Impaired glucose absorption in children with severe malnutrition.
OBJECTIVE
To quantify intestinal glucose absorption in children with two types of severe malnutrition, kwashiorkor and marasmus, compared with healthy children.


METHODS
Children with kwashiorkor (n = 6) and marasmus (n = 9) and control subjects (n = 3) received a primed (13 mg/kg), constant infusion (0.15 mg/kg/min) of [6,6H2]glucose for 4.5 hours. Two hours after start of the infusion an oral bolus of glucose 1.75 g/kg labeled with [U-13C]glucose 10 mg/g was given and was followed by periodic blood sampling. Mathematical modeling was applied to determine oral glucose absorption.


RESULTS
Median total glucose absorption was 5.9 mmol/kg, interquartile range (IQR) 4.5-6.7 mmol/kg and 4.4 (IQR 2.9-5.9) mmol/kg in children with kwashiorkor and marasmus compared with 7.7 (IQR 5.8-9.0) mmol/kg in control subjects; P = .03 compared with marasmus). Children with the lowest glucose absorption were found specifically in the kwashiorkor group and marasmic children with hypoalbuminemia. Severe impairment in absorption correlated with urinary 8-hydroxydeoxyguanosine secretion (r = -0.62, P = .01).


CONCLUSIONS
Severe malnutrition is associated with an impaired glucose absorption and decreased glucose absorption correlates with oxidative stress in these children.
Bandsma
Robert H J
RH
Department of Biochemistry, College of Medicine, University of Malawi, Blantyre, Malawi. robert.bandsma@sickkids.ca
Spoelstra
Martijn N
MN
Mari
Andrea
A
Mendel
Marijke
M
van Rheenen
Patrick F
PF
Senga
Edward
E
van Dijk
Theo
T
Heikens
Geert Tom
GT
D001786:Blood Glucose / Q000378:metabolism*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D005260:Female; D005943:Gluconeogenesis / Q000502:physiology; D005947:Glucose / Q000008:administration & dosage* / Q000493:pharmacokinetics; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D007408:Intestinal Absorption; D007732:Kwashiorkor / Q000097:blood / Q000175:diagnosis / Q000401:mortality; D008295:Malawi; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000175:diagnosis* / Q000401:mortality*; D018384:Oxidative Stress / Q000502:physiology; D011502:Protein-Energy Malnutrition / Q000097:blood / Q000175:diagnosis / Q000401:mortality; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate
D001786:Blood Glucose; D005947:Glucose