title: Kwashiorkor and marasmus are both associated with impaired glucose clearance related to pancreatic β-cell dysfunction.
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)H(2)]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.
authors.affiliation: Center for Liver, Digestive and Metabolic Diseases, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Martijn N
authors.initials: MN
authors.lastname: Spoelstra
authors.forename: Andrea
authors.initials: A
authors.lastname: Mari
authors.forename: Marijke
authors.initials: M
authors.lastname: Mendel
authors.forename: Edward
authors.initials: E
authors.lastname: Senga
authors.forename: Patrick
authors.initials: P
authors.lastname: van Rheenen
authors.forename: Theo H
authors.initials: TH
authors.lastname: van Dijk
authors.forename: Dirk-Jan
authors.initials: DJ
authors.lastname: Reijngoud
authors.forename: Remco G T
authors.initials: RG
authors.lastname: Zegers
authors.forename: Geert Tom
authors.initials: GT
authors.lastname: Heikens
authors.forename: Robert H J
authors.initials: RH
authors.lastname: Bandsma
mesh_terms: D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007223:Infant; D007333:Insulin Resistance; D050417:Insulin-Secreting Cells / Q000378:metabolism*; D007732:Kwashiorkor / Q000097:blood / Q000378:metabolism*; D008297:Male; D011502:Protein-Energy Malnutrition / Q000097:blood / Q000378:metabolism*; D013997:Time Factors
chemical_list: D015415:Biomarkers; D001786:Blood Glucose