1. Respiratory quotients in semi-starvation

One of the most valuable and detailed scientific reports on the effects of famine on man is based on observations made by Jewish physicians in the Warsaw ghetto (FLIEDERBAUM, 1979). It includes metabolic studies carried out on 70 individuals with protracted, severe undernutrition. The fasting, non-protein RQs recorded by the Jewish physicians were unusually high, with values between 0.95 to 0.98 in the majority of cases. This finding led them to conclude that the higher than normal RQ and the concomitant reduced nitrogen excretion in the urine were strongly suggestive of the exclusive utilisation of carbohydrate as metabolic fuel by these severely undernourished individuals. It is not clear from these accounts, whether the subjects maintained stable weight at the time and what their dietary intakes were like. The Jewish physicians also observed in these severely under nourished individuals that supplementation of 300 g of cane sugar daily for a week, in addition to the regular hospital diet, resulted in a rise in the fasting protein-free RQ. A similar rise in RQ was also observed within two hours following an oral sucrose load. These observations led them to conclude that patients with famine starvation or 'hunger-disease', as they preferred to call it, had a high fasting RQ, demonstrating a physiological ability of these individuals to burn endogenous carbohydrate. The further rise in RQ after an oral sucrose load implied that they retained the ability to rapidly burn exogenously administered sugars. The Jewish physicians also made the observation that, in terminal cases of hunger-disease, with losses of body weight exceeding 50%, the RQ was between 0.72 to 0.74. It is not clear whether these individuals with terminal undernutrition were losing weight at the time of the BMR measurements. It appears that the relatively high RQs of these patients fell to low levels in the terminal stages of severe weight loss, just prior to their death.