STARVATION 2nd SEMINAR OF 3rd BLOCK

Prepared by
• Mariam Samer • Mohamed El.Gammal
• Mariam EL.Bahaiy • Mohamed El.Kastawy
• Mariam El.Nahas • Manar Abdelkader
• Mariam Mamdouh
Under the supervision of
Dr. Mona A Hussain
Dr. Safinaz Hamdy Abd El Rahman
OBJECTIVES
• Explain the meaning of starvation & fasting
• Mention reasons that lead to starvation
• Mention the stages or the phases of starvation
• Mention the normal fasting & postprandial blood glucose level
• Explain the importance of maintaining an average of blood glucose
• Mention different sources of blood glucose in normal feeding state
& starvation
• Identify the hormones that promote the influx & efflux of glucose,
fat & protein into and out of energy storage pools and their impact
on the uptake of glucose by tissues
• Establish specific roles for insulin, glucagon & catecholamines
• Describe the changes in metabolic fuels utilization that occur in
long – and short- term fasting and in acute and sustained exercises
• Understand how increases & decreases in hormone secretion
produce these changes
• Complications of long-term fasting (diseases resulting from
starvation)
• Treatment of starvation and it’s complications
WHAT IS THE MEANING OF
STARVATION ?
• It is a severe deficincy in caloric energy intake below the
level needed to maintain an organism's life

• it is the most extreme form of malnutrition

• it can cause organ damage and eventually death

DEFINITION OF STARVATION
ACCORDING TO WHO

• The WHO also states that malnutrition is by far the

biggest contributor to childmortality,present in half
of all cases
DEFINITION OF STARVATION
ACCORDING TO WHO

• The WHO also states that malnutrition is by far the biggest

contributor to childmortality,present in half of all cases
• HUNGER is the single gravest threat to the world's
public health
TYPES OF STARVATION
Acute starvation
• This condition results from
sudden and complete
cessation of food and
water.
Chronic starvation
• This condition results from
gradual deficiency in the
supply of food and water
CAUSES OF THE STARVATION

• The basic cause of starvation is an imbalance between

energy intake and energy expenditure
• This imbalance can arise from one or more medical
conditions or circumstantial situation
EARLY SYMPTOMS
• Under nutrition is a
contributory factor in the
death
• of 3.1million children
under five every year
• It currently affects about
842million people,or about
one in eight people in the
world population 12.5%
Exhaustion Dehydration

Circulatory failure due to

brown atrophy of heart

Electrolyte Hypothermia
imbalance
FASTING
Normal fasting

Fasting is the willing abstinence or reduction from

some or all food, drink, or both, for a period of time
DIAGNOSTIC FAST

• Fasting means not eating or drinking for a period of time before your lab
tests.Some blood tests are sensitive to food and drink
• Some common tests that require fasting are blood
• cholesterol,triglyceride and glucose level tests
• Some tests that check for vitamin levels,such as Vitamin E or Amayle
PEOPLE CAN LEAVE WITHOUT

• oxygen for 5 to 10 minutes

• Water for 3 to 8 days

• Food for 70 days

THE IMPORTANCE OF MAINTAINING
AN AVERAGE OF BLOOD GLUCOSE

• The brain exclusively use s glucose a s a fuel (GLUT-1 of the BBB is insulin
independent), completely oxidizing approximately 140 g/day to CO2 and H2O.

• The brain contains no significant stores of glycogen and is , therefore ,

completely dependent on the availability of blood glucose.
• If blood glucose levels fall below 40 mg/100 ml, cerebral function
is impaired

• The brain also lacks significant store s of TAG, and the FAs
circulating in the blood make little contribution to energy
production be cause FAs bound to albumin do not efficiently cross
the BBB
SOURCES OF BLOOD GLUCOSE
Normal feeding state
•  From Carbohydrates of the
Diet
Starvation
•  forming new glucose from
non CHO molecules
GLUCONEOGENSIS
• From Liver Glycogen by
GLYCOGENOLYSIS
INSULIN
Insulin is a peptide hormone produced by the β cells of the islets of
Langerhans of the pancreas, which are clusters of cells that are
embedded in the endocrine portion of the pancreas. The islets make
up only about 1%– 2% of the total cells of the pancreas.
metabolic effects are anabolic, for example
synthesis of glycogen,
triacylglycerols (TAGs),
and proteins
STRUCTURE OF INSULIN
• Insulin is composed of 51 amino acids arranged in two polypeptide
chains, designated A (21 amino acids) and B (30 amino acids),
which are linked together by two disulfide bridges
SYNTHESIS OF INSULIN
• Biosynthesis involves production of two inactive precursors, PR proinsulin(remove
signal sequence) and proinsulin(formation of disulfate bond, release of C-peptide),
that are sequentially cleaved to form the active hormone plus C-peptide [Note: The
C-peptide is a good indicator of insulin production and secretion.] Insulin is stored in
the cytosol in granules that, given the proper stimulus, are released by exocytosis.
SYNTHESIS OF INSULIN

• Insulin is degraded by insulin-degrading enzyme, which is

present in the liver and, to a lesser extent, in the kidneys.
Insulin has a plasma half-life of approximately 6 minutes.
This short duration of action permits rapid changes in
circulating levels of the hormone.
REGULATION OF INSULIN
SECRETION
1-Stimulation of insulin
secretion:
insulin secretion is increased by
glucose,
amino acids,
and gastrointestinal peptide hormones
REGULATION OF INSULIN
SECRETION

2-Inhibition of insulin secretion:

The synthesis and release of insulin are decreased when there is

scarcity of dietary fuels

during periods of physiologic stress (for example, infection hypoxia, and
vigorous exercises)
catecholamines norepinephrine and epinephrine(which are made from
tyrosine in the sympathetic nervous system and the adrenal medulla)
REGULATION OF INSULIN
SECRETION

• The regulation of insulin secretion is summarized in Figure

METABOLIC EFFECTS OF INSULIN
• Effects on carbohydrate metabolism

• Effects on lipid metabolism

• Effects on protein synthesis

METABOLIC EFFECTS OF INSULIN

Effects of insulin in carbohydrates metabolism in liver, muscle &

adipose tissue

• In the liver and muscle, insulin increases glycogen synthesis

• In the muscle and adipose, insulin increases glucose uptake

METABOLIC EFFECTS OF INSULIN
Effects on lipid metabolism
Adipose tissue responds rapidly to a rise in insulin causes
release of fatty acids by inhibiting the activity of hormone-sensitive
lipase, which degrades lipids in adipose tissue

Effects on protein synthesis

In most tissues, insulin stimulates the entry of amino acids into cells
and protein synthesis
GLUCAGON
• Source of secretion : A
cells or ALPHA cells of
pancreas
• Chemistry : glucagon is a
polypeptide with a
molecular weight of 3500
• It has 29 amino acid
ACTIONS OF GLUCAGON

• Effect of glucagon on carbohydrates metabolism

• Effect of glucagon on protein metabolism
• Effect of glucagon on fat metabolism
• Other actions of glucagon
EFFECT OF GLUCAGON ON
CARBOHYDRATE METABOLISM
• Increases glycogenolysis in liver and not in
muscle
• Glycogen
• Glucose-1-phosphate ( inhibit glycogen
synthetase )
• Glucose
• Increases gluconeogenesis in liver
• Formation of glucose from lactate, pyruvate,
glycerol & amino acids
EFFECT OF GLUCAGON ON PROTEIN
METABOLISM
• Increases gluconeogenesis by increasing transport
of amino acids into the liver
• Lowers plasma amino acids
• Calorigenic effect
• Due to increased hepatic deamination of amino
acids
EFFECT OF GLUCAGON ON FAT
METABOLISM

• Increases lipolysis : excess FFA oxidized- energy

production- ketogenesis in liver
• Increases release of FFA & glycerol from adipose tissue
and makes it available for peripheral utilization
• Prevents synthesis of triglycerides
• Thus glucagon – ketogenic & hyperglycemic hormone
OTHER ACTIONS OF GLUCAGON

• Inhibit renal tubular Na reabsorption – natriuresis

• Increases cardiac force of contraction – activation of
myocardial adenyl cyclase
• Stimulate secretion of growth hormone, insulin &
somatostatin
• Regulation of appetite
• Increases secretion of bile
• Inhibit secretion of gastric juice
STIMULATORS OF GLUCAGON
SECRETION
• Low plasma ( glucose )
• Amino acids ( ala, ser, cys, thr )
• GI hormones ( CCK, gastrin )
• Cortisol, growth hormone
• Infections, other stresses
• Beta-adrenergic stim, Ach
INHIBITORS OF GLUCAGON
SECRETION
• Elevated plasma (glucose)
• Somatostatin
• Secretion
• FFA, ketones
• Insulin
• Alpha-adrenergic stim, GABA
 ADAPTATION TO

STARVATION
CHANGES IN THE METABOLIC FUELS UTILIZATION DURING LONG-TERM FASTING
FUEL STORES
Only about one third of
the body’s protein can be
used for energy
production without fatally
compromising vital
function
LIVER IN FASTING
The primary role of liver in energy metabolism during fasting is
maintenance of blood glucose through the synthesis and distribution of
fuel molecules for use by other organs

A. Carbohydrates B. Fat metabolism

metabolism

Fatty acids Ketogenesis

Glycogenolysis Gluconeogenesis oxidation
Carbohydrates metabolism Fat metabolism
ADIPOSE TISSUE IN FASTING

• A. Carbohydrates
metabolism
• B. Fat metabolism
1. Increased degradation of TAG
2. Increased release of fatty acids
3. Decreased uptake of fatty acids
RESTING SKELETAL MUSCLE IN FASTING

• A. Carbohydrates metabolism
• B. lipid metabolism
• C. Protein metabolism
BRAIN IN FASTING
KIDNEY IN LONG-TERM FASTING

• Gluconeogenesis (50% come

from the kidneys)
• Compensation for ketoacidosis
• Glutaminase and ammonia
COMPLICATIONS
OF STARVATION
COMPLICATIONS OF STARVATION

• Malnutrition • Constipation
• Dehydration
• Electrolyte imbalance
• Bone loss
• Loss of monthly menstrual
• Fatigue period
• High blood pressure
• Effects on the brain
TREATMENT
OF STARVATION & IT’S COMPLICATIONS
 Starvation
Definition Phases

Ca s
use e
s complications Typ

Insulin Glucagon
effect Adaptation effect
REFERENCES
• Vander's Human Physiology The Mechanisms of Body
Function by Eric P. Widmeyer
• Guyton and Hall Textbook of Medical Physiology 13th
Edition
• Lippincott's Illustrated Reviews Biochemistry 5th
Edition