Smith S R, Edgar P J, Pozefsky T, Chhetri M K, Prout T E
Metabolism. 1975 Sep;24(9):1073-84. doi: 10.1016/0026-0495(75)90101-8.
Glucose tolerance, insulin secretion, and responses to arginine infusion were studied in 17 adults with severe protein-calorie malnutrition (PCM) in Calcutta, India. Patients were selected for the severity of their malnutrition and for absence of other diseases. After 2-4 mo of refeeding there was complete clinical recovery, and control studies were performed. Glucose tolerance, as assessed by intravenous glucose-tolerance test (IVGTT), was reduced in PCM. Insulin response, both to glucose and to arginine infusion, was clearly reduced. The K value of the IVGTT correlated well with the ratio of mean to basal serum insulin during the first 40 min of the test. Basal serum insulin was nearly unchanged in PCM as compared with after recovery, although one patient studied serially showed a temporary drop in basal insulin during the first week of refeeding. In PCM, plasma amino acid levels failed to fall in response to arginine-induced insulin secretion as they did in the control studies. It appears that insulin secretory response is severely reduced in PCM and that a degree of insulin resistance in relation to body weight is present. These changes result in diminished glucose tolerance and probably in a reduced rate of tissue utilization of amino acids. Such alterations may be of adaptive significance in chronic PCM.
在印度加尔各答，对17名患有严重蛋白质 - 热量营养不良（PCM）的成年人的葡萄糖耐量、胰岛素分泌及精氨酸输注反应进行了研究。患者因营养不良严重程度及无其他疾病而入选。经过2 - 4个月的再喂养，患者实现了完全临床康复，并进行了对照研究。通过静脉葡萄糖耐量试验（IVGTT）评估，PCM患者的葡萄糖耐量降低。对葡萄糖和精氨酸输注的胰岛素反应均明显降低。IVGTT的K值与试验前40分钟内平均血清胰岛素与基础血清胰岛素的比值密切相关。与康复后相比，PCM患者的基础血清胰岛素几乎没有变化，尽管一名接受连续研究的患者在再喂养的第一周基础胰岛素出现了暂时下降。在PCM患者中，血浆氨基酸水平对精氨酸诱导的胰岛素分泌没有像对照研究那样下降。看来PCM患者的胰岛素分泌反应严重降低，并且存在与体重相关的一定程度的胰岛素抵抗。这些变化导致葡萄糖耐量降低，可能还导致氨基酸组织利用率降低。这种改变在慢性PCM中可能具有适应性意义。
