Metabolic and hormonal responses to a protein-glucose meal in normal infants and in marasmus and marasmic kwashiorkor

Glucose metabolism in adult survivors of severe acute malnutrition

CONTEXT AND OBJECTIVES

The clinical syndromes of severe acute malnutrition may have early life origins because children with marasmus have lower birth weight than those with kwashiorkor. We hypothesized that resultant metabolic effects may persist into adulthood. We investigated whether marasmus survivors (MS) are more insulin resistant and glucose intolerant than kwashiorkor survivors (KS).

RESEARCH DESIGN AND SETTING

This was a case-control study in Jamaican adults.

SUBJECTS

We performed oral glucose tolerance tests on 191 adults (aged 17-50 y; 52% male; body mass index 24.2 ± 5.5 kg/m(2)). There were 43 MS; 38 KS; 70 age-, sex-, and body mass index-matched community controls; and 40 age- and birth weight-matched controls.

MEASUREMENTS

We measured insulin sensitivity with the whole-body insulin sensitivity index, and β-cell function with the insulinogenic index and the oral disposition index.

RESULTS

Fasting glucose was comparable across groups, but glucose intolerance was significantly more common in MS (19%) than in KS (3%), community controls (11%), and birth weight-matched controls (10%). The whole-body insulin sensitivity index was lower in MS than KS (P = .06) but similar between MS and controls. The insulinogenic index and oral disposition index were lower in MS compared with all three groups (P < .01).

CONCLUSIONS

Marasmus survivors tend to be less insulin sensitive, but have significantly lower insulin secretion and are more glucose intolerant compared with kwashiorkor survivors and controls. This suggests that poor nutrition in early life causes β-cell dysfunction, which may predispose to the development of diabetes.

Plasma amino acids in term neonates after a feed of human milk or formula. II. Characteristic changes in individual amino acids

Postprandial changes in plasma amino acids were studied in 23 term neonates who had previously been breast-fed ad libitum. As a test meal the infants received from a bottle a weight-based amount of banked human milk (true protein 0.8 g/100 ml) or formula with either 1.5 or 3.0 g of protein (adapted or non-adapted) per 100 ml. As regards the essential amino acids, all rose markedly in the plasma after the feed. The postprandial increments were relatively highest for the branched-chain amino acids, which rose 50-300% above the prefeeding concentrations. Peak values were found after human milk at 30 min but after formulas at 60 min. In extent and duration the rises were directly proportional to the amino acid loads given. This was also true for most semi- and non-essential amino acids, but plasma glycine, in contrast, regularly decreased, and plasma alanine continued to rise until 120 min after the beginning of the feed; neither change correlated with intake. After the milk feeds commonly given to neonates, postprandial alterations in plasma amino acids seem to be highly predictable.