Weeks Of Refeeding Research Articles

Effects of cyclic enteral nutrition on the immunological status of malnourished patients

The effects of 2 weeks of refeeding by cyclic enteral nutrition on chronically malnourished (mean global nutritional deficiency 19.9 ± 1.1%) hospitalized patients were assessed in a prospective study with special attention paid to immunological status. All patients were immunodeficient, with cell-mediated immunity being more affected than humoral immunity. After 2 weeks of refeeding, nutritional status had improved by 29.8%. Initially abnormal parameters of humoral immunity (IgM, C3 and C4) improved significantly ( P < 0.05) between day 0 and day 15. The following cell-mediated immunity parameters also improved significantly ( P < 0.05): CD8, monocyte count, natural killer cell activity and skin tests. Short-term refeeding by cyclic enteral nutrition appears to be a safe and effective way of improving immunodeficiency in chronically malnourished patients, with predictable consequences on infection.

Energy expenditure in anorexia nervosa: can fat-free massas measured by bioelectrical impedance predict energy expenditure in hospitalized patients?

Anorexia nervosa (AN) is associated with a reduced metabolically active fat-free mass (FFM) and basal metabolic rate (BMR). Excessive refeeding results in major fat deposition which is not well tolerated by patients. Prediction of BMR is, therefore, a clinical issue during refeeding, but measurement by indirect calorimetry is time-consuming and not widely available. The study aim was to determine if and when BMR could be estimated from prediction formulas based on FFM derived from bioelectrical impedance analysis (BIA) in AN patients during refeeding. Indirect calorimetry and BIA were prospectively measured bi-weekly in 9 AN patients (body mass index 13.7 ± 0.5 kg/M 2) for 10 weeks of refeeding. Initial BMR was 969 ± 46.7 kcal/d and 27.7 ± 1.4 kcal/kg FFM, and at week 10 increased to 1360 ± 44.6 kcal/d and 35.8 ± 0.8 kcal/kg FFM. While correlations improved with increasing weight, FFM and body mass index, prediction formulas are insufficient to permit prediction of BMR based on weight or FFM, even after 10 weeks of refeeding. To allow for optimal nutritional support, indirect calorimetry measurements may be useful in the early weeks of refeeding because of a large variability of basal metabolic rate between patients.

Induction of Δ9-fatty acyl desaturation in rainbow trout ( Oncorhynchus mykiss) liver by dietary manipulation

Hepatic stearoyl Δ9-fatty acyl desaturation was demonstrated to be modulated in trout by dietary manipulation. Desaturation was very low in hepatocytes isolated from the livers of starved fish with only 2% of [1- 14c]18:0 converted to Δ9-desaturase products (18:1n-9 and 20:1n-9). After 6 weeks of feeding a commercial (fish oil-containing) pelleted trout diet, 50% of the radioactivity from [1- 14c]18:0 was converted to Δ9-desaturase products. Another period of starvation, after the 6-week feeding period, reduced Δ9-desaturation with only 4–5% of radioactivity from [1- 14c]18:0 being converted to Δ9-desaturase products in hepatocytes. Subsequent refeeding produced a much more rapid induction of Δ9-desaturation with the activity significantly increased after only 3 days refeeding and the activity restored to the level before starvation after only 1 week of refeeding. The fatty acid composition of the diet appeared to be less important to the induction of hepatic Δ9-desaturation than the overall nutritional status because Δ9-desaturation in livers of fish fed a high saturated fatty acid diet, comprising 96% palmitic acid (16:0), was similar to that of fish fed a fish oil-containing diet.

Biliary lithocholate and cholestasis during and after total parenteral nutrition: an experimental study.

To evaluate the role of lithocholic acid (LCA) in the etiology of parenteral nutrition-associated cholestasis (PN-AC), we studied (i) the changes in the percentage of biliary LCA and (ii) the emergence and resolution of cholestatic changes in the liver after total parenteral nutrition (TPN) and after 6 weeks of oral feeding following the TPN. We compared these changes in rabbits on TPN support (via a central vein) for 14 days (TPN, n = 8) with those after 6 weeks of refeeding (Post-TPN, n = 8). Age-matched rabbits on lab chow served as controls (CHOW, n = 8). At the end of the diet regimens, the common bile duct was cannulated under anesthesia, and hepatic bile collected for measurements of bile flow and bile acid (BA) secretion rates, and BA profiles. The 60-min biliary excretion of sulfobromophthalein (BSP) after an intravenous bolus (5 mg/kg) was determined. A liver biopsy was taken for light microscopy. After 14 days of TPN, bile flow was reduced by 60%, bile acid secretion by 52%, and BSP excretion by 38%. On refeeding, only the BSP excretory rate recovered fully. In the TPN group, histology of the liver showed hepatocellular degeneration and portal tract inflammation; these resolved after refeeding leaving a mild portal fibrosis in 4/8 rabbits. Total colonic stasis occurred during TPN. With TPN, a decrease in the percentage of biliary glycochenodeoxycholate and an increase in LCA% were seen, whereas after refeeding the increase was in the percentage of glycoursodeoxycholate. An LCA% > or = 6 was associated with liver cell damage. After 6 weeks of refeeding, the structural cholestasis disappeared, but the decreases in basal bile flow and bile acid secretion (functional cholestasis) persisted. These data associate an increase in biliary LCA with the emergence of cholestasis during TPN in rabbits.

Infections during severe primary undernutrition and subsequent refeeding: paradoxical findings

Our earlier uncontrolled observations during primary famine and subsequent refeeding did not suggest that severe undernutrition inevitably increases vulnerability to infection. Some infections appeared suppressed by famine but reactivated by refeeding. To examine prospectively the occurrence of infections in a large cohort of primary famine victims before and during refeeding. From 1973 to 1993, 4382 famine victims aged 14 or more with an estimated weight loss greater than 25% were weighed and examined for infection before and after one, two, three and four weeks of refeeding. In 137, serum C-reactive protein was measured in an effort to detect latent asymptomatic infections before and after two weeks of refeeding. Refeeding diets included wheat, sorghum, millet, ghee and milk powder. Mean weight loss +/- SD was 28.7 +/- 2.3%. Before refeeding overt infections were found in 4.9%, an incidence rising to 29.1% at two weeks of refeeding and declining after four. Those developing infections gained more weight at two weeks, 4.6 3 +/- 0.81 kg, than those never infected, 3.94 +/- 0.76 (p = < 0.001 t test). C-reactive protein levels confirmed the presence of latent infections before refeeding. Severe undernutrition can suppress certain infections, mostly those due to intracellular pathogens and especially P. falciparum. Refeeding reactivates suppressed infection and can increase vulnerability to certain new infections especially of viral origin. Those gaining weight the most rapidly may be at greatest risk. Refeeding with foods alien to local culture could play a role in reactivating latent infections. Our findings may be limited to severe undernutrition and not apply to lesser forms or secondary undernutrition in hospital patients. These studies were done during charitable provision of medical care to famine victims.

Deficient induction of the immune response to oral immunization with cholera toxin in malnourished rats during suckling

Malnourished rats during suckling were orally immunized with cholera toxin (CT) after different periods of refeeding. Intestinal fluids, sera, and supernatant fluids from cultured mesenteric lymph node (MLN) cells were obtained after rats were given three doses of CT and analyzed by enzyme-linked immunosorbent assay (ELISA) to evaluate the specific antibody response. Serum-specific immunoglobulin G (IgG), IgA, and IgM were severely diminished in malnourished rats immunized with three doses of CT after 1 week of refeeding when compared with those of controls. Also, a decreased IgA ELISA titer of the intestinal fluids and abrogation of the capacity to neutralize the CT in the intestinal ligated loop test were found. When a booster was given at 113 days of age, the immune response continued to be affected in the serum and the intestinal fluid. The results from the analysis of the supernatant fluids from cultured MLN cells were coincident with those mentioned above. When one dose of CT was administered into Peyer's patches (PP) after 1 week of refeeding, an impaired immune response was found in the intestinal fluid of malnourished rats during suckling compared with that of controls. This result together with the analysis of supernatant from MLN and PP cell cultures suggests that antigen triggering in the PP was affected. When the refeeding period was extended to 30 days and then the first dose of CT was administered, the antibody immune responses in intestinal fluid serum and supernatant fluid approached control values. These observations reinforce the fact that the gut-associated lymphoid tissue immaturity of the rats when they received the first CT dose (at 28 days old) was the main reason for the decreased immune response observed in the experimental group.

Changes in perceptions and emotions before and after refeeding in anorexia nervosa: a pilot study

AbstractObjective: Physiological and psychological distortions associated with eating are recognised within the syndrome of anorexia nervosa. The purpose of this study was to compare subgroups of restricting and bulimic anorexic patients (AN-R and AN-B) with control subjects, and with themselves after six weeks of refeeding and weight gain, on a series of indices before and after a standard meal. Method: Nineteen consecutively admitted female AN patients completed visual analogue ratings of hunger, satiety, depression, urge to binge, urge to vomit and food craving during the first week and sixth week of hospitalisation. A female control group of seven subjects completed similar ratings for one week. The patient ratings were compared to those of the control subjects at baseline before and after a meal. Further comparisons between the two patient groups were also carried out six weeks after treatment. Results: As expected, AN patients reported significantly higher ratings of depression, urges to vomit, urges to binge and higher satiety levels when compared to controls. Comparisons between the patient subgroups revealed that at baseline AN-B patients had significantly higher urges to vomit that AN-R patients after meals, and reported significantly less satiety both before and after eating. Also, an increase in depression after the meal, at baseline, was reported by both groups although after six weeks higher levels of depression were recorded before rather than after the meal. There was also a significant decrease in food cravings after six weeks compared to baseline for both patient groups.Conclusions: The findings in this study provide further evidence that clinically significant differences exist between subtypes of patients suffering from anorexia nervosa, and highlight the differential, change in various symptoms during intense hospital treatment.

Morphology and cellularity of brain and visceral organs of severely undernourished baby pigs are restored after eight weeks of refeeding

Our objective was to assess the response of specific organs and tissues to dietary rehabilitation following severe calorie undernutrition. Pigs were weaned at 4 d of age, with 1/2 (C; n=4) given free access to a nutritionally adequate diet throughout the experiment (87d), and 1/2 (R; n=4) fed an adequate diet at 4% of body weight daily for 31 d, then given free access to an adequate diet for 8 wk. Growth rates of C and R pigs were similar during the 8-wk refeeding period; C pigs were approximately 9 kg heavier than R pigs at d 87. Body length, absolute organ weights, total body K, and total body lean mass were also reduced in R pigs. However, relative weights of small intestine, large intestine, cerebellum, and cerebrum were significantly greater in R than in C pigs. Protein and DNA concentration, content, and the protein/DNA ratio in liver, small intestine and cerebrum were not significantly different between C and R pigs. Our results suggest that a 4–5 wk period of severe undernutrition in neonatal pigs not malnourished prenatally or during the first 4 d postnatal, and in the absence of concomitant infections and diarrhea, does not produce permanent adverse effects on functional development.

Effects of food restriction and refeeding on adipocyte glucose metabolism in Zucker rats

Chronic food restriction has been shown to enhance glucose metabolism in adipocytes from lean Zucker rats at 10, 26, and 52 weeks of age compared to ad libitum-fed lean rats. Only adipocytes from food restricted 10-week-old obese rats demonstrated this response. In this study, lean and obese rats were food restricted from 5 until 14 weeks of age to determine the age at which adipocytes from obese rats were no longer affected by this intervention. Effects of 1 week of refeeding were also determined. When the rats were killed, body weights were highest in control rats followed by restricted/refed and then restricted rats within each genotype. Epididymal pad weights of lean rats were resistant to dietary intervention, while those of obese-restricted and obese-restricted/refed rats weighed less than pads of obese-control rats. Retroperitoneal pad weight was lowered by food restriction in both genotypes; but only that of lean-restricted/refed rats totally recovered with refeeding. Adipocytes of lean-restricted rats had the highest conversion of glucose to CO 2. Glyceride-glycerol production was higher in obese compared to lean rats, but restricted rats had elevated conversion of glucose to fatty acids. In general, these results indicate that by 14 weeks of age obese Zucker rats no longer respond to food restriction with an elevated rate of glucose metabolism in adipocytes.

The effect of different nutritional states on cell-mediated cytotoxicity

We have studied the effect of acute short-term starvation (in 9 patients) and of prolonged caloric deprivation (in 10 patients with anorexia nervosa), on cell-mediated cytotoxicity (CMC). CMC became severely depressed after six days on a very low caloric diet (1.2 +/- 1.4 vs. 7.0 +/- 2.9 lytic units/10(6) cells; P less than 0.01). CMC was also low in our patients with anorexia nervosa compared to a matched control group (3.3 +/- 1.7 vs. 10.0 +/- 3.0 lytic units/10(6) cells; P less than 0.01) and increased in most of the patients studied (five cases) after the first 3-4 weeks of refeeding in correlation with weight gain. Dietary deprivation may lead to a significant impairment in cell-mediated cytotoxicity, which appears to be reversible after refeeding.

Refeeding after various times of ingestion of a low protein diet: Effects on food intake and body weight in rats

Rats born of protein-deprived mothers were fed on a low protein (LP) diet (5% casein) from weaning. In each time sequence (0, 1, 3, 5, 8 and 16 weeks after weaning), 12 of them were refed on an isocaloric well-balanced diet (18% casein) for 2 weeks. Food intake, body and adipose tissue weights and protein efficiency ratio (PER) were measured in the refed rats as well as in 12 LP rats. At weaning and after one week, refed (RF) rats immediately increased their food intake. This increase was delayed at weeks 3, 5 and 8 and occurred during the second week of refeeding only. At week 16, there was a significant decrease during the first week when compared with LP rats. Body weight increased regularly during each refeeding period without any significant augmentation of the proportion of adipose tissue. During all the experiment (except at week 16), PER in the RF group remained high (about 3 g body weight/g protein) during the first week of refeeding, and fell to 2.0–2.5 g/g during the second week. It was particularly significantly greater than that of the LP rats between week 3 and 5 where an important decrease was observed in this group (1.99±0.36 vs. 3.23±0.58 g body weight/g protein during the 1–3 weeks period). It appeared therefore that protein restriction during gestation and lactation in dams had no effect on the mechanisms controlling food intake of their offspring at weaning. They were modified after 3 weeks of LP diet but could be rapidly restored by the ingestion of a well-balanced diet. RF rats could always diminish their growth deficit induced by the LP diet mainly because of a better protein utilization in RF rats during the first week of rehabilitation.

Changes in body composition during refeeding of patients with anorexia nervosa

Changes in body composition were studied in 13 girls with anorexia nervosa before and during 2 months of refeeding. Fat body mass and fat-free body mass were derived from skin-fold measurements. Total body potassium was measured by whole body counter, and intracellular water was calculated from it. Extracellular water was measured as the bromide space after oral bromide administration. A gradual increase was noted in weight, fat body mass, fat-free body mass, and total body potassium during refeeding. Extracellular water was expanded on admission and increased in all patients in the first weeks of treatment; later it fell to normal. Most of the changes in fat-free body mass over the first weeks of refeeding could be accounted for by an expansion in extracellular water. Particular care must therefore be taken with fluid balance during the first few weeks of refeeding.

FLUID BALANCE ABNORMALITY ON REFEEDING PATIENTS WITH ANOREXIA NERVOSA (AN)

Starvation and malnutrition are associated with an altered body composition. We studied the changes in body composition on refceding 10 girls with AN before and during 2 mons. of refeeding. Fat mass (FM) and fat free body mass (FFBH) were derived from skin-fold measurements, and total body potassium (TBK). TBK was measured by whole body counter. Extracellular water (ECW) was measured by oral bromide.A gradual increase was noticed in wt, FM, FFBM and TBK over refeeding. However, ECW was expanded on admission and increased in all our patients on the first weeks of treatment, coming down to normal later on.We concluded that refeeding is associated with abnormal expansion of the extracellular bed. Most of the changes in FFBM over the first weeks of refeeding can be acounted by the expanded ECW. This expansion is most probably due to abnormal fluid handling by the kidney. Fluid balance and fluid restrictions should be kept, to avoid fluid overload on refeeding.

The Performance of Broiler Chicks During and Following a Severe Feed Restriction at an Early Age

Growth, feed efficiency, and abdominal fat were evaluated in broiler chicks that had been subjected to a severe feed restriction at the age of 1 week. The restriction period lasted 6 to 28 days, during which time the birds received 30 to 45 kcal/day in the different experiments. Feed restriction was followed by a period of refeeding which continued up to the age of 8 to 9 weeks.In the restricted birds, weight gain was lower during the first 2 weeks of refeeding but later exceeded that of the controls. In some cases this growth pattern resulted in an almost complete compensation for the weight gain lost during restriction. An improved feed efficiency in restricted groups was observed during refeeding, due in part to their lower body weight. Plots of cumulative feed efficiency vs. body weight indicate that with body weight over 1500 g, cumulative efficiency was improved over the controls. The extent of improvement at final weights was 2 to 3%, 2 to 4%, 5 to 9%, and 5% in the less severe restriction groups of trials 1, 2, 3, and 4, respectively. Abdominal fat at 8 weeks of age was reduced by the early, energy restriction. The possible practical benefit of an early energy restriction regimen is discussed.

Relationship between Plasma Somatomedin-C and Liver Somatogenic Binding Sites in Neonatal Rats during Malnutrition and after Short and Long Term Refeeding*

To determine the mechanism(s) for the growth retardation associated with malnutrition early in life, the relationships among plasma somatomedin-C (SM-C), plasma GH, and hepatic bovine GH-binding sites were assessed in rat pups that were milk-deprived from birth until weaning (21 days). After this period of malnutrition, body weight, tail length, plasma SM-C, and liver GH-binding capacity of the malnourished animals were significantly (P less than 0.001) reduced below those of control, well fed rats [SM-C at 21 days, 0.06 +/- 0.01 vs. 0.30 +/- 0.04 U/ml (mean +/- SE); GH binding, 2.96 +/- 0.39 vs. 7.19 +/- 0.80 pmol/liver]. The number of GH-binding sites per mg DNA was also reduced (0.59 +/- 0.06 vs. 1.08 +/- 0.11 pmol/mg DNA; P less than 0.001). After 1 week of ad libitum refeeding (days 21-28), body weight and tail length of malnourished pups increased significantly but showed no signs of catching up with that of control pups. Plasma SM-C and liver GH-binding capacity in the malnourished rats also rose significantly (P less than 0.005) after refeeding, but remained as far below controls as at 21 days [SM-C on day 28, 0.19 +/- 0.02 vs. 0.53 +/- 0.02 U/ml (P less than 0.001); GH binding, 6.59 +/- 0.99 vs. 12.94 +/- 1.60 pmol/liver (P less than 0.005)]. After 7 weeks of refeeding (days 21-70), tail length but not body weight recovered, while plasma SM-C levels were normalized. The mean number of GH binding sites per mg DNA in the malnourished rats was not significantly different from that in controls and reached for the males and the females, respectively, 79% and 86% of control binding. When expressed per liver, GH binding followed a similar pattern; for the males, binding capacity returned to 73% of the control value (20.45 +/- 1.82 vs. 27.93 +/- 3.49 pmol/liver; P = NS), and for the females, it returned to 77% of the control value (36.42 +/- 1.76 vs. 47.42 +/- 4.13 pmol/liver; P less than 0.01). In the young rats up to day 28, liver GH-binding capacities correlated with plasma SM-C concentrations (r = 0.81; P less than 0.01), while in the adult rats no correlation was present. During malnutrition and refeeding, there were no changes in the affinity constants of the hepatic GH-binding sites or in plasma GH concentrations.(ABSTRACT TRUNCATED AT 400 WORDS)

Oral triiodothyronine administration lowers plasma fibronectin levels in humans

It has been shown that both serum triiodothyronine (T 3) and plasma fibronectin values decline with fasting and increase with treatment of diabetic ketoacidosis in a paralles manner. 13 To evaluate the mechanism responsible for these changes, we examined the effects of both oral T 3 administration and fasting in six healthy, adult subjects. Initial plasma fibronectin values were normal in four subjects (group 1) and decreased in two subjects (group 2). Initial serum T 3 and thyroxine (T 4) values were normal in both groups. Despite a substantial rise in serum T 3 values with oral T 3 administration, plasma fibronectin fell in group 1 subjects. Fasting caused a significant decline in serum T 3 levels, but only a small further decline of plasma fibronectin concentrations. Serum T 3 levels rose after 1 week of refeeding, whereas plasma fibronectin levels in group 1 did not return toward normal. Plasma fibronectin values did not change in group 2 subjects with oral T 3, fasting, or refeeding. In conclusion, there is no simple cause-and-effect relationship between previously observed changes in plasma fibronectin and serum T 3 concentrations. High doses of oral T 3 will lower plasma fibronectin levels in subjects with initially normal plasma fibronectin values and a normal caloric intake.

Whole Body Protein Synthesis and Turnover in Normal Man and Malnourished Patients With and Without Known Cancer

Plateau enrichment of 15N-ammonia following 24 hour continuous intravenous infusion of 15N-glycine was used to measure total body protein turnover and synthesis in normal volunteers and malnourished patients, with and without cancer. The mean postabsorptive total body protein synthesis rate in three normal controls was 2.5 g protein/kg/day. Protein synthesis and turnover decreased by a mean of 23% following one week of fasting, and returned to baseline levels following one week of refeeding. In three malnourished patients without known tumor, whole body protein synthesis and turnover was similar to controls; following seven to ten days of total parenteral nutrition (TPN) in the nontumor-bearing patients whole body protein synthesis and turnover decreased by 18%. Three of seven malnourished patients with known tumors had marked elevations in total body protein synthesis and turnover; TPN increased protein turnover in five of seven patients with known cancer. This study suggests that some malignant tumors can increase whole body protein synthesis and turnover in both the malnourished and fed state. This increase in protein turnover may represent a direct effect of the tumor, or reflect concomitant illness.

Whole body protein synthesis and turnover in normal man and malnourished patients with and without known cancer.

Plateau enrichment of 15N-ammonia following 24 hour continuous intravenous infusion of 15N-glycine was used to measure total body protein turnover and synthesis in normal volunteers and malnourished patients, with and without cancer. The mean postabsorptive total body protein synthesis rate in three normal controls was 2.5 g protein/kg/day. Protein synthesis and turnover decreased by a mean of 23% following one week of fasting, and returned to baseline levels following one week of refeeding. In three malnourished patients without known tumor, whole body protein synthesis and turnover was similar to controls; following seven to ten days of total parenteral nutrition (TPN) in the nontumor-bearing patients whole body protein synthesis and turnover decreased by 18%. Three of seven malnourished patients with known tumors had marked elevations in total body protein synthesis and turnover; TPN increased protein turnover in five of seven patients with known cancer. This study suggests that some malignant tumors can increase whole body protein synthesis and turnover in both the malnourished and fed state. This increase in protein turnover may represent a direct effect of the tumor, or reflect concomitant illness.

Influence of Initial Food Restriction on Subsequent Body Weight Gain and Body Fat Accumulation in Rats

To determine the effect of initial food restriction on sub sequent body weight gain and body fat accumulation, rats were restricted to 75, 50, or 25% of the intake of control rats for 1 week and were subse quently pair-fed on a food intake basis to the control rats. As expected, restricted rats gained weight at a slower rate and had less body fat at the end of the restriction period than control rats. Upon refeeding the same amount of food as consumed by the control rats, these rats gained more body fat than control rats. This compensatory fat gain occurred regardless of whether the rats were force-fed twice daily, meal-fed once daily, or allowed to consume the food throughout the day. Both a high-carbohydrate and a high-fat diet produced compensatory fat gain. Compensation was apparent as early as the first week of refeeding and was greater in rats which had been restricted to 50 or 25% of ad libitum intake than in rats less severely restricted. Restricted rats were also refed on a body weight basis. They gained as much weight and fat as the ad libitum fed controls, indicating that the restricted rats were more efficient in converting dietary energy to body fat when refed than rats fed ad libitum continuously. These results suggest that the initial food restriction inherent in many studies involving meal frequency may cause the subsequent increased food ef ficiency and greater accumulation of body fat often attributed to an altera tion in meal pattern. Our studies indicate that meal pattern has a minimal influence on body fat content provided the control animals are pair-fed throughout the entire experiment. J. Nutr. 108: 1724-1732, 1978. INDEXING

Endocrine and metabolic alterations with food and water deprivation

Two healthy men were evaluated before and after a 56-day raft voyage to determine endocrine and metabolic status immediately after and during the recovery phase after long-term caloric, protein, and water deprivation. Daily intake during the trip consisted of no protein, 300 ml water, and for the first 40 days, 300 kcal glucose. The subjects lost weight from 84.1 to 58.1 and 78.3 to 57.7 kg, respectively. Significant variations included: 1) decreased excretion and loss of diurnal pattern of 17-hydroxycorticoids with normal serum corticoid levels and variation; 2) decreased serum testosterone levels and concomitant low follicle stimulating hormone and low normal luteinizing hormone levels; 3) decreased urinary 17-ketosteroid levels; 4) low plasma insulin levels with normal serum glucose concentrations; 5) increased triglyceride content in the 1.006 less than d less than 1.063 lipoproteins during fasting with a marked increase in high density lipoprotein cholesterol upon refeeding. The percent content of the R-serine (C-I) apoprotein among the soluble apoproteins of very low density lipoproteins diminished markedly during the fast; 6) abnormal liver function immediately after fasting with increased abnormality after the 2 weeks of refeeding and return to normal by 6 weeks; 7) normal fat and xylose absorption, normal estradiol, estrone and prolactin levels, and renal function studies.