Göschke H, Thölen H
Schweiz Med Wochenschr. 1977 Dec 10;107(49):1847-50.
In the first part of the study oral glucose tolerance tests (GTT) or insulin tolerance tests (ITT) were performed in 22 lean and 22 obese nondiabetics before and after fasts of at least 6 days' duration. Deterioration of glucose tolerance was greater in lean than in obese individuals. Plasma levels of factors known to influence glucose tolerance (glucagon, growth hormone, free fatty acids, ketones) were significantly higher in fasting lean than in fasting obese subjects. Furthermore, delayed insulin rise (GTT) and decreased insulin sensitivity (ITT) were observed after starvation in lean subjects but not in the obese, which could explain the greater deterioration of glucose tolerance in the lean population. In the second part of the study glucose and fructose tolerance were compared during 4-hour infusions of these substrates (0.5 g/kg/h) in 8 normal subjects before and after two 4-day fasts. After starvation, glucose as well as fructose infusion resulted in plasma levels of the infused hexose significantly higher than in control, and the rise in plasma lactate and pyruvate was delayed. These results contradict the view widely held in the literature, that fructose metabolism remains unimpaired in the fasting state.
在研究的第一部分，对22名体型偏瘦和22名肥胖的非糖尿病患者进行了口服葡萄糖耐量试验（GTT）或胰岛素耐量试验（ITT），试验分别在至少为期6天的禁食前后进行。体型偏瘦者的葡萄糖耐量恶化程度大于肥胖者。已知会影响葡萄糖耐量的因子（胰高血糖素、生长激素、游离脂肪酸、酮体）的血浆水平，在禁食的体型偏瘦者中显著高于禁食的肥胖受试者。此外，饥饿后体型偏瘦者出现胰岛素上升延迟（GTT）和胰岛素敏感性降低（ITT），而肥胖者未出现，这可以解释体型偏瘦人群中葡萄糖耐量恶化程度更高的原因。在研究的第二部分，对8名正常受试者在两次为期4天的禁食前后，于4小时内输注这些底物（0.5g/kg/h）期间的葡萄糖和果糖耐量进行了比较。饥饿后，输注葡萄糖以及果糖均导致所输注己糖的血浆水平显著高于对照组，且血浆乳酸和丙酮酸的上升延迟。这些结果与文献中广泛持有的观点相矛盾，即果糖代谢在禁食状态下仍不受影响。
