The Effect of Acute Hypoxia Under Fed and Fasted States on Circulating B-Hydroxybutyrate Levels in Humans
Creators: name: Marcoux, Caroline
Publisher: name: Université d'Ottawa / University of Ottawa
Year: 2022
Subjects: ketone bodies
hydroxybutyrate
hypoxia

description: Introduction: Exposure to hypoxia may alter substrate utilization through diverse mechanisms. Acute hypoxia is known to increase circulating nonesterified fatty acid (NEFA) levels and reduce systemic sensitivity to insulin. The hepatic fate of NEFA is dictated by major pathways such as esterification to triglycerides and complete/partial oxidation, the latter leading to ketogenesis. To our knowledge, the effect of hypoxia on ketogenesis, more specifically ß-hydroxybutyrate (ßOHB), remains unknown in humans. Moreover, adipose tissue is a significant site of NEFA liberation into circulation, and insulin inhibits this process. Under acute hypoxia, systemic insulin resistance develops, and the suppression of lipolysis is impeded. Therefore, the objective of this study was to determine the effect of acute hypoxia on plasma circulating ßOHB levels. Furthermore, to better understand how hypoxic and prandial conditions may modulate plasma NEFA and ketonemia, we calculated the βOHB:NEFA ratio and the adipose tissue insulin resistance index (Adipo-IR), which respectively gives indications of the partial hepatic oxidation of NEFA and the adipose tissue insulin sensitivity. Methods: Plasma samples from 3 different randomized crossover studies were retrospectively assessed for ßOHB concentrations. In the first study, 14 healthy men (23 ± 3.5 years) were exposed to 6 hours of normoxia or intermittent hypoxia (IH) (15 hypoxic events per hour) following an isocaloric meal (IH-Fed). In the second study, 10 healthy men (26 ± 5.6 years) were exposed to 6 hours of continuous normobaric hypoxia (CH) (FiO2= 0.12) or normoxic conditions in the fasting state (CH-Fasted). In the third study, 9 healthy men (24 ± 4.5 years) were exposed to 6 hours of CH in a constant prandial state. ßOHB, NEFA and insulin levels were measured during all sessions (CH-Fed). The adipose tissue insulin resistance index (Adipo-IR) was also calculated from NEFA and insulin levels. Results: In study 1 (IH-Fed), ßOHB and NEFA levels tended to be greater over 6 hours of IH (condition x time interaction, p = 0.108 and p = 0.062, respectively) compared to normoxia. In study 2 (CH-Fasted), ßOHB and NEFA levels increased over time in both experimental conditions, and this effect tended to be greater under CH (condition x time interaction, p = 0.070 and p = 0.046, respectively). In study 3 (CH-Fed), ßOHB levels slightly increased up to 180 min before falling back to initial concentrations by the end of the protocol in both normoxia and CH (p = 0.062), while NEFA slightly increased under CH (p = 0.006). Adipo-IR tended to increase after 6 hours of hypoxia compared to normoxia in the first two studies (main effect of condition, p = 0.024; p = 0.097, respectively), and significantly increased over time under hypoxia in CH-Fed (condition x time interaction, p = 0.004). Conclusion: Acute normobaric hypoxia exposure significantly increases plasma ßOHB concentrations over time in healthy men. The stimulating effect of hypoxia on plasma ßOHB levels is however attenuated during postprandial and postprandial states. Contribution to advancement of knowledge: To our knowledge, this research provides some of the first evidence that an acute exposure to hypoxia increases plasma ßOHB levels in humans. It also reveals potential underlying mechanism that modulate ketogenesis upon hypoxia exposure. Overall, this thesis provides further insights into the homeostatic response of healthy men to oxygen deprivation.