Effect of protein-supplemented fasting on metabolic and hormonal responses to epinephrine infusion in obese subjects.

The present study aimed at investigating the effects of an epinephrine (EPI) intravenous infusion (10 micrograms/min for 30 min) in normal subjects and in obese patients before and after 13 days of protein-supplemented fasting (PSF, 70 g protein/day). Blood glucose, plasma free fatty acids (FFA), lactate, insulin (IRI) and glucagon were determined before, during (15, 30 min) and after (+30 and +60 min) the EPI infusion. 1. When compared to lean control subjects, obese patients exhibited a less marked rise in blood glucose and a more important increase in plasma FFA, EPI infusion decreased IRI plasma levels in normals but not in the obese. Plasma glucagon was lower in the obese under basal conditions and their A cell reactivity to EPI was clearly reduced. 2. Comparison of the results obtained in obese patients before and after PSF revealed that EPI-induced blood glucose rise was not altered despite lower basal values after PSF. Plasma lactate response was impaired, probably because of the depletion in muscle glycogen. Reduction in basal plasma IRI was associated with a significantly higher FFA mobilization. Abnormally low basal EPI-stimulated glucagon concentrations persisted after PSF despite concomitant reductions in blood glucose and plasma IRI.

[Effects of a hypocaloric protein diet on changes in arterial pressure produced by adrenaline infusion]. / Effets de la diète hypocalorique protéique sur les modifications de la pression artérielle provoquées par perfusion d'adrénaline.

In 9 obese patients, epinephrine infusion (10 microgram/min) did not significantly modify the mean arterial blood pressure (MBP) in basal conditions. This infusion reduced MBP (-7 mm Hg, p less than 0.05) after 13 days of protein-supplemented fasting. This difference in the cardio-vascular reactivity to circulatory epinephrine could contribute to the decrease in the arterial blood pressure observed during protein-supplemented fasting.

Hormonal and metabolic adaptation to protein-supplemented fasting in obese subjects.

Thirty hospitalized, severely obese patients (40 +/- 2 yr, 82 +/- 4 percent weight excess) were submitted to a 13-d protein-supplemented fast (PSF) with 70 g milk proteins/d (1.26 MJ or 300 kcal). The mean weight loss during PSF was 5.4 +/- 0.3 kg corresponding to 422 +/- 39 g/d. Comparison of the urinary nitrogen excretion with daily protein intake revealed that the nitrogen balance was equilibrated during PSF. Blood glucose decreased moderately but significantly during the whole PSF period whereas plasma insulin was only reduced during the first 9 d and tended to rise thereafter. Plasma FFA increased rapidly and remained elevated until the end of the study (+ 60 per cent); serum total cholesterol and plasma triglycerides showed a 26 and a 35 per cent decrease respectively. Basal plasma glucagon was slightly increased. Due to the low sodium intake (42 mmol/d) urinary sodium excretion dropped rapidly. Simultaneously both systolic (-13 mmHg) and diastolic (-7 mmHg) arterial blood pressure decreased significantly. The biological tolerance was good: metabolic acidosis was prevented with sodium bicarbonate, excessive rise in serum uric acid was corrected with allopurinol and a marked decrease in serum potassium was avoided with an appropriate dose of spironolactone. Twenty-six patients could be weighed 6 to 15 months after PSF: 12 showed a further weight reduction (6.6 +/- 1.6 kg) and seven a discrete weight gain (1.0 +/- 0.4 kg). Thus, PSF was well accepted and was profitable in 19 out of our 30 patients. It should be restricted to cases of severe and refractory obesity and performed under careful medical supervision.

[Decreased secretion of epinephrine during protein-supplemented fasting in obese subjects (author's transl)]. / Diminution de la sécrétion d'adrénaline au cours de la diète hypocalorique protélique chez l'obèse.

The protein-supplemented fasting induces a progressive but moderate decrease in blood glucose (-26%) and a marked rise in plasma free fatty acids levels (+ 43%). Nevertheless the secretion of epinephrine by the adrenal medulla, as indirectly estimated by the ratio of the basal urinary elimination to the recovery percentage from the urine of an epinephrine infusion, shows a significant decrease (- 36%) during the protein diet. Thus the enhanced lipolysis does not result from an adrenergic overactivity but merely depends upon the marked reduction in the plasma insulin level (- 38%).

Computer-assisted instruction for diabetics. An original project developed at the University of Liège, Belgium.

An experiment conducted at the University of Liège, Belgium in the computer-assisted teaching of juvenile-type insulin-dependent diabetics is reported. The course was designed to individualize teaching in order to give a minimum of basic information to a maximum of patients. The original computer-assisted instruction system DOCEO II is described; methods and programming techniques are summarized. The course was evaluated on fifty patients who attended the first four lessons. The improvement in knowledge was impressive: scores corrected for guessing were 9.59 +/- 4.43 out of 20 before the course and 17.04 +/- 2.26 out of 20 after the course (paired t test: p less than 0.001). The system was enthusiastically accepted by the patients and is now routinely used in our Institution. Long-term studies are in progress to determine whether increased knowledge leads to better self-care, improved control and, ultimately, reduced incidence of diabetic complications.