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1. Fasting Glucose Variation Predicts Microvascular Risk in ACCORD and VADT

   https://doi.org/10.1210/clinem/dgaa941  

   Zhou, Jin J; Koska, Juraj; Bahn, Gideon; Reaven, Peter (December 2020, The Journal of Clinical Endocrinology & Metabolism)

   Abstract Aims The association of glycemic variability with microvascular disease complications in type 2 diabetes (T2D) has been under-studied and remains unclear. We investigated this relationship using both Action to Control Cardiovascular Risk in Diabetes (ACCORD) and the Veteran Affairs Diabetes Trial (VADT). Methods In ACCORD, fasting plasma glucose (FPG) was measured 1 to 3 times/year for up to 84 months in 10 251 individuals. In the VADT, FPG was measured every 3 months for up to 87 months in 1791 individuals. Variability measures included coefficient of variation (CV) and average real variability (ARV) for fasting glucose. The primary composite outcome was time to either severe nephropathy or retinopathy event and secondary outcomes included each outcome individually. To assess the association, we considered variability measures as time-dependent covariates in Cox proportional hazard models. We conducted a meta-analysis across the 2 trials to estimate the risk of fasting glucose variability as well as to assess the heterogenous effects of FPG variability across treatment arms. Results In both ACCORD and the VADT, the CV and ARV of FPG were associated with development of future microvascular outcomes even after adjusting for other risk factors, including measures of average glycemic control (ie, cumulative average of HbA1c). Meta-analyses of these 2 trials confirmed these findings and indicated FPG variation may be more harmful in those with less intensive glucose control. Conclusions This post hoc analysis indicates that variability of FPG plays a role in, and/or is an independent and readily available marker of, development of microvascular complications in T2D. 

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2. Heterogeneous effects of genetic variants and traits associated with fasting insulin on cardiometabolic outcomes

   https://doi.org/10.1038/s41467-025-57452-y  

   Sevilla-González, Magdalena; Smith, Kirk; Wang, Ningyuan; Jensen, Aubrey E; Litkowski, Elizabeth M; Kim, Hyunkyung; DiCorpo, Daniel A; Hsu, Sarah; Cui, Jinrui; Liu, Ching-Ti; et al (December 2025, Nature Communications)
3. From self-deprivation to cooperation: How Ramadan fasting influences risk-aversion and decisions in resource dilemmas

   https://doi.org/10.1016/j.cresp.2023.100152  

   Rad, Mostafa Salari (January 2023, Current Research in Ecological and Social Psychology)
4. Intra-seasonal variation in feeding rates and diel foraging behaviour in a seasonally fasting mammal, the humpback whale

   https://doi.org/10.1098/rsos.211674  

   Nichols, Ross C; Cade, David E; Kahane-Rapport, Shirel; Goldbogen, Jeremy; Stimpert, Alison; Nowacek, Douglas; Read, Andrew J; Johnston, David W; Friedlaender, Ari (July 2022, Royal Society Open Science)

   Antarctic humpback whales forage in summer, coincident with the seasonal abundance of their primary prey, the Antarctic krill. During the feeding season, humpback whales accumulate energy stores sufficient to fuel their fasting period lasting over six months. Previous animal movement modelling work (using area-restricted search as a proxy) suggests a hyperphagic period late in the feeding season, similar in timing to some terrestrial fasting mammals. However, no direct measures of seasonal foraging behaviour existed to corroborate this hypothesis. We attached high-resolution, motion-sensing biologging tags to 69 humpback whales along the Western Antarctic Peninsula throughout the feeding season from January to June to determine how foraging effort changes throughout the season. Our results did not support existing hypotheses: we found a significant reduction in foraging presence and feeding rates from the beginning to the end of the feeding season. During the early summer period, feeding occurred during all hours at high rates. As the season progressed, foraging occurred mostly at night and at lower rates. We provide novel information on seasonal changes in foraging of humpback whales and suggest that these animals, contrary to nearly all other animals that seasonally fast, exhibit high feeding rates soon after exiting the fasting period 

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5. Distinct Metabolic States Are Observed in Hypoglycemia Induced in Mice by Ricin Toxin or by Fasting

   https://doi.org/10.3390/toxins14120815  

   Kempa, Jacob; O’Shea-Stone, Galen; Moss, Corinne E.; Peters, Tami; Marcotte, Tamera K.; Tripet, Brian; Eilers, Brian; Bothner, Brian; Copié, Valérie; Pincus, Seth H. (November 2022, Toxins)

   Hypoglycemia may be induced by a variety of physiologic and pathologic stimuli and can result in life-threatening consequences if untreated. However, hypoglycemia may also play a role in the purported health benefits of intermittent fasting and caloric restriction. Previously, we demonstrated that systemic administration of ricin toxin induced fatal hypoglycemia in mice. Here, we examine the metabolic landscape of the hypoglycemic state induced in the liver of mice by two different stimuli: systemic ricin administration and fasting. Each stimulus produced the same decrease in blood glucose and weight loss. The polar metabolome was studied using 1H NMR, quantifying 59 specific metabolites, and untargeted LC-MS on approximately 5000 features. Results were analyzed by multivariate analyses, using both principal component analysis (PCA) and partial least squares-discriminant analysis (PLS-DA), to identify global metabolic patterns, and by univariate analyses (ANOVA) to assess individual metabolites. The results demonstrated that while there were some similarities in the responses to the two stimuli including decreased glucose, ADP, and glutathione, they elicited distinct metabolic states. The metabolite showing the greatest difference was O-phosphocholine, elevated in ricin-treated animals and known to be affected by the pro-inflammatory cytokine TNF-α. Another difference was the alternative fuel source utilized, with fasting-induced hypoglycemia primarily ketotic, while the response to ricin-induced hypoglycemia involves protein and amino acid catabolism. 

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