Document Detail

Mechanisms behind decreased endogenous glucose production in malnourished children.
MedLine Citation:
PMID:  20657348     Owner:  NLM     Status:  MEDLINE    
Severe malnutrition is a major health problem in developing countries and can present itself as kwashiorkor or marasmus. Although marasmus is characterized by clinical wasting, kwashiorkor is associated with peripheral edema, oxidative stress, hypoalbuminemia, and hypoglycemia. The etiology of the hypoglycemia is poorly understood. We determined endogenous glucose production (EGP) in children with severe malnutrition. Children with kwashiorkor, marasmus, and controls received a primed constant infusion of [6,6H2]glucose for 2 h. An i.v. bolus of 13C-ketoisocaproic acid (KIC) was given, and breath samples were obtained during 2 h. Isotope dilution was used to calculate EGP, and 13CO2/12CO2 production was determined. Mean EGP ± SEM was 5.5 ± 0.3 mg/kg/min in the kwashiorkor group and 6.9 ± 0.4 mg/kg/min and 7.6 ± 0.7 mg/kg/min in the marasmic and control group, respectively, (p < 0.05 kwashiorkor versus marasmus and controls). EGP correlated with serum albumin concentration (r = 0.67; p < 0.001) and urinary 8-hydroxydeoxyguanosine as a marker of oxidative stress (r = -0.62; p < 0.005). 13CO2 secretion as a marker of hepatic mitochondrial function was significantly higher in the marasmic group compared with kwashiorkor and controls. We conclude that decreased EGP in severely malnourished children is related to the degree of hypoalbuminemia and oxidative stress but is not associated with a clear defect in hepatic mitochondrial function.
Robert H J Bandsma; Marijke Mendel; Martijn N Spoelstra; Dirk-Jan Reijngoud; Theo Boer; Frans Stellaard; Bernard Brabin; Reijnout Schellekens; Edward Senga; Geert Tom Heikens
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Pediatric research     Volume:  68     ISSN:  1530-0447     ISO Abbreviation:  Pediatr. Res.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-10-13     Completed Date:  2011-02-01     Revised Date:  2013-03-05    
Medline Journal Info:
Nlm Unique ID:  0100714     Medline TA:  Pediatr Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  423-8     Citation Subset:  IM    
Department of Biochemistry, University of Malawi, Blantyre 360, Malawi.
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MeSH Terms
Blood Glucose / metabolism*
Child Nutrition Disorders / metabolism*
Developing Countries
Glucagon / metabolism
Gluconeogenesis / physiology
Glucose / administration & dosage,  biosynthesis*
Hydrocortisone / metabolism
Hypoalbuminemia / metabolism
Insulin / metabolism
Kwashiorkor / metabolism*
Liver / metabolism
Oxidative Stress
Protein-Energy Malnutrition / metabolism*
Serum Albumin / metabolism
Reg. No./Substance:
0/Blood Glucose; 0/Insulin; 0/Serum Albumin; 50-23-7/Hydrocortisone; 50-99-7/Glucose; 9007-92-5/Glucagon

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