Ayuno y ayuno modificado: aspectos fisiológicos y bioquímicos
Resumen
La obesidad viene convirtiéndose en uno de los grandes problemas de salud de las sociedades modernas. Se manifiesta particularmente en países industrializados como los EUA, donde del 10 al 40 0/0 de la población es afectada ( 5, 42, 66). En países subdesarrollados, a pesar de existir pocos datos epidemiológicos al respecto, se cree que la incidáncia es menor. Sin embargo, un estudio reciente en escolares brasileros (3), mostró una prevalencia global de obesidad del 16.7 0/0. Es importante notar que, *mientras en EUA la obesidad es más frecuente en estratos sociales pobres (44), en Brasil ocurre justamente lo contrario
Repetidos estudios demuestran que personas con peso 20 0/0 mayor que su peso ideal presentan tasas de mortalidad elevadas, principalmente por enfermedades cardiovàsculares (37, 42, 49). En pacientes con obesidad mórbida (100 0/0 sobre el peso ideal) la mortalidad llega a ser 12 veces mayor que en poblaciones de peso normal (18).
• Dr. Décio Laks Eizirik Dr. Patricio López J.
Las dietas tradicionales para obesidad, que mantienen una proporción entre carbohidratos (CH), proteinas y grasas, pero reducida cantidad total de calorías, no dan resultados satisfactorios en el manejo de la obesidad severa. Como ejemplo, apenas 5 0/0 de los pacientes tratados con este tipo de de dietas pierden 20 0 más kg y solamente 25 0/0 disminuyen 9 kg o más, posteriormente, mantienen esta pérdida (72). Entre las justificaciones que explican estos pobres resultados, se destacan basicamente la sensación de hambre de los pacientes y la lenta pérdida de peso (9), sin dejar de considerar, en algunos casos, alteraciones primarias en el metabolismo intermediario y macanismos de termogénesis (I I, 41, 48, 56).
Por estos motivos, en los últimos años se han estudiado dietas mas restrictivas y que no mantienen la habitual relación entre los diversos componentes alimenticios (CH, proteinas y grasas). Para la comprensión y elaboración de estos programas dietéti 218
cos, fue fundamental el conocimiento de los fenómenos fisiológicos y adaptativos que ocurren en el organismo humano durante períodos de ayuno.
En esta revisión trataremos de abordar algunos aspectos metabólicos y hormonales observados durante el ayunó, y a partir de ahí, estudiaremos los aspectos fisiológicos de una de las nuevas dietas propuestas: el ayuno modificado con ingesta proteíca
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2. APFELBAUM, The effects ofveryrestrictive protein diets. CL/N. ENDOCRINOL. ME— TAB., 1976.
3. ARTEGA, H.P.,• SANTOS, I.E. and OLIVEIRA, J.E.D.: Obesity among school children of different socieconomic levels in a developing country. INT. J. OBESITY, in press.
4. AXELROD, L.; SLOWAN, S.D.; JONES, P.L. and MA R T/N, LB.: Persistence ofketosis despite supression of /ipo/ysis by 16, 76 Dimethy/prostag/andin E2 in experimental diabetic keto acidosis in rats. DIABETES, 28 (10): 905-913, 1979.
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9. B/STRAIN, B.R.: Recent developments in the treatment of obesity, with particular reference to semistarvation cetogenic regimens. DIABETES CARE, 7 (6):379-384, 7978.
10 B/S TRAIN, B.R.: Low calorie protein versus mixed diet. N. ENGL. J. MED., 303 (3): 757-758, 1980.
11 BOND Y, P.K.: Metabolic obesity? N. ENGL. J. MED., 303 (18): 1057-1058, 1980.
12 BUCHANAN, K.D.: "Glucagon". In: Baja], J. (ed.). Insulin and metabolism. Amsterdam, Excerpta Medico, 1977, cap. 72, pp. 233-271.
13. CAHIL, G.F: Starvation in man. N.ENGL. J. MED., 282 (12): 668-675, 1970.
14. CAHIL, G.F. and AOICI, T.T.: Rena/ gluconeogenesis and amino acid metabolism in man. MED. CLIN. N. AMER., 59 (3): 751-761, 1975.
15 CAHILL, G.F.: Starvation In man. CLIN. ENDOCRINOL. METAB., 5 (2): 397-475, 1976.
16. COIMBA, C.C.; GROSS, J.L. and M/GLIO— RINI, R.H.: Intraventricu/ar 2-deoxyg/ucose, glucose, insulin, and free fatty acid mobilization. AM. J. PHYS/OL., 236 (4): 377-332, 7979.
17. De HA VEN, J.; SHERWIN, R.; HENDLER, R. and FELIG, P. : Nitrogen and sodiun balance and aympathetic nervous-system activity in obese subjects treated with a low-calorie protein or mixed diet. N. ENGL. J. MED., 302 (9): 477482, 1980.
18. DREN/CK, E.L GURUNANJAPPA, S.D.; SELTZER' F. and JOHNSON, D. G.: Excesive mortality and causes of death in morbid/y obese men. J.A .M.A 243 (5):443-445, 7980.
19. EXTON, J.H.: Gluconeogenesis. METABO— LISM, F. and JOHNSON, D. G.: Excessive mortality and causes of death in morbidly obese men. J.A.M.A., 243 (5):433-445, 1980.
20. EXTON, J.H.,• Hormonal control of gluconeogenesis. Midwest Conference of Endocrinology and Metabolism, 12th, University of Mis 226 souri-Hormones and Energy Metabolism. •ADV. EXP. MED. Bio., 711: 125-167, 1979.
21. FAIN, J.N. and SHEPERD, R.E.: Hormonal regulation of lipo/ysis: role of cyclic nucleotides, adenosine and free fathy acids. Midwets Conferehce of Endocrinology and Metabo[ism, 12th, University pf Missouri-Hormones and Energy Metabolism. A VD. EXP. MED. mo., 117:43-77, 1979.
22. FELIG' OWEN. O.E.; WAHREN. J. and CAHILL, G.F.: Amino acid metabolism during prolonged starvation. J. CLIN. INVEST., 48 (3): 584594, 1969.
23. FEL/G, POZEFSKY, T.: MARL/SS, E. and CAHIL, G.F.: Alan/ne: key role In gluconeogenesis. SCIENCE, 167 (3920): 1003-1004, 1970.
24. FEL/G, p. : Four questions about protein diets. N. ENGL. J. MED., 298 (78): 1025-1026, 1978.
25. FELIG, P .. • "Starvation". ln. De Groot, L.I. (ed.). ENDOCRINOLOGY, New York, Grune e Stratton, 1979, cap. 147, pp. 1927-1940.
26. FOSS, M.C.: Metabo/ismo de carbohidratos e /ip/dos e dieta hiperprotéica (Livre de carbohidratos). TESE DE DOUTORAMENTO, Faculdade de Medicina de Ribeirao Preto, USO, 1978.
27. FRIEDMAN, N.; EXTON, J.M. and PARK, IR.: Interaction of adrenal steroids and glucagon on g/uconeogenesis in perfused rat liver. BIOCHEM. BIOPHYS. RES. COMMUN., 29 113-120, 1967.
28. GARDNER, D.F.; KAPLAN, M.K.,• STANLEV, C.A. and UT/GER, R.D.: Effect of Tri-iodothyronine replacement on the metabolic and pituitary responses to starvation. N, ENGL. J. MED., 300 (17):579-584, 7979.
29. GARDNER, D.F.; KAPLAN, M.K.; STAN—LEV, C.A. and UT/GER, R.D.: T3 metabo/ism in starvation. N.ENGL. J. MED., 302 (3). 763-764, 1979.
30. GARRISON, J.C. and BORLAND, M.K.: Regulation of mitochondria/ pyruvato-carboxi/ation and g/uconeogenesis in rat hapatocytes via an -adrenergic, AMPc independent mechanism. J. BIOL. CHEM., 254 (4): 1129-1133, 1979.
31. GOODNER, C.I.; KOERKER, D.J.,• WERBACH, J.M.; TO/VOLA, P. and GALE, C.C.: Adrenergic regulation of /ipo/ysis and insulin secretion in the fasted baboon. AM. J. PH Y— sm., 224 534539, 1973.
32. GOORNO, w.E.,• RECTOR, F.c. and SELDIN, D. W.: Relation of renal g/uconeogenesis to ammonia production in the dog and rat.
33. AMER. J.PHYS/OL., 1967.
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Laks D, López P. Ayuno y ayuno modificado: aspectos fisiológicos y bioquímicos. Rev Fac Cien Med (Quito) [Internet]. 26 de junio de 2017 [citado 15 de noviembre de 2024];6(3-4):217-29. Disponible en: https://revistadigital.uce.edu.ec/index.php/CIENCIAS_MEDICAS/article/view/475
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