Insulin secretion and glucose tolerance in adults with protein-calorie malnutrition

Glucose tolerance, insulin secretion, and responses to arginine infusion were studied in 17 adults with severe protein-calorie malnutrition (PCM) in Calcutta, India. Patients were selected for the severity of their malnutrition and for absence of other diseases. After 2-4 mo of refeeding there was complete clinical recovery, and control studies were performed. Glucose tolerance, as assessed by intravenous glucose-tolerance test (IVGTT), was reduced in PCM. Insulin response, both to glucose and to arginine infusion, was clearly reduced. The K value of the IVGTT correlated well with the ratio of mean to basal serum insulin during the first 40 min of the test. Basal serum insulin was nearly unchanged in PCM as compared with after recovery, although one patient studied serially showed a temporary drop in basal insulin during the first week of refeeding. In PCM, plasma amino acid levels failed to fall in response to arginine-induced insulin secretion as they did in the control studies. It appears that insulin secretory response is severely reduced in PCM and that a degree of insulin resistance in relation to body weight is present. These changes result in diminished glucose tolerance and probably in a reduced rate of tissue utilization of amino acids. Such alterations may be of adaptive significance in chronic PCM.

The pituitary-gonadal axis in men with protein-calorie malnutrition

The pituitary-gonadal axis was studied in 28 men with severe protein-calorie malnutrition in a Calcutta hospital. The men were selected for the severity of their malnutrition and for absence of other diseases. They had clinical findings of hypogonadism and low total and unbound plasma testosterone. During 2-5 months of refeeding there was clinical recovery and increase of plasma testosterone to normal. Plasma LH was high in malnutrition, decreased during refeeding, and remained above normal after refeeding. Some patients failed to show LH elevation in malnutrition despite low plasma tesosterone. Plasma FSH was high in malnutrition, decreased during refeeding, and was near the level of normal Indian men after refeeding. HCG 4000 IU im per day for 3 days produced subnormal increments in plasma testosterone both in malnutrition and after refeeding; corresponding decreases in FSH occurred. It is concluded that the hypogonadism of protein-calorie malnutrition is primarily on the basis of diminished Leydig cell function. Appropriate pituitary LH response is intact in some patients, but is either absent or inadequate in others. Subclinical Leydig cell insufficiency, indicated by LH elevation and subnormal response to HCG, persists after refeeding has produced recovery from malnutrition and clinical hypogonadism. FSH elevation in malnutrition may be secondary to the reduced Leydig cell function.

Circulating thyroid hormones and thyrotropin in adult patients with protein-calorie malnutrition

We studied plasma concentrations of thyroxine (T4), triiodothyronine (T3), free T4, free T3, thyrotropin (TSH), albumin and thyroxine-binding globulin (TBG) before and following 56 to 145 days (mean, 85) of refeeding in ten Indian patients who had severe protein-calorie malnutrition (PCM). The mean baseline plasma T4 concentration of 8.2 mug per 100 ml in these patients was comparable to the corresponding post-treatment value of 7.7 mug per 100 ml. However, since the dialyzable fraction of T4 (DFT4) was considerably higher (0.048 vs 0.029%), the mean baseline plasma free T4 concentration, 3.8 ng per 100 ml, was significantly greater than the mean post-treatment value of 2.2 ng per 100 ml. The mean baseline plasma concentration of T3, 21 ng per 100 ml, was markedly lower than the corresponding value of 96 ng per 100 ml after treatment. The mean plasma concentration of free T3, 94 pg per 100 ml, was also significantly lower than the post-treatment value of 303 pg per 100 ml. This was the case even when the mean DFT3 prior to treatment was significantly higher than that following treatment (0.46 vs 0.32%). The mean baseline ratio of plasma concentrations of total T3 and T4 (T3/T4 X 100) of 0.25 was significantly lower than the corresponding normal value of 1.3 after treatment. The mean plasma TSH concentration of 6.0 muU per ml in patients prior to treatment was comparable to the mean value of 5.5 muU per ml following treatment. The mean baseline plasma concentration of TBG of 3.3 mg per 100 ml was also comparable to the mean post-treatment value of 3.6 mg per 100 ml. The data on thyroid hormone levels in PCM can be explained if there were i) a selective increase in metabolic clearance rate of T3 without a change or a decrease in that of T4 and ii) a reversible defect in extrathyroidal conversion of T4 to T3. The latter possibility appears more likely.

Further studies with the potentiated reagin response to egg albumin

High titers of reagins were obtained in rats by initial immunization with egg albumin and <i>B. pertussis </i>and subsequent infection with larvae of <i>N. brasiliensis. </i>These antibodies have physicochemical properties and biological activities identical to those of rat immunoglobulin E (IgE). IgE type antibodies against <i>N. brasiliensis </i>are also produced in these same animals but not until the titers of IgE against egg albumin have decreased.

Extrapulmonary tuberculosis with erythema nodosum and occlusive arterial disease

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