Kwashiorkor and marasmus are both associated with impaired glucose clearance related to pancreatic β-cell dysfunction

• Published in: Metabolism, clinical and experimental Vol. 61; no. 9; pp. 1224 - 1230
• Main Authors: Spoelstra, Martijn N, Mari, Andrea, Mendel, Marijke, Senga, Edward, van Rheenen, Patrick, van Dijk, Theo H, Reijngoud, Dirk-Jan, Zegers, Remco G.T, Heikens, Geert Tom, Bandsma, Robert H.J
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.09.2012; Elsevier
• Subjects: Biological and medical sciences; Biomarkers - blood; Blood Glucose - metabolism; Endocrinology & Metabolism; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Glucose Tolerance Test; Humans; Infant; Insulin Resistance; Insulin-Secreting Cells - metabolism; Kwashiorkor - blood; Kwashiorkor - metabolism; Male; Medical sciences; Metabolic diseases; Other nutritional diseases (malnutrition, nutritional and vitamin deficiencies...); Protein-Energy Malnutrition - blood; Protein-Energy Malnutrition - metabolism; Time Factors; Vertebrates: anatomy and physiology, studies on body, several organs or systems; FFA; mid upper arm circumference; oral glucose tolerance test; tracer-to-tracee ratio; free fatty acids; MDA; MUAC; EGP; endogenous glucose production; TTR; 8-hydroxydeoxyguanosine; SEM; malondialdehyde; standard error of the mean; OGTT; 8-OhdG; Association; Kwashiorkor; Dysfunction; Nutrition disorder; Marasmus; β Cell; Clearance; Glucose; Malnutrition; Pancreas; Endocrinology
• ISSN: 0026-0495; 1532-8600
• DOI: 10.1016/j.metabol.2012.01.019

Abstract Severe malnutrition is a major health problem in developing countries and can present as kwashiorkor or marasmus. Kwashiorkor is associated with septicaemia, profound metabolic changes including hepatic steatosis, altered protein metabolism and increased oxidative stress. Limited data suggest that children with kwashiorkor have an impaired glucose tolerance and insulin secretion. Our objective was to determine glucose tolerance in children with kwashiorkor compared to marasmus and its relation to insulin secretion and sensitivity. Six children with kwashiorkor and 8 children with marasmus were studied. We were also able to include 3 healthy children for comparison. They received a primed (13 mg/kg), constant infusion (0.15 mg/kg/min) of [6,6-2 H2 ]glucose for 4 h with serial blood sampling. In addition, an oral glucose tolerance test (OGTT) was performed with labeled 10 mg/g [U-13 C]glucose. Glucose clearance was determined using mathematical modeling. Glucose clearance rates during the OGTT were −392 (range 309) mL/kg in children with kwashiorkor, −156 (426) mL/kg in marasmus and 279 (345) mL/kg in the control group. Glucose clearance rates correlated with plasma albumin concentrations ( r = 0.67, P = .001). Insulin responses were strongly impaired in both kwashiorkor and marasmus. There was no indication of peripheral or hepatic insulin resistance in the malnourished groups. We show that glucose clearance rates are affected in both children with marasmus as well as kwashiorkor, which correlate with plasma albumin concentrations. The disturbed glucose clearance in malnutrition is related to an impairment in insulin availability.