileri konusunda çelişkili veriler bulunmaktadır. Her iki beslenme modeli de obezitede vücut ağırlık kontrolü için uygulanabilecek yaklaşımlar olabilir; ancak uzun dönemli etkilerinin ortaya konulması için uzun süreli takip çalışmalarına ihtiyaç duyulmaktadır.

Failure in Systems and Culture: Barriers That Prevent Implementation of Evidence-Based Fasting Times for Patients in the Acute Care Setting.

There is strong evidence supporting fasting guidelines of 6 hours' fast from solids and 2 hours' fast from fluids prior to surgery. Despite this, patients spend prolonged periods of time fasting for surgery with a lack of research to support translating this evidence into practice, particularly for emergency surgical theater lists. This study aims to explore barriers and enablers to reduce prolonged fasting for patients on emergency surgical lists in the acute care setting. Qualitative interviews were undertaken with 22 health professionals on acute surgical wards within a quaternary referral hospital in Sydney, Australia. Semistructured interviews explored barriers and enablers to implementing evidence-based fasting practices for patients on emergency surgical lists, using a theoretical domains framework. Interviews were transcribed verbatim and analyzed using an inductive thematic approach. Key barriers to implementing reduced fasting included unpredictable, inflexible systems; cultural concerns; and gaps in knowledge. Major enablers to reducing fasting times are the recognition of patient distress caused by excessive fasting and desire by all 22 interviewees to address the problem. This research is the first to explore barriers and enablers to implementing interventions to address excessive fasting. This research highlights the complexity of the issue and the need for a multifaceted translational intervention addressing limitations in systems and cultural barriers.

Seasonal variation of total mercury and condition indices of Arctic charr (Salvelinus alpinus) in Northern Québec, Canada

The winter ecology of anadromous Arctic charr, an important fish species for Indigenous populations, has remained poorly detailed in the literature beyond descriptions of seasonal fasting and resulting declines in condition. However, prolonged periods of reduced feeding can have significant consequences for other variables, such as tissue contaminant levels. To more thoroughly detail seasonal changes, biological information (fork length, total weight, age, sex, somatic condition), stable isotopes (δ13C, % carbon, δ15N, % nitrogen), dorsal muscle % lipid, caloric densities, and total mercury (THg) concentrations were assessed in anadromous Arctic charr collected from Deception Bay, Canada, during the summer and over-wintering periods. Significant reductions in somatic condition, total weight, and % nitrogen, consistent with prolonged periods of fasting, were found for post-winter captured Arctic charr, but % lipid and caloric densities were significantly higher in these fish. THg also varied seasonally and was significantly higher in summer collected tissue. When tested individually via linear regression, significant relationships were seasonally dependent, but limited in number. All previously mentioned parameters were then incorporated into multi-variable models which better explained variations in the data. While there was no clear best model for explaining the % lipid values, caloric densities, and THg, season, condition, and stable isotope values (% carbon and % nitrogen) were the best indicators of % lipid content and caloric densities. THg concentrations were best explained by total weight, somatic condition, and δ13C. Seasonal variation in fish condition measures and THg may be indicative of condition selective mortality that yields apparent improvement through the disproportionate removal of poorer conditioned fish from the population during the over-wintering period. This hypothesis was further supported by mortality estimates and the results of the multi-predictor variable models. Collectively, this research highlights the importance of understanding seasonal dynamics for anadromous Arctic charr populations.

The HNF‐1a variant induces endogenous glucose production and Ketonuria in female mice

BACKGROUNDType 2 diabetes (T2D) diagnoses in the Anishininiiwuk (Oji‐Cree) linguistic group of central Canada are among the highest in the world. A genetic variant in the transcription factor hepatic nuclear factor‐1a (HNF‐1a), known as HNF‐1a G319S is present in this population which has been strongly associated with earlier onset of T2D. Historically, T2D was rare in Anishininiiwuk communities provided an active lifestyle required for land‐based food procurement, and potentially with prolonged periods of fasting. As a result of colonization, this lifestyle was abruptly altered leading to a decrease in hunter‐gatherer societies. In the liver, HNF‐1a plays an important role in glucose homeostasis and suppression of hepatic steatosis, but it is unclear if the G319S variant affects liver function. We hypothesize that the G319S variant promotes greater hepatic fuel production and confers a metabolic advantage in the fasted state.METHODSCRISPR/Cas9 gene editing was used to knock‐in the HNF‐1a G319S G&gt;A 955 single nucleotide substitution into C57BL6 mice. These mice express the G319S variant at endogenous levels and in appropriate tissues. Mice fed chow diet ad libitum were sacrificed at 6 months of age, and liver tissues were collected for gene expression analysis, glycogen content measurements, and for hematoxylin and eosin staining. In addition, pyruvate tolerance tests were performed, and urine ketone levels measured in mice fasted for 12 hours.RESULTSDifferences in hepatic steatosis and glycogen content were not observed between the wildtype (G/G), heterozygous (G/S), and homozygous (S/S) HNF‐1a mice. Female mice with two copies of the variant S‐allele (S/S) displayed elevated endogenous glucose production on a pyruvate tolerance test, as well as elevated ketones in the urine.MAIN FINDINGS/CONCLUSIONSIndependent of hepatic steatosis, female homozygous (S/S) HNF‐1a mice show greater endogenous glucose production, and higher ketone levels in their urine, indicative of a greater capacity to generate and mobilize endogenous fuels.Support or Funding InformationThis work was supported by a CIHR project grant awarded to CAD (PJT‐159633).

Effect of pre-anesthetic fasting on gastric emptying and plasma glucose in healthy dogs of different age groups

ABSTRACT: Gastric emptying and plasma glucose were evaluated in young and adult dogs, fed with dry and wet food, submitted to different periods of pre-anesthetic fasting (6, 8, and 12 hours). Forty healthy dogs were selected, which were segmented into four groups according to the age group and type of diet. It was evaluated the gastric emptying by ultrasound and serum glycemia. Only 17.5% presented complete gastric emptying, and no significant differences were found between the 6 and 8-hour fasting evaluations, or between the age groups and the diets, considering significance level p&lt;0.05. Mean plasma glucose values from the groups indicated normal glycemia at all times of evaluation. A significant difference was found between the means of glycemia in young and adult dogs, with the 8-hour fasting with wet diet (p=0.03) and with 12 hours with dry diet (p=0.04). Healthy young and adult dogs, in physiological equilibrium, maintain average values of plasma glucose despite prolonged periods of pre-anesthetic fasting, which may be necessary, since 8-hour fasting for solid food is not enough to provide complete gastric emptying.

RETRACTED: Antidpressants and antipsychotics: anaesthetic implications

Abstract An estimate from the World Health Organization assumes that about 450 million people suffer from mental and behavioral disorders worldwide. In the UK, the lifetime prevalence of mental health conditions is upwards of 10%. Despite this, there is surprisingly little in the way of guidelines for the perioperative management of patients on psychoactive medications and it is largely based on the individual clinician's experience. These are medications that might have significant anaesthetic implications. 1 The anaesthetist may face challenges related to the nature of the psychiatric condition itself, interactions of psychoactive and anaesthetic drugs, and the problems caused by the condition requiring surgery (e.g. electrolyte derangement and prolonged periods of fasting). This article aims to summarize the commonly used groups of psychoactive medications and outline their implications for the anaesthetist.

Nutrition in Liver Cirrhosis: Clinical Practice Recommendations

Liver disease and nutritional status affect each other mutually. Hepatic function is impaired by malnutrition and can be improved by nutrition therapy. Liver cirrhosis leads to prognostically relevant malnutrition in a stage dependent manner. Protein depletion and sarcopenia are its key features. Patients with liver cirrhosis should undergo systematic screening for risk of malnutrition and if positive sarcopenia should be assessed and a nutrition plan devised. In cirrhotic patients, spontaneous food intake frequently does not meet requirements and prolonged (> 12 h) periods of fasting must be avoided. In a stepwise fashion nutritional counseling, oral nutritional supplements, enteral tube feeding and parenteral nutrition as third-line-therapy should be used. In cirrhotic patients, nutrition therapy can improve morbidity and mortality by ensuring the adequate provision of energy, protein and micronutrients.

Changes in Human Gut Microbiota Composition Are Linked to the Energy Metabolic Switch During Ten Days of Fasting

Background: Fasting has been documented to have therapeutic benefits. Any consequence of the drop in external nutrient supply to the human gut microbiota during prolonged periods of fasting is unknown. Methods: We analysed the effects of a ten-day periodic fasting on the human gut microbiota in an observational study including 15 healthy men. We also monitored the energy metabolic switch from carbohydrates to fatty acids and ketones, parameters of intestinal permeability, inflammatory status, and well-being. Participants fasted according to the peer-reviewed Buchinger therapeutic fasting guidelines with a daily caloric intake of 200-250 kcal. Findings: Serum biochemistry confirmed the metabolic switch from carbohydrates to fatty acids and ketones. Emotional and physical well-being were enhanced. Faecal 16S rRNA gene amplicon sequences showed that fasting caused a large decrease in the relative abundance of bacteria known to degrade dietary polysaccharides such as Lachnospiraceae and Ruminococcaceae. There was a concomitant increase in Bacteroidetes and Proteobacteria (Escherichia coli and Bilophila wadsworthia), known to use host derived energy substrates and in particular to ferment aminoacids. BCAA production increased during the fast. Changes in taxa abundance were associated with serum glucose and faecal BCAA, suggesting that fasting-induced changes in gut microbiota are associated to host energy metabolism. These effects were reversed after three months. Although SCFA levels were not changed at the end of the ten-day fasting period, their levels were increased after three months. The levels of four cytokines (IL-6, IL-10, IFNγ, TNFα) increased when food was reintroduced, suggesting that food intake reactivated the postprandial immune response. Interpretations. We reveal that changes in faecal microbiota composition of healthy subjects during ten days of fasting are associated with energy metabolism. This suggests that the gut microbiota plays a role in physiological adaptations to a ten-day periodic fasting, potentially influencing its beneficial health effects. Clinical Trial Registration: German Clinical Trials Register (DRKS-ID: DRKS00011165, 24/10/2016). Funding Statement. The study was financed by Amplius GmbH, Uberlingen, Germany. This company has the task to develop a research department for the Buchinger Wilhelmi Clinics Uberlingen and Marbella who are the funders. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. No additional external funding received for this study. Declaration of Interests: FWT is managing director of Amplius GmbH, that is in charge of the scientific documentation for BWC. Amplius GmbH is a company that conceives, coordinates and develops fasting research. All authors declare that no competing interest exist. Ethics Approval Statement: This study was approved by the medical council Baden-Wurttemberg (application number: F-2016-090, 27/09/2016) and registered at the German Clinical Trials Register (DRKS-ID: DRKS00011165, 24/10/2016). It was conducted at the Buchinger Wilhelmi clinic (BWC) in Uberlingen (Germany), in accordance with the principles of the Declaration of Helsinki between 20/11/2016 and 10/12/2016.

SUN-LB014 Intermittent Complete Fasting for Complicated Severe Obesity in Older Diabetic Subjects: Preliminary Evidence for Massive Fluid and Fat Loss with Improvement in Cardiac and Renal Failure

Background: Diabetic subjects with life-long massive obesity that have reached old age, often develop heart failure, severe hypertension and renal failure. Fluid retention necessitates increasing doses of diuretics, with further decline in renal function. Rationale: In older obese subjects who failed numerous standard dietary attempts and have developed complications which preclude bariatric surgery, prolonged periods of long and repetitive intermittent fasting may lead to a) regular fasting diuresis, such that will lessen the need for diuretics; b) fat loss. Both may ameliorate intractable comorbidities. Goal: To examine whether or not complete intermittent fasting can positively impact fluid overload, functional status and life quality in old obese diabetic subjects with heart and renal failure. Methods: Two 77y/o outpatient men were instructed to avoid any caloric intake, but consume calorie-free fluids ad libitum for 36 hours (last evening meal on the pre-fasting day; first next meal◊ breakfast on the post- fasting day), twice a week (total fasting hours 72/168 weekly hours) over 17 [patient A; A] and 13 months [patient B; B]. Insulin, GLP-1 analogs and oral drugs were individually adjusted for each fasting interval. Results: Extent of Experience: We accrued experience of 30 patient months. Effects: within this time frame, the following effects were observed: 1) Weight (and BMI) declined from 92 to 77kg (37.8->31.6kg/m2) and 108 to 84.6kg (40◊31kg/m2) in A, and B, respectively. 2) Heart failure (diastolic dysfunction with preserved systolic function) and functional capacity: we recorded: I. Improvement from NYHA class IV and III to II in B, A); II. Cessation of pulmonary edema events ( vs. 2 events/ patient in the preceding year); III: decrease >50% in the doses of furosemide; d/c of IV furosemide; IV: disappearance of peripheral edema; 3) Improvement in renal function in B (eGFR 15.7-->36.7cc/min) and stabilization in A (35cc/ml); 4) Improvement in anemia: hemoglobin rose by 2Gr% in B and 0.8gr% in A; 5) HgA1C was unchanged in A (7.8, 7.7%) in A and declined in B (6.7% ->5% in B). 5) Hypertension was not affected. Safety: hypoglycemia was not detected with regular, multiple point home glucose monitoring on the fasting days. Hyperkalemia was present a priori in both patients, required continuous f/u and treatment, but no other electrolyte and mineral abnormalities were seen. Compliance: Several events of partial/complete skipping of fasting resulted in fluid accumulation and leg edema, following which self-reported compliance has been nearly complete. At the present time, these subjects refuse to get off the protocol. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. s presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

Identification of serological markers for pre- and postoperative fasting periods

Prolonged preoperative fasting periods lead to catabolic states and decelerate recovery after surgery. Valid plasma markers reflecting the patients' metabolic state may improve tailored nutrition support before surgery. Within this study, we sought to advance the knowledge on fasting time-sensitive plasma markers that allow the metabolic characterisation of surgical patients for an optimised preoperative metabolic preparation. Patients scheduled for elective surgery of the upper (n=23) or lower (n=27) gastrointestinal tract participated in a prospective observational study. Patients' charateristics and nutritional status were recorded and blood samples were drawn on the day of admission. Further blood samples were collected before skin incision of the surgical procedure, on postoperative day 3 and on the day of discharge. Values of clinical chemistry, electrolytes, hemograms and plasma amino acids were determined and correlated with fasting times. Preoperative fasting times were positively correlated with plasma levels of valine, leucine, serine, α-amino butyric acid, free fatty acids, 3-hydroxy butyric acid and significantly negative correlated with chloride and glutamic acid. Postoperative fasting times were correlated with erythrocytes, leukocytes and plasma levels of albumin, CRP, HDL, asparagine and 3-methylhistidine. The multivariate regression analysis revealed glutamic acid and valine as significant independent predictors of preoperative fasting periods. The regression model showed best performance (sensitivity of 90.91% and specificity of 92.31%) to detect patients fasted for ≥20h. Valine and glutamic acid appear as independent metabolic markers for accurate prediction of prolonged fasting periods, independent of the overall nutritional status, age or BMI of patients.

Lipid acquisition and tissue storage in hagfish: new insights from an ancient vertebrate.

Hagfishes are ancient vertebrates, which have the ability to tolerate nearly a year of food deprivation with energy during fasting maintained using lipid stores. While lipid transporters are evolutionarily conserved, there are relatively few studies examining mechanisms of lipid acquisition in teleosts and no reports in the primitive and evolutionarily important agnathans. We examined tissue lipid droplet distribution and used gut sac preparations to characterize uptake mechanisms of the monounsaturated fatty acid, oleic acid (OA; 18:1 cis-9), in the Pacific hagfish. OA absorption was carrier-mediated and demonstrated saturable concentration-dependent uptake with an affinity constant of 55 ± 7µM, and a maximal rate of uptake of 1311 ± 97pmol cm- 2h- 1. Additionally, regulation of intestinal transport was demonstrated as feeding significantly increased uptake. To further examine post-prandial effects on fatty acid transport, hagfish were dosed with bovine insulin, which had no effect on OA intestinal acquisition, but did lower plasma glucose. Overall, this is the first evidence for intestinal fatty acid acquisition in an agnathan, which are ideal models for understanding the evolution of nutrient transport processes in vertebrates, and are particularly suited to lipid research owing to their dependence upon this energy source during prolonged periods of fasting.