This study investigated the molecular alterations underlying the physiological adaptations
to starvation and refeeding in human skeletal muscle. Forty-eight hours’ starvation reduced
whole-body insulin sensitivity by 42% and produced marked changes in expression of key
carbohydrate (CHO) regulatory genes and proteins: SREBP1c and hexokinase II (HKII) were
downregulated 2.5- and 5-fold, respectively, whereas the pyruvate dexydrogenase kinase 4
(PDK4) was upregulated 4-fold. These responses were not dependent on the phosphorylation
status of Akt and FOXO1. On the other hand, starvation and the concomitant increase in
circulating free fatty acids did not upregulate the expression of transcription factors and genes
involved in fat metabolism. Twenty-four hours’ refeeding with a CHO-rich diet completely
reversed the changes in PDK4, HKII and SREBP1c expression in human skeletal muscle but
failed to fully restore whole-body insulin sensitivity. Thus, during starvation in healthy humans,
unlike rodents, regulation of fat metabolism does not require an adaptive response at transcriptional
level, but adaptive changes in gene expression are required to switch off oxidative
glucose disposal. Lack of effect on key proteins in the insulin-signalling pathway may indicate that
changes in intracellular substrate availability/flux may be responsible for these adaptive changes
in glucose metabolism. This may represent an important aspect of the molecular basis of the
development of insulin resistance in metabolic conditions characterized by energy restriction.