title: Severe catabolic state after an overnight fast in patients with chronic renal failure.
abstract: OBJECTIVE
  Starvation causes more rapid development of a catabolic state in patients with liver cirrhosis than in normal subjects. Because the kidneys have a gluconeogenic activity similar to that of the liver, we tested whether patients with chronic renal failure develop a catabolic state after an overnight fast.
  
  
  METHODS
  The effect of an overnight fast on diurnal changes in respiratory quotient (RQ) was studied in 12 normal subjects and 12 patients with stable chronic renal failure. Changes in RQ in the early morning after an overnight fast were also studied in 27 patients with chronic renal failure not on dialysis. We also examined the effect on RQ of consuming a light snack in the evening before the measurements.
  
  
  RESULTS
  The RQ before breakfast, but not at other times, was significantly lower in patients with renal failure than in normal subjects (0.824 ± 0.051 versus 0.868 ± 0.038, P < 0.05). This indicated that patients with renal failure had higher fat use and developed a catabolic state early in the morning. The RQ before breakfast showed significant inverse correlations with creatinine levels (r = -0.604, P < 0.001). Supplementation with a carbohydrate-rich snack in the evening resulted in a significant increase of 0.07 ± 0.04 (P < 0.05) in mean RQ in the early morning. This suggested that a late evening snack is useful for improving the catabolic state of patients with renal failure.
  
  
  CONCLUSIONS
  Starvation involving an overnight fast facilitates catabolism of visceral and muscle proteins in renal failure. This suggests that nutritional management of renal failure should focus not only on the contents of a meal, but also on the timing of the meal.
authors.affiliation: Department of Nutrition and Metabolism, the University of Tokushima Graduate School, Tokushima, Japan. yutaka-nakaya@nutr.med.tokushima-u.ac.jp
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Nakaya
authors.forename: Takaaki
authors.initials: T
authors.lastname: Shimohata
authors.forename: Sayaka
authors.initials: S
authors.lastname: Haraguchi
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Nakao
authors.forename: Jun
authors.initials: J
authors.lastname: Minaguchi
authors.forename: Haruo
authors.initials: H
authors.lastname: Sumitani
authors.forename: Nagakatsu
authors.initials: N
authors.lastname: Harada
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sakaue
mesh_terms: D000368:Aged; D002245:Carbon Dioxide / Q000378:metabolism; D003404:Creatinine / Q000097:blood*; D004040:Dietary Carbohydrates / Q000494:pharmacology / Q000627:therapeutic use; D004734:Energy Metabolism; D005215:Fasting / Q000502:physiology*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000378:metabolism*; D050356:Lipid Metabolism; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology*; D011506:Proteins / Q000378:metabolism
chemical_list: D004040:Dietary Carbohydrates; D011506:Proteins; D002245:Carbon Dioxide; D003404:Creatinine