34-day total fast in an adult man

The aim of this work was to investigate the changes of cardiac performance by both electrocardiography (ECG) and echocardiography (ECHOc), in addition to anthropometric and hormonal variables before, during and after prolonged total fasting (TF) and re-feeding in an overweight adult man. Physical examination, laboratory and hormonal measurements, ultrasonographic study of body fat distribution, ECG and ECHOc study were performed before during and after 34 days of TF and after 17 days of isocaloric re-feeding. The subject was a 52-year old Caucasian who was overweight with increased abdominal fat content (BMI: 28.6; W/H ratio: 0.95) and increased levels of arterial systolic and diastolic blood pressure (SBP, DBP). HPLC measurements of urinary catecholamine levels (HPLC), ECHOc study of cardiac performance, ultrasonographic study of body fat distribution were performed. The subject starved for 34 days losing 22kg, but after that time he was compelled to re-feed because of nausea and severe vomiting. A marked ketosis (ketonuria > 1200mg/day) was already present after 6 days of TF. After 17 days of TF norepinephrine (NE) and epinephrine (EPI) urinary levels showed a two-fold and nine-fold increase respectively, but they became undetectable at the end of TF. After 17 days of re-feeding catecholamine urinary levels were similar to those measured after 17 days of TF. After both TF and 17-day isocaloric re-feeding we found a decrease of visceral fat content and W/H ratio reached the normal values for age-matched subjects (W/H ratio after TF: 0.80, after re-feeding: 0.80). TF was associated with decreases of cardiac left ventricular end diastolic volume (-28.8%), end diastolic volume index (-24.4%) and ejection fraction (-32.7%) as compared with those measured by ECHOc in the basal period. After the two-week re-feeding all abnormalities of cardiac performance were completely reversed. Both TF and 17-day isocaloric re-feeding induced a correction of abdominal obesity and a decrease in visceral fat content. An impaired cardiac performance was demonstrable by echocardiography (ECHOc) after just 2 weeks of TF. However, we may argue that the cardiac abnormalities were reversible since they disappeared after re-feeding. To our knowledge this is the first echocardiographic demonstration of TF-mediated change of the cardiac performance in humans.