Fasting increases serum bilirubin levels in clinically normal, healthy males but not females : a retrospective study from phase I clinical trial participants

Aim: To examine if fasting affects serum bilirubin levels in clinical healthy males and females. Methods: We utilised retrospective data from phase 1 clinical trials where blood was collected in either a fed or fasting state at screening and pre-dosing time points and analysed for total bilirubin levels as per standard clinical procedures. Participants were clinically healthy males (n = 105) or females (n = 30) aged 18 to 48 inclusive who participated in a phase 1 clinical trial in 2012 or 2013. Results: We found a statistically significant increase in total serum bilirubin levels in fasting males as compared to non-fasting males. The fasting time correlated positively with increased bilirubin levels. The age of the healthy males did not correlate with their fasting bilirubin level. We found no correlation between fasting and bilirubin levels in clinically normal females. Conclusions: The recruitment and screening of volunteers for a clinical trial is a time-consuming and expensive process. This study clearly demonstrates that testing for serum bilirubin should be conducted on non-fasting male subjects. If fasting is required, then participants should not be excluded from a trial based on an elevated serum bilirubin that is deemed non-clinically significant.

Safe perioperative fasting : implementation of evidence based guidelines and an ‘at risk’ checklist

Introduction Guidelines existed at the Royal Children’s Hospital (RCH) to direct preoperative/pre-procedural fasting in day patients undergoing general anaesthetic. However audit, risk analyses and a recent research project at the RCH identified prolonged pre-procedural fasting times in children undergoing day surgical and gastroenterology procedures. Aims 1. Reduce median fasting time to <8 hrs for children admitted for a day procedure under general anaesthetic; 2. Identify children at risk of perioperative hypoglycaemia. Methods The study was conducted in 4 phases: 1) revision and implementation of evidence-based perioperative fasting guidelines with staff education relating to these guidelines; 2) cross-sectional descriptive study with day surgical patients (n = 377) requiring preoperative fasting. ‘Normal risk’ and ‘High risk’ groups were identified for fasting hypoglycaemia using an ‘at risk’ checklist. Venous blood glucose (BGL) testing was performed at a) anaesthetic induction; b) prior to first caloric food/fluid postoperatively; 3) chart audit to evaluate efficacy of guidelines and parent information; 4) development of recommendations for clinical practice. Results The median fasting time for children having morning surgery (14 hrs, IQ range 5–22 hrs) was twice as long compared to afternoon lists (7 hrs, IQ range 6–22 hrs) (p < 0.001). Median fasting times were not significantly different between ‘at risk’ and control groups (p = 0.496). However the proportion of children who experienced hypoglycaemia (BGL <3 mmol/L) was greater in the ‘at risk’ group (5, 8%) compared to the control group (18, 4.3%). Although not statistically significant (x2 = 2.254, p = 0.133), ‘at risk’ children appear more likely to experience hypoglycaemia as children in the control group, constituting a clinically significant finding. Conclusion Appropriate identification and management of ‘high risk’ children, will reduce the risk of deleterious sequelae in children undergoing surgical or investigative procedures requiring general anaesthesia.

Effects of pre-slaughter fasting on broiler welfare, meat quality, and intestinal integrity

The Brazilian Ministry of Agriculture (MAPA) regulations establish 12 hours as the maximum pre-slaughter fasting period for broilers; however, many processing plants have considered this time is not sufficient, and consequently return the birds to the farms, with consequent economic losses and welfare problems. Therefore, it is necessary to investigate the possible effects of longer pre-slaughter fasting times. The objective of the present study was to evaluate the effect of pre-slaughter fasting times longer than those established by MAPA on broiler welfare, breast meat quality, and intestinal integrity. Forty 42-d-old broilers were submitted to different pre-slaughter fasting times: group I: 6 hours, group II 9h, group III 12h, and group IV 15h. Bird welfare was assessed before slaughter. After sacrifice, intestinal samples were collected to assess their morphology and morphometrics, and the Pectoralis major muscle was analyzed for pH and color. There was no influence (p>0.05) of treatments on breast muscle pH or color.There were no significant changes in intestinal morphometrics (p<0.05). Bird behavior was affected (p<0.05), suggesting that welfare was impaired as fasting time increased, but no differences in the analyzed parameters were detected between broilers fasted for 12 or 15 hours. It was concluded that the behavioral differences between birds fasted for 12 and 15 hours are not sufficient to assert that those fasted for 15 hours were in worse welfare conditions.

Influence of the starting time of preslaughter feed withdrawal on welfare of pigs and pork quality

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Postprocedural effects of gastrointestinal endoscopy performed as a day case procedure in children : implications for patient and family education

A prospective design that included a survey tool, nursing care records, and telephone interview was used to determine postprocedural effects experienced by children and families following gastrointestinal endoscopy performed as a day procedure. One hundred twenty-one children attending a pediatric gastroenterology unit for endoscopy under general anesthesia participated in the study. Physical symptoms, day care/school attendance, behavioral issues, and economic factors in the 72 hours post procedure were identified. Over half the children (n = 69, 57%) experienced pain in the hospital post procedure. Pain was reported by 73 children (60%) at home on the day of the procedure, by 55 children (45%) on Day 1 post procedure, and by 37 children (31%) on Day 2 post procedure. The throat was the most common site of pain. Nausea or vomiting was experienced by 37 children (31%) at some time following their procedure but was not associated with procedure type, age, or fasting time. Over half the children (n = 53, 51%) who usually attended day care or school did not attend the day following their procedure. Twenty-four parents (40%) who would normally have worked on the day after the procedure did not attend employment. These findings have been used to improve the preprocedural information and discharge management of patients treated in a pediatric gastroenterology ambulatory setting. © The Society of Gastroenterology Nurses & Associates 2007. All Rights Reserved.

Tempo de jejum dos suínos no manejo pré-abate sobre a perda de peso corporal, o peso do conteúdo estomacal e a incidência de úlcera esofágica-gástrica

O objetivo deste trabalho foi avaliar os efeitos do tempo de jejum (9, 12, 15 e 18 horas) dos animais na granja (TJG) e da posição na carroceria do caminhão (PBO) durante o transporte da granja ao frigorífico sobre: a perda de peso corporal (PPC), o peso do estômago cheio (PEC) e vazio (PEV), o peso do conteúdo estomacal (PCE) e o escore de lesão na mucosa esofágica-gástrica (ELG). Foram utilizadas 192 fêmeas, com peso vivo médio de 134,51±11,80kg. No modelo, foram considerados os efeitos de bloco (estação do ano, BL), TJG, PBO e da interação entre BL x TJG. Verificou-se efeito significativo do TJG apenas sobre o peso do conteúdo estomacal. Não se observou efeito significativo da PBO sobre qualquer das variáveis avaliadas. Dos suínos avaliados, 90,3% apresentaram PEC menor que 500 gramas e 8,56% com PEC entre 500 e 800 gramas. A prevalência de suíno com ELG foi baixa (14,97%), sendo que, dos animais com ELG, 13,90% apresentaram lesão de grau 1 e 1,09% eram grau dois. Conclui-se que animais submetidos a jejum na granja de 15 horas apresentam menor peso do conteúdo estomacal ao abate.

Tempo de jejum na granja sobre o perfil hormonal e os parâmetros fisiológicos em suínos de abate pesados

O objetivo deste estudo foi avaliar o tempo de jejum na granja e a posição dos animais na carroceria do caminhão durante o transporte ao abatedouro sobre o status hormonal e fisiológico de suínos de abate pesados visando obter melhorias no manejo pré-abate e reduzir perdas na qualidade de carne. Foram utilizadas 64 fêmeas com peso médio de 133+11kg, oriundas de duas granjas de terminação. Os tempos de jejum avaliados foram nove, 12, 15 e 18h, enquanto que as posições consideradas na carroceria foram box (frente, meio e atrás), piso (inferior e superior) e lado (lateral direita e esquerda). Ao abate, foram medidos os níveis de glicose, lactato e CPK no sangue. A concentração de cortisol na saliva (CCS) foi medida nas granjas (24 horas antes e após embarque) e no abatedouro (logo após o descarregamento e antes do abate). A freqüência cardíaca foi monitorada durante todo o manejo pré-abate. Foi observado o efeito da interação entre TJG e o local de avaliação sobre a CCS e a freqüência cardíaca. A CCS e a freqüência cardíaca aumentaram significativamente da granja ao desembarque no abatedouro em relação ao descanso pré-abate no abatedouro foi observada uma redução (P<0,05) nos valores. A CCS variou em função do TJG e o local de avaliação da seguinte maneira: suínos com 18 horas de jejum apresentaram menor (P<0,05) variação na CCS durante o transcorrer das diferentes etapas do manejo pré-abate do que suínos com TJG menores e, entre estes, os animais com TJG de nove horas apresentaram a maior (P<0,05) variação. Antes do abate, os suínos com TJG de nove horas apresentaram o maior valor (P<0,05) de CCS quando comparados aos outros TJG. Conclui-se que o TJG promove mudanças (P<0,05) nos valores do cortisol na saliva e na freqüência cardíaca no manejo pré-abate, mas não afetam (P>0,05) os níveis de glicose, lactato e CPK no abate dos suínos.

Refining the intestinal motility test in mice to reduce animal stress

A new protocol using 3-h fast animal for intestinal motility test was developed in our laboratory aiming the 3R's concept to reduce the stress of animals. Our results may aid in formulating recommendations that can be included in revised guidelines with regard to fasting time of mice.

Protocol to refine intestinal motility test in mice

We propose a new protocol intended to conform to the 3Rs (replacement, reduction, and refinement) principle, using animals fasted for 3 h to control intestinal motility, which reduced stress in the animals. In this new protocol, mice are deprived of food for a short time (3 h) and are not killed. The mice are observed until evacuation containing charcoal is observed, and the experimental results are based on the charcoal evacuation time. The present study may aid the formulation of recommendations that can be included in revised guidelines relating to the fasting time of mice. This new concept of an intestinal motility test conforms with respectful science.

Efeito das condições pré-abate sobre a qualidade da carne de suínos pesados

The objective of this study was to evaluate pig fasting time at the farm (FT= 9, 12, 15 or 18 hours) and pig position into the pig lorry compartment on pork quality through liquid drip loss (DLL), pH1 evaluated at 45 minutes post slaughter and pHu evaluated 24 hours post slaughter. One hundred ninety two females, weighing 133±11 kg, from two farms were used. Pig locations were evaluated on truck compartment considering front, middle and rear (TCL) position and top or botton decks (LUD). The following effects were considered in the statistical model: block (BL= farm), FT, TCL, LUD and the interaction between BL and FT. The FT affected significantly the pH1 of Longissimus dorsi (LD) muscle, and pHu of Semispinalis capitis (SC), Longissimus dorsi (LD) and Semimembranosus (SM) muscles. Fasting time at farm equal or shorter than 12 hours resulted in carcasses with lower pHu values at LD and SM muscles and fasting time above 15 hours resulted in higher pHu on SC. There were no observed effect (p>0.05) of the evaluated sources of variation on DLL. TCL affected pH1 of SC, LD and SM muscles, and pHu of LD and SM muscles. Pigs located in middle or rear position in the lorry had no difference in pH1 of the evaluated muscles. But pigs located in the middle position of the lorry had greater values of pHu on LD and SM. It is stated that pigs fasting time at farm need to be close to 15 hours in aim of obtain higher frequency of pHu values in the normal range (5.55time transport the pigs location in lorry's compartment had effect on meat pH, however, without affect its quality.

Determinação de curva glicolítica em carcaças de aves PSE (Pale, soft, exsudative) e normal em linha de abate industrial

Some quality defects can cause changes in attributes of the meat, among these we can detach the PSE meat (Pale, Soft and Exudative). The PSE meat is pale, flaccid and exudative and result from sudden pH decrease while the carcass is still under high temperature. The identification of PSE meat has been done by measuring pH and L* (Lightness). However, studies suggest that a more precise evaluation of the kinetics of pH and temperature decrease has to be conducted to better understand the etiology of PSE meat in poultry. The aim of this study was to obtain the glycolytic curve for normal and PSE meat of chicken, through the pH, L* and CRA (water holding capacity) analysis. This experiment was conducted with carcasses obtained from a commercial slaughterhouse (n = 35) of Cobb lineage, 50 days old, from the same batch of creation and with the same pre-slaughter fasting time (10h). Samples of breast fillets were obtained from carcasses randomly collected immediately at the output of pre-cooling chiller, and the analysis of pH, temperature and L * were conducted in the same in times 1h35, 2h35, 3h35, 5h35, 8h35, 11h35, 14h35, 17h35, 20h35, 23h35 and 25h35 post mortem. The CRA analyzes were performed at the time of 25h35 post mortem. The pH measurements indicated that only from the 04 time (8h35 post mortem) was possible to verify an indicative of stabilization, being that PSE meat pH was 5,69±0,07, and normal meat was 5,93±0,09. The final pH (25h35 post mortem) was 5,98±0,06 and L* 57,30± 2,39 for normal meat, while for PSE meat the result was 5,72±0,06 and L* 59,44±1,51. To CRA, the average of the samples (67,19±3.13 and 64,45± 2.66) showed a difference between the normal chicken fillets and PSE respectively. The data found in this study are consistent with those reported by own research group in another slaughterhouse and contradicts similar works, but made at room temperature, indicating that for chickens under commercial conditions the resolution of rigor mortis occurs after 8h35 post mortem.

Increased cardio-metabolic risk is associated with increased TV viewing time

Purpose: Television viewing time, independent of leisure-time physical activity, has cross-sectional relationships with the metabolic syndrome and its individual components. We examined whether baseline and five-year changes in self-reported television viewing time are associated with changes in continuous biomarkers of cardio-metabolic risk (waist circumference, triglycerides, high density lipoprotein cholesterol, systolic and diastolic blood pressure, fasting plasma glucose; and a clustered cardio-metabolic risk score) in Australian adults. Methods: AusDiab is a prospective, population-based cohort study with biological, behavioral, and demographic measures collected in 1999–2000 and 2004–2005. Non-institutionalized adults aged ≥ 25 years were measured at baseline (11,247; 55% of those completing an initial household interview); 6,400 took part in the five-year follow-up biomedical examination, and 3,846 met the inclusion criteria for this analysis. Multiple linear regression analysis was used and unstandardized B coefficients (95% CI) are provided. Results: Baseline television viewing time (10 hours/week unit) was not significantly associated with change in any of the biomarkers of cardio-metabolic risk. Increases in television viewing time over five years (10 hours/week unit) were associated with increases in: waist circumference (cm) (men: 0.43 (0.08, 0.78), P = 0.02; women: 0.68 (0.30, 1.05), P <0.001), diastolic blood pressure (mmHg) (women: 0.47 (0.02, 0.92), P = 0.04), and the clustered cardio-metabolic risk score (women: 0.03 (0.01, 0.05), P = 0.007). These associations were independent of baseline television viewing time and baseline and change in physical activity and other potential confounders. Conclusion: These findings indicate that an increase in television viewing time is associated with adverse cardio-metabolic biomarker changes. Further prospective studies using objective measures of several sedentary behaviors are required to confirm causality of the associations found.

A study of patient attitudes towards fasting prior to intravenous sedation for dental treatment in a dental hospital department

INTRODUCTION: Intravenous sedation is the most commonly used method of sedation for the provision of adult dental care. However, disparity exists in pre-operative fasting times in use for patients throughout the United Kingdom.

AIMS: The aims of the study were to obtain information on the effects of existing extended pre-operative fasting regimens, to canvas patient opinions on the fasting process, and to record their positive and negative experiences associated with it.

METHODS: A prospective cross-sectional descriptive study using survey methodology was conducted of adult patients attending a dental hospital for operative treatment under intravenous sedation. Sixty-four questionnaires were distributed over a four-month period, beginning 2nd October 2007.

RESULTS: The surveyed patient pool consisted of 38 females and 14 males with a mean age of 32.4 years. The response rate achieved was 81.2%. Seventy-one per cent of patients indicated that normally they consumed something for breakfast, the most common items being tea and toast. Fifty-one per cent of patients indicated that they would wish to eat the same as normal prior to their appointment and 59% wished to drink as normal. Only 19% of respondents reported that they did not wish to eat anything, with 8% preferring not to drink anything at all. Seventy-nine per cent of the patients reported that they had experienced at least one adverse symptom after fasting and 42% had experienced two or more such symptoms. In general, those patients with more experience of sedation found fasting less unpleasant than those attending for the first time (P<0.05). In addition, one-quarter of all patients indicated that the fasting process had made them feel more nervous about their sedation appointment.

CONCLUSIONS: The extended fasting regimen prior to intravenous sedation appeared to affect patients' wellbeing, as the majority reported adverse symptoms.

Metabolic changes in Brycon cephalus (Teleostei, Characidae) during post-feeding and fasting

Metabolic changes during the transition from post-feeding to fasting were studied in Brycon cephalus, an omnivorous teleost from the Amazon Basin in Brazil. Body weight and somatic indices (liver and digestive tract), glycogen and glucose content in liver and muscle, as well as plasma glucose, free fatty acids (FFA), insulin and glucagon levels of B. cephalus, were measured at 0, 12, 24, 48, 72, 120, 168 and 336 h after the last feeding. At time 0 h (the moment of food administration, 09.00 h) plasma levels of insulin and glucagon were already high, and relatively high values were maintained until 24 h post-feeding. Glycemia was 6.42 +/- 0.82 mM immediately after food ingestion and 7.53 +/- 1.12 MM at 12 h. Simultaneously, a postprandial replenishment of liver and muscle glycogen reserves was observed. Subsequently, a sharp decrease of plasma insulin occurred, from 7.19 +/- 0.83 ng/ml at 24 h of fasting to 5.27 +/- 0.58 ng/ml at 48 h. This decrease coincided with the drop in liver glucose and liver glycogen, which reached the lowest value at 72 h of fasting (328.56 +/- 192.13 and 70.33 +/- 14.13 mumol/g, respectively). Liver glucose increased after 120 h and reached a peak 168 h post-feeding, which suggests that hepatic gluconeogenesis is occurring. Plasma FFA levels were low after 120 and 168 h and increased again at 336 h of fasting. During the transition from post-feeding to fast condition in B. cephalus, the balance between circulating insulin and glucagon quickly adjust its metabolism to the ingestion or deprivation of food. (C) 2002 Elsevier B.V. All rights reserved.

ALTERED FOCI OF HEPATOCYTES IN RATS INITIATED WITH DIETHYLNITROSAMINE AFTER PROLONGED FASTING

The influence of fasting on the potential of diethylnitrosamine (DEN) to initiate liver cucinogenesis was tested in a medium-term assay using the development of putative preneoplastic altered foci of hepatocytes (AFH) as the endpoint. Male Wistar rats fasted for 48 hr were given a single ip injection of DEN (200 mg/kg body weight). Partial hepatectomies were carried out at wk 3 and the rats were killed at wk 8. Fasted rats exhibited a small increase in the numbers of AFH with glutathione S-transferase in the placental form and eosinophilic AFH when compared with non-fasted animals. However, after a 6-wk exposure to 0.05% sodium phenobarbital in the diet, there were no differences in the numbers of AFH between fasted and non-fasted animals. Fasting also increased DEN-dependent centrilobular cell necrosis and specifically drug metabolism as indicated in vivo by a decreased time of paralysis of the lower limbs induced by zoxazolamine (40 mg/kg body weight, ip) and by an unaltered sleeping time induced by sodium pentobarbital (40 mg/kg body weight, ip). The results indicate that although fasting during the initiation stage of carcinogenesis increases DEN hepatotoxicity, it does not interfere quantitatively with the development of liver preneoplastic lesions.