Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/116646
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Type: Journal article
Title: Effects of starvation and short-term refeeding on gastric emptying and postprandial blood glucose regulation in adolescent girls with anorexia nervosa
Author: Heruc, G.
Little, T.
Kohn, M.
Madden, S.
Clarke, S.
Horowitz, M.
Feinle-Bisset, C.
Citation: American Journal of Physiology - Endocrinology and Metabolism, 2018; 315(4):565-573
Publisher: American Physiological Society
Issue Date: 2018
ISSN: 0193-1849
1522-1555
Statement of
Responsibility: 
Gabriella A. Heruc, Tanya J. Little, Michael R. Kohn, Sloane Madden, Simon D. Clarke, Michael Horowitz and X Christine Feinle-Bisset
Abstract: Postprandial glucose is reduced in malnourished patients with anorexia nervosa (AN), but the mechanisms and duration for this remain unclear. We examined blood glucose, gastric emptying, and glucoregulatory hormone changes in malnourished patients with AN and during 2 wk of acute refeeding compared with healthy controls (HCs). Twenty-two female adolescents with AN and 17 age-matched female HCs were assessed after a 4-h fast. Patients were commenced on a refeeding protocol of 2,400 kcal/day. Gastric emptying (13C-octanoate breath test), glucose absorption (3-O-methylglucose), blood glucose, plasma glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), insulin, C-peptide, and glucagon responses to a mixed-nutrient test meal were measured on admission and 1 and 2 wk after refeeding. HCs were assessed once. On admission, patients had slower gastric emptying, lower postprandial glucose and insulin, and higher glucagon and GLP-1 than HCs ( P < 0.05). In patients with AN, the rise in glucose (0-30 min) correlated with gastric emptying ( P < 0.05). With refeeding, postprandial glucose and 3-O-methylglucose were higher, gastric emptying faster, and baseline insulin and C-peptide less ( P < 0.05), compared with admission. After 2 wk of refeeding, postprandial glucose remained lower, and glucagon and GLP-1 higher, in patients with AN than HCs ( P < 0.05) without differences in gastric emptying, baseline glucagon, or postprandial insulin. Delayed gastric emptying may underlie reduced postprandial glucose in starved patients with AN; however, postprandial glucose and glucoregulatory hormone changes persist after 2 wk of refeeding despite improved gastric emptying. Future research should explore whether reduced postprandial glucose in AN is related to medical risk by examining associated symptoms alongside continuous glucose monitoring during refeeding.
Keywords: Anorexia nervosa; gastric emptying; glucagon-like peptide-1; glucose; hypoglycemia; insulin; starvation
Rights: © 2018 the American Physiological Society. All rights reserved.
RMID: 0030099369
DOI: 10.1152/ajpendo.00149.2018
Grant ID: http://purl.org/au-research/grants/nhmrc/1022706
http://purl.org/au-research/grants/nhmrc/627002
http://purl.org/au-research/grants/nhmrc/1103020
Appears in Collections:Medical Sciences publications

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