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Insulin sensitivity and insulin clearance in adult survivors of malnutrition

Insulin sensitivity and insulin clearance in adult survivors of malnutrition
Insulin sensitivity and insulin clearance in adult survivors of malnutrition
Context and Objective: Among the clinical syndromes of severe acute malnutrition (SAM), adult survivors of marasmus (MS) have worse glucose tolerance than kwashiorkor survivors (KS). We hypothesized that MS have lower insulin sensitivity and insulin clearance (MCR) than KS. We investigated glucose metabolism in a cohort of adult survivors of SAM and a control group that was not exposed to SAM.

Research Design and Setting: This was a cross sectional, observational study of Jamaican adults.

Subjects: 40 non-diabetic adult survivors of SAM (20 MS and 20 KS) and 13 age, sex and BMI-matched controls. Exclusion criteria: diabetes, pregnancy, lactation, smoking, chronic illnesses and glucocorticoid use.

Measurements: We performed 150-minute hyperinsulinaemic, euglycaemic clamps, measured serum adiponectin, anthropometry and body composition on the participants. We estimated insulin sensitivity using the M-value and MCR was calculated.

Results: The mean age (± SD) was 27.2 ± 8.1 years, BMI was 23.6 ± 5.0 kg/m2 and 45% were male. MS and KS were similar in age, weight, BMI, fat free mass and fat mass. MS had similar insulin sensitivity to KS (M-weight: 9.1 ± 3.2 vs. 8.7 ± 4.6 mg.kg-1.min-1; P = 0.51). MCR was also similar among MS and KS (P = 0.49). When all SAM survivors were compared to the community controls, both insulin sensitivity and MCR were similar (P-values ? 0.16).
Conclusions: Lean young adult survivors of marasmus and kwashiorkor have similar insulin sensitivity and insulin clearance. It remains to be seen whether this is also true among obese survivors of malnutrition.
0021-972X
1-14
Thompson, D.
f02914bc-43d6-4944-91f6-6ee85e697788
Francis-Emmanuel, P.
c1ed6bb2-95d5-4b04-9bfe-0c2f6b616a7b
Barnett, A.
4791e2cd-78a3-46a2-a1d5-9947e42d6db4
Royal - Thomas, T.
e382706b-11d8-4f70-8595-a4c646ebbfe8
Osmond, C.
2677bf85-494f-4a78-adf8-580e1b8acb81
Hanson, M.
1952fad1-abc7-4284-a0bc-a7eb31f70a3f
Byrne, C.
1370b997-cead-4229-83a7-53301ed2a43c
Gluckman, P.
dadc86d4-4eaa-4589-b560-413a9e564558
Forrester, T.
84984e0d-1dd5-479c-91ed-b3d9c0fbd9d3
Boyne, M.
a22b2b0b-fa0c-4b81-9325-423e5a20e6d0
Thompson, D.
f02914bc-43d6-4944-91f6-6ee85e697788
Francis-Emmanuel, P.
c1ed6bb2-95d5-4b04-9bfe-0c2f6b616a7b
Barnett, A.
4791e2cd-78a3-46a2-a1d5-9947e42d6db4
Royal - Thomas, T.
e382706b-11d8-4f70-8595-a4c646ebbfe8
Osmond, C.
2677bf85-494f-4a78-adf8-580e1b8acb81
Hanson, M.
1952fad1-abc7-4284-a0bc-a7eb31f70a3f
Byrne, C.
1370b997-cead-4229-83a7-53301ed2a43c
Gluckman, P.
dadc86d4-4eaa-4589-b560-413a9e564558
Forrester, T.
84984e0d-1dd5-479c-91ed-b3d9c0fbd9d3
Boyne, M.
a22b2b0b-fa0c-4b81-9325-423e5a20e6d0

Thompson, D., Francis-Emmanuel, P., Barnett, A., Royal - Thomas, T., Osmond, C., Hanson, M., Byrne, C., Gluckman, P., Forrester, T. and Boyne, M. (2016) Insulin sensitivity and insulin clearance in adult survivors of malnutrition. Journal of Clinical Endocrinology & Metabolism, 1-14. (In Press)

Record type: Article

Abstract

Context and Objective: Among the clinical syndromes of severe acute malnutrition (SAM), adult survivors of marasmus (MS) have worse glucose tolerance than kwashiorkor survivors (KS). We hypothesized that MS have lower insulin sensitivity and insulin clearance (MCR) than KS. We investigated glucose metabolism in a cohort of adult survivors of SAM and a control group that was not exposed to SAM.

Research Design and Setting: This was a cross sectional, observational study of Jamaican adults.

Subjects: 40 non-diabetic adult survivors of SAM (20 MS and 20 KS) and 13 age, sex and BMI-matched controls. Exclusion criteria: diabetes, pregnancy, lactation, smoking, chronic illnesses and glucocorticoid use.

Measurements: We performed 150-minute hyperinsulinaemic, euglycaemic clamps, measured serum adiponectin, anthropometry and body composition on the participants. We estimated insulin sensitivity using the M-value and MCR was calculated.

Results: The mean age (± SD) was 27.2 ± 8.1 years, BMI was 23.6 ± 5.0 kg/m2 and 45% were male. MS and KS were similar in age, weight, BMI, fat free mass and fat mass. MS had similar insulin sensitivity to KS (M-weight: 9.1 ± 3.2 vs. 8.7 ± 4.6 mg.kg-1.min-1; P = 0.51). MCR was also similar among MS and KS (P = 0.49). When all SAM survivors were compared to the community controls, both insulin sensitivity and MCR were similar (P-values ? 0.16).
Conclusions: Lean young adult survivors of marasmus and kwashiorkor have similar insulin sensitivity and insulin clearance. It remains to be seen whether this is also true among obese survivors of malnutrition.

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Accepted/In Press date: 3 August 2016
Organisations: Human Development & Health

Identifiers

Local EPrints ID: 399345
URI: http://eprints.soton.ac.uk/id/eprint/399345
ISSN: 0021-972X
PURE UUID: c42238a4-a7b4-4232-a304-f884008aac8f
ORCID for C. Osmond: ORCID iD orcid.org/0000-0002-9054-4655
ORCID for M. Hanson: ORCID iD orcid.org/0000-0002-6907-613X
ORCID for C. Byrne: ORCID iD orcid.org/0000-0001-6322-7753

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Date deposited: 12 Aug 2016 15:50
Last modified: 07 Oct 2020 05:13

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