Center for Liver, Digestive and Metabolic Diseases, University Medical Center Groningen, Groningen, The Netherlands.
Metabolism. 2012 Sep;61(9):1224-30. doi: 10.1016/j.metabol.2012.01.019. Epub 2012 Mar 3.
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.
严重营养不良是发展中国家的一个主要健康问题，可表现为夸希奥科或消瘦型营养不良。夸希奥科与败血症、包括肝脂肪变性在内的深刻代谢变化、蛋白质代谢改变和氧化应激增加有关。有限的数据表明，患有夸希奥科的儿童糖耐量和胰岛素分泌受损。我们的目的是确定与消瘦型营养不良相比，患有夸希奥科的儿童的葡萄糖耐量及其与胰岛素分泌和敏感性的关系。研究了 6 名患有夸希奥科的儿童和 8 名患有消瘦型营养不良的儿童。我们还能够纳入 3 名健康儿童进行比较。他们接受了 13mg/kg 的[6,6-(2)H(2)]葡萄糖的初始（13mg/kg）和恒速（0.15mg/kg/min）输注 4 小时，同时进行了连续采血。此外，还进行了 10mg/g[U-(13)C]葡萄糖的口服葡萄糖耐量试验（OGTT）。使用数学模型确定葡萄糖清除率。在 OGTT 期间，夸希奥科患儿的葡萄糖清除率为-392（范围 309）mL/kg，消瘦型营养不良患儿为-156（426）mL/kg，对照组为 279（345）mL/kg。葡萄糖清除率与血浆白蛋白浓度相关（r=0.67，P=.001）。在夸希奥科和消瘦型营养不良患儿中，胰岛素反应均严重受损。营养不良组没有外周或肝胰岛素抵抗的迹象。我们表明，在消瘦型营养不良和夸希奥科患儿中，葡萄糖清除率均受到影响，这与血浆白蛋白浓度相关。营养不良时葡萄糖清除率的紊乱与胰岛素可用性受损有关。
