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.