Fasting State Metabolism — MCQs
Major source of energy for brain in fasting/starvation?
Liver produces ketones but cannot use it due to the deficiency of which of the following enzyme?
What is the main source of ketone bodies during fasting?
In a person fasting overnight with carnitine deficiency, which of the following chemicals increase in quantity in blood?
Gluconeogenesis is inhibited by?
In a patient who has been in a state of starvation for 72 hours, which of the following is the primary mechanism for maintaining blood glucose levels?
Not done by insulin:
Which hormone inhibits hormone-sensitive lipase?
Which hormone is known to repress the biosynthesis of the enzyme pyruvate carboxylase?
Ketone body formation without glycosuria is seen in ?
Fasting State Metabolism Indian Medical PG Practice Questions and MCQs
Question 1: Major source of energy for brain in fasting/starvation?
- A. Glucose
- B. Glycogen
- C. Fatty acids
- D. Ketone bodies (Correct Answer)
Explanation: ***Ketone bodies*** - During **prolonged fasting or starvation**, the body depletes its **glycogen stores** and begins to break down fatty acids. The liver converts these fatty acids into **ketone bodies**, such as **acetoacetate and beta-hydroxybutyrate**. - These **ketone bodies** can cross the **blood-brain barrier** and be used by the brain as an alternative energy source when glucose becomes scarce, preventing protein breakdown for gluconeogenesis. *Glucose* - While **glucose** is the primary and preferred energy source for the brain under normal physiological conditions, its availability significantly decreases during **prolonged fasting or starvation**. - The brain requires a continuous supply of glucose, but in states of severe caloric restriction, the body must conserve glucose for other critical functions and adapt by using alternative fuels. *Glycogen* - **Glycogen** is a stored form of glucose found predominantly in the **liver and muscles**. - The brain itself has minimal **glycogen stores**, which are rapidly depleted during fasting, and thus cannot be a major long-term energy source. *Fatty acids* - **Fatty acids** are a major energy source for many tissues in the body, especially during fasting, but they **cannot directly cross the blood-brain barrier** in significant amounts to fuel the brain. - Instead, **fatty acids** are metabolized into **ketone bodies** in the liver, which then serve as the brain's alternative fuel.
Question 2: Liver produces ketones but cannot use it due to the deficiency of which of the following enzyme?
- A. Alkaline phosphatase
- B. Alanine transaminase
- C. Thiophorase (Correct Answer)
- D. Thiolase
Explanation: ***Thiophorase*** - The liver lacks **thiophorase (succinyl-CoA:3-ketoacid CoA transferase)**, which is crucial for converting **acetoacetate** to **acetoacetyl-CoA**. - This enzyme deficiency prevents the liver from utilizing ketones as an energy source, even though it is a primary site for their production. *Alkaline phosphatase* - **Alkaline phosphatase** is a non-specific enzyme found in various tissues, including bone, liver, and intestine. - Its primary role is to **hydrolyze phosphate esters**, and it is not directly involved in ketone metabolism. *Alanine transaminase* - **Alanine transaminase (ALT)** is a liver enzyme primarily involved in **amino acid metabolism**, specifically in the transfer of an amino group from alanine to α-ketoglutarate. - It plays no direct role in the synthesis or utilization of ketone bodies. *Thiolase* - **Thiolase** is an enzyme involved in both the synthesis and breakdown of ketone bodies. - It converts **two acetyl-CoA molecules into acetoacetyl-CoA** during ketogenesis and also cleaves acetoacetyl-CoA into two acetyl-CoA molecules during ketolysis in extrahepatic tissues.
Question 3: What is the main source of ketone bodies during fasting?
- A. Glucose
- B. Amino acids
- C. Glycogen
- D. Fatty acids (Correct Answer)
Explanation: ***Fatty acids*** - During **fasting**, the body shifts from carbohydrate to fat metabolism to produce energy. - **Fatty acids** are broken down in the liver through **beta-oxidation** to form acetyl-CoA, which is then converted into ketone bodies. *Glucose* - **Glucose** is the primary energy source in the fed state, not during fasting. - During fasting, **glucose levels** decrease, prompting the body to seek alternative fuel sources. *Amino acids* - While some **amino acids** can be converted into glucose (gluconeogenesis) or ketone bodies, they are a secondary source. - **Protein breakdown** for energy is primarily a long-term adaptation to starvation, not the main initial source of ketone bodies. *Glycogen* - **Glycogen stores** (mainly in the liver and muscles) are used during the initial hours of fasting. - Once these stores are depleted, usually within 12-24 hours, the body relies on **fatty acid oxidation** for energy, leading to ketone body production.
Question 4: In a person fasting overnight with carnitine deficiency, which of the following chemicals increase in quantity in blood?
- A. Ketone body levels
- B. Fatty acid levels (Correct Answer)
- C. Glucose levels
- D. Amino acid levels
Explanation: ***Fatty acid levels*** - **Carnitine deficiency** impairs the transport of **long-chain fatty acids** into the mitochondria for beta-oxidation. - This leads to an accumulation of **fatty acids** in the blood as they cannot be efficiently metabolized for energy during fasting. - Therefore, **fatty acid levels increase** in the blood. *Ketone body levels* - **Ketone bodies** are produced from the **beta-oxidation of fatty acids** in the liver. - With **carnitine deficiency**, fatty acid oxidation is impaired, thus **reducing** the production of ketone bodies, not increasing them. *Glucose levels* - During **fasting**, the body relies on **gluconeogenesis** and **glycogenolysis** to maintain glucose levels. - With carnitine deficiency primarily affecting fat metabolism and preventing fatty acid utilization, the body cannot spare glucose effectively. - This leads to **hypoglycemia** (decreased glucose), not increased glucose levels. *Amino acid levels* - **Amino acid metabolism** is largely independent of **carnitine**. - While amino acids can be used for gluconeogenesis during fasting, carnitine deficiency does not directly cause an increase in circulating amino acid levels.
Question 5: Gluconeogenesis is inhibited by?
- A. Cholecystokinin
- B. 5-alpha reductase
- C. Insulin (Correct Answer)
- D. Glucagon
Explanation: ***Insulin*** - **Insulin** is a key hormone released in response to high blood glucose, promoting glucose uptake and storage, and **inhibiting hepatic glucose production** through gluconeogenesis and glycogenolysis. - It achieves this by decreasing the transcription and activity of key gluconeogenic enzymes like **phosphoenolpyruvate carboxykinase (PEPCK)** and **glucose-6-phosphatase**. *Cholecystokinin* - **Cholecystokinin (CCK)** is a gastrointestinal hormone primarily involved in digestion, stimulating bile release and pancreatic enzyme secretion. - It does not directly regulate gluconeogenesis; its main role is related to **fat and protein digestion**. *5-alpha reductase* - **5-alpha reductase** is an enzyme involved in steroid metabolism, converting testosterone to the more potent androgen, dihydrotestosterone (DHT). - This enzyme has no direct role in the regulation of **gluconeogenesis**. *Glucagon* - **Glucagon** is a hormone that has the opposite effect of insulin, stimulating gluconeogenesis and glycogenolysis to increase blood glucose levels during fasting or hypoglycemia. - Its primary action is to **promote** hepatic glucose output, not inhibit it.
Question 6: In a patient who has been in a state of starvation for 72 hours, which of the following is the primary mechanism for maintaining blood glucose levels?
- A. Increased gluconeogenesis (Correct Answer)
- B. Increased protein degradation
- C. Increased glycogenolysis
- D. Increased ketosis due to breakdown of fats
Explanation: ***Increased gluconeogenesis*** - After 72 hours of starvation, **hepatic glycogen stores** are completely depleted, making gluconeogenesis the primary and essential mechanism to maintain **blood glucose levels**. - This process synthesizes glucose from non-carbohydrate precursors like **amino acids** (mainly alanine and glutamine), **lactate**, and **glycerol** to supply glucose for obligate glucose-dependent tissues like **red blood cells** and the **renal medulla**, and provides baseline glucose for the brain. - Gluconeogenesis occurs primarily in the **liver** and to a lesser extent in the **kidney cortex** during prolonged fasting. *Increased protein degradation* - While **protein degradation** does occur to supply amino acids for gluconeogenesis, the body actively minimizes this to preserve muscle mass, especially after prolonged starvation. - The initial phase of starvation (first 24-48 hours) sees more significant protein breakdown, but its rate decreases substantially after 72 hours as the body becomes increasingly **protein-sparing** and shifts to fatty acid oxidation and ketone body production. *Increased glycogenolysis* - **Hepatic glycogen stores** are typically depleted within **12-24 hours** of starvation. - After 72 hours, there is essentially no glycogen remaining to break down, so **glycogenolysis** cannot contribute to maintaining blood glucose at this stage. *Increased ketosis due to breakdown of fats* - **Ketosis** does dramatically increase after 72 hours of starvation as the body shifts to using **fatty acids** for energy and producing **ketone bodies** (β-hydroxybutyrate and acetoacetate) for the brain and other tissues. - However, while ketone bodies serve as an alternative fuel source for the brain (providing up to 60-70% of its energy needs), they **cannot replace glucose entirely** because certain tissues (red blood cells, renal medulla) are obligate glucose users and cannot utilize ketones. - The question specifically asks about maintaining **blood glucose levels**, which requires gluconeogenesis, not ketone production.
Question 7: Not done by insulin:
- A. Glycolysis
- B. Lipogenesis
- C. Ketogenesis (Correct Answer)
- D. Glycogen synthesis
Explanation: ***Ketogenesis*** - **Ketogenesis** is primarily a catabolic process stimulated by low insulin levels or insulin resistance, particularly during prolonged fasting or uncontrolled diabetes. - Insulin's main role is to promote anabolic processes and energy storage, thus it **inhibits ketogenesis** rather than performing it. *Glycolysis* - **Insulin** promotes **glycolysis** by increasing the expression and activity of key glycolytic enzymes, facilitating glucose breakdown for energy. - It enhances the uptake of **glucose into cells**, where it can then be metabolized via glycolysis. *Lipogenesis* - **Insulin** is a potent stimulator of **lipogenesis**, promoting the synthesis of fatty acids and triglycerides from excess glucose. - This process helps store excess energy in adipose tissue, converting carbohydrates into **fat**. *Glycogen synthesis* - **Insulin** directly stimulates **glycogen synthesis** (glycogenesis) in the liver and muscle cells. - It promotes the uptake of **glucose** and activates enzymes like **glycogen synthase**, leading to storage of glucose as glycogen.
Question 8: Which hormone inhibits hormone-sensitive lipase?
- A. Insulin (Correct Answer)
- B. GH
- C. ACTH
- D. Thyroid hormone
Explanation: ***Insulin*** - **Insulin** is a key anabolic hormone that promotes energy storage and inhibits catabolic processes, including the breakdown of triglycerides. - It directly inhibits **hormone-sensitive lipase (HSL)** activity, thus reducing the release of free fatty acids from adipose tissue. *Thyroid hormone* - **Thyroid hormones** (T3 and T4) generally promote catabolism and increase metabolic rate, including the mobilization of lipids. - They tend to **stimulate rather than inhibit** hormone-sensitive lipase expression and activity. *GH* - **Growth hormone (GH)** has lipolytic effects, meaning it promotes the breakdown of fats to provide energy. - GH typically **stimulates HSL activity** and increases the release of free fatty acids from adipocytes. *ACTH* - **Adrenocorticotropic hormone (ACTH)** primarily stimulates the adrenal cortex to produce cortisol. - **Cortisol** can have lipolytic effects in certain contexts and does not directly inhibit HSL; instead, catecholamines act as direct stimulators of HSL.
Question 9: Which hormone is known to repress the biosynthesis of the enzyme pyruvate carboxylase?
- A. Cortisol
- B. Glucagon
- C. Insulin (Correct Answer)
- D. Growth hormone
Explanation: ***Insulin*** - **Insulin** is an anabolic hormone that promotes glucose utilization and opposes **gluconeogenesis**. - While insulin does inhibit hepatic glucose production, it primarily acts by **repressing PEPCK (phosphoenolpyruvate carboxykinase)**, the rate-limiting enzyme of gluconeogenesis, rather than directly repressing pyruvate carboxylase biosynthesis. - **Note:** Modern biochemistry emphasizes that insulin's main transcriptional target in gluconeogenesis is **PEPCK**, not pyruvate carboxylase. However, this was the expected answer for **NEET-2012**, reflecting the understanding at that time. - Insulin also promotes dephosphorylation and inactivation of gluconeogenic enzymes and enhances glucose uptake and glycolysis. *Glucagon* - **Glucagon** is a catabolic hormone that **activates** enzymes involved in **gluconeogenesis** and glycogenolysis to raise blood glucose levels. - It would **increase**, not repress, the biosynthesis and activity of gluconeogenic enzymes including **pyruvate carboxylase**. *Cortisol* - **Cortisol** is a glucocorticoid hormone that **stimulates gluconeogenesis** in the liver as part of the stress response. - It typically **upregulates** the synthesis and activity of gluconeogenic enzymes like **pyruvate carboxylase** and **PEPCK**. *Growth hormone* - **Growth hormone** generally **increases insulin resistance** and can have a **diabetogenic effect**, promoting glucose production rather than repressing gluconeogenic enzymes. - It does not directly repress gluconeogenic enzyme biosynthesis; its metabolic effects favor lipolysis and protein synthesis.
Question 10: Ketone body formation without glycosuria is seen in ?
- A. Diabetes mellitus
- B. Diabetes insipidus
- C. Starvation (Correct Answer)
- D. Obesity
Explanation: ***Starvation*** - During **starvation**, the body depletes its **glycogen stores** and begins to break down **fat for energy**. This process leads to the production of **ketone bodies** (acetoacetate, beta-hydroxybutyrate, and acetone) as an alternative fuel source for the brain and other tissues. - Since there is no underlying problem with **insulin production** or action, blood glucose levels are typically low or normal, and therefore, **glycosuria** (glucose in the urine) is absent. *Diabetes mellitus* - In **uncontrolled diabetes mellitus**, especially Type 1, the body cannot effectively use **glucose** due to lack of insulin, leading to high blood glucose levels (**hyperglycemia**) and subsequently **glycosuria**. - The body then compensates by breaking down **fats**, leading to the formation of **ketone bodies** (**diabetic ketoacidosis**), which results in both **ketonuria** and **glycosuria**. *Diabetes insipidus* - **Diabetes insipidus** is a condition characterized by the inability to conserve water due to insufficient **antidiuretic hormone (ADH)** production or action, leading to excessive urination and thirst. - It does not involve abnormalities in **glucose metabolism** or **ketone body production** and therefore does not typically present with ketonuria or glycosuria. *Obesity* - While **obesity** can lead to **insulin resistance** and is a risk factor for Type 2 Diabetes, it does not directly cause **ketone body formation** in the absence of metabolic derangements such as those seen in uncontrolled diabetes or prolonged starvation. - In most cases of obesity without diabetes, **glucose metabolism** is still adequate enough to prevent significant reliance on **fat breakdown** for energy, meaning there is usually no ketonuria or glycosuria.
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