Institute of Home Economics, University of Delhi, Delhi, 110016, India.
National Institute for Medical Research, Mwanza, Tanzania.
F1000Res. 2022 Jul 12;11:777. doi: 10.12688/f1000research.123389.2. eCollection 2022.
: Prenatal growth retardation may increase the risk of later chronic non-communicable diseases (NCDs), including diabetes; however, long-term effects of wasting malnutrition in childhood or adulthood are less studied. Pancreatic exocrine and endocrine functions, both critical for nutrition and NCD aetiology, may not fully recover following malnutrition. However, the evidence and mechanistic information is piecemeal. We hypothesise that wasting malnutrition at any age has long-term detrimental effects on endocrine and exocrine pancreatic structure and function. The SAMPA international research programme will assess pancreatic structure and function in 3700 participants from ongoing observational nutrition cohorts, two adolescent and four adult, in Zambia, Tanzania, Philippines, and India. Pancreas size, structure, and calcification will be assessed by ultrasound and computed tomography (CT) scan; exocrine function by faecal elastase and serum lipase; and endocrine function by haemoglobin A1c (HbA1c) and blood glucose, insulin and C-peptide concentrations during an oral glucose tolerance test (OGTT). In-depth hormonal analyses of incretins, glucagon, proinsulin and trypsinogen during OGTT and intravenous glucose tolerance tests will be done in subsets of adult participants. Pancreatic size and function outcomes will be compared between people with and without prior wasting malnutrition. Analyses will investigate effect modification by sex, current age, time since malnutrition, current body mass index and dietary patterns. Mathematical modelling of OGTT data will be used to estimate the relative contribution to glucose dysregulation of decreased insulin production, changes in insulin clearance and increased insulin resistance. Proinsulin/insulin ratio will be analysed in archived samples from the Tanzanian cohort using a nested case-control design to investigate whether abnormal values precede diabetes. SAMPA, a large-scale multi-centre research programme using data from people with or without prior wasting malnutrition to assess several aspects of pancreatic phenotype, will provide coherent evidence for future policies and programmes for malnutrition and diabetes.
产前生长迟缓可能会增加以后患慢性非传染性疾病（NCD）的风险，包括糖尿病；然而，儿童期或成年期的消瘦性营养不良的长期影响研究较少。胰腺外分泌和内分泌功能对营养和 NCD 的发病机制都很关键，在营养不良后可能无法完全恢复。然而，证据和机制信息是零碎的。我们假设，任何年龄的消瘦性营养不良都会对内分泌和外分泌胰腺的结构和功能产生长期的不利影响。SAMPA 国际研究计划将在赞比亚、坦桑尼亚、菲律宾和印度的四个成人和两个青少年正在进行的观察性营养队列中，对 3700 名参与者进行胰腺结构和功能评估。通过超声和计算机断层扫描（CT）评估胰腺大小、结构和钙化；粪便弹性蛋白酶和血清脂肪酶评估外分泌功能；血红蛋白 A1c（HbA1c）和口服葡萄糖耐量试验（OGTT）期间的血糖、胰岛素和 C 肽浓度评估内分泌功能。在成人参与者的亚组中，将在 OGTT 和静脉葡萄糖耐量试验期间对肠降血糖素、胰高血糖素、胰岛素原和胰蛋白酶原进行深入的激素分析。OGTT 数据的数学模型将用于估计胰岛素产生减少、胰岛素清除率变化和胰岛素抵抗增加对葡萄糖失调的相对贡献。将使用嵌套病例对照设计分析来自坦桑尼亚队列的存档样本中的胰岛素原/胰岛素比值，以研究异常值是否先于糖尿病。SAMPA 是一项大型多中心研究计划，使用有或没有消瘦性营养不良史的人的数据来评估胰腺表型的几个方面，将为未来的营养不良和糖尿病政策和计划提供一致的证据。
