Human Metabolism. Keith N. Frayn

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terms anabolism and catabolism are useful but can be confusing and have frequently been misused. They should be used to refer to whole-body energy strategy:

      Hence, in the postprandial state, after a meal, we are entering an anabolic state, whereas in the post-absorptive state, following absorption and disposition of the meal, we are entering a catabolic state. This is signalled by insulin.

      Classic physiological catabolic states include fasting/starvation (decreased energy intake) and exercise (increased energy expenditure). Diabetes mellitus is an example of a pathological catabolic state (failure of insulin signalling).

      If the terms are applied to individual metabolic pathways, or even individual steps, confusion can arise. For example glycolysis may be thought of as ‘catabolic’ in exercising muscle, breaking down glucose to provide energy for contraction (net energy mobilisation), but ‘anabolic’ in liver in the well-fed postprandial state, when absorbed glucose is converted to pyruvate, but the resulting acetyl-CoA undergoes lipogenesis to fat for energy storage. When analysing metabolism it is important to consider the whole body (anabolic? catabolic?) as well as individual tissues, as these all have specialised metabolic profiles and functions (see Chapter 5).

      The body is subject to many catabolic signals (e.g. ‘stress hormones,’ catecholamines, glucocorticoids, glucagon etc., but one major anabolic signal – insulin. Insulin inhibits catabolism, and therefore when it declines, unopposed catabolism results. This is one rea- son why insulin is such a crucial signal, and diabetes such an important disease.

      The rate of energy production is measured under basal conditions (no voluntary muscle contraction; thermoneutrality) – ‘basal metabolic rate’ (BMR), and is affected by many factors, including muscle contraction, food ingestion, size, gender, age, temperature, sepsis, and several hormones, including thyroid hormones and catecholamines. The metabolic rate can be estimated by measuring the oxygen consumption (VO2; indirect calorimetry). For carbohydrate metabolism the rate of CO2 production (VCO2) equals VO2 (C6H12O6 + 6O2 → 6CO2 + 6H2O) and the ratio VCO2/VO2, termed the respiratory quotient (RQ), is 6/6 = 1. For lipid oxidation, however, this is not true (e.g. tripalmitin: 2C51H98O6 + 145O2 → 102CO2 + 98H2O; RQ = 102/145 = 0.70) and measurement of RQ can provide useful information on substrate selection and utilisation. This will be discussed further in Chapter 11 (Box 11.2).

      1.3.1.1 Energy transduction

      1.3.1.2 Energy substrates

      By utilising three, chemically diverse, fuel groups, overall metabolic flexibility and hence efficiency are achieved. Energy derived from these compounds is all based on a reduced carbon atom i.e. the C–H bond. Hence, the more C–H bonds, the more reduced the molecule and the more energy it contains, whereas oxidised or partially oxidised carbon (C–O) lacks biochemically usable energy (see Section 1.2.1.3). However, generally speaking, the more reduced the substrate, the less water soluble it is likely to be. This may be an advantage or a disadvantage, depending on the role of the substrate.

      Fats are the most energy-dense metabolic fuels (∼37 kJ g−1): lipids are highly reduced (energetic), water-insoluble, and very energy-dense, hence their function as the principal energy store for free-living animals, and are major energy providers to most (oxidative) tissues. However, their water-insolubility makes lipids problematic and slow to mobilise, and unlike carbohydrates they cannot yield energy anaerobically – they must be oxidised, therefore cannot be used by red blood cells (erythrocytes) and renal medulla. Because they are more reduced, relatively more oxygen is required to extract energy from lipids (2.8 ATP/O2) compared to carbohydrates (3.7 ATP/O2) and this may be critical in high work-load oxygen-challenged tissues such as myocardium (and exercising skeletal muscle). The storage form of lipids for energy provision is triacylglycerol, which comprises three fatty acids esterified to a glycerol backbone. Being highly hydrophobic and reduced, triacylglycerols are very energy dense and a highly efficient energy store. However, triacylglycerols are relatively slow to mobilise, must be oxidised to yield energy and cannot provide energy anaerobically, and the NEFAs from which they are assembled are amphipathic (detergent- like) and hence potentially toxic in high concentrations, disrupting structural lipids especially in the central nervous system: they cannot cross the blood-brain barrier so also cannot be used by the central nervous system (more detail in Section 5.6). Furthermore, fatty acids cannot be converted into carbohydrates or proteins, limiting their metabolic flexibility.

      Proteins (polymers of amino acids) have similar energy content to carbohydrates (∼17 kJ g−1), but each protein has a specific biological function and they are not used as dedicated energy stores. Amino acids (proteins) have similar energy yields to carbohydrates i.e. they are partially oxidised to about the same extent as carbohydrates, and overall have comparable solubility; since most can be converted into glucose (‘glucogenic’), they have similar metabolic flexibility to carbohydrates. In catabolic states of carbohydrate depletion (e.g. starvation), however, proteins are broken down to their constituent amino acids for conversion into glucose to supply glucose-dependent tissues such as brain and erythrocytes

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