Glucose metabolism in adult survivors of severe acute malnutrition

J Clin Endocrinol Metab. 2014 Jun;99(6):2233-40. doi: 10.1210/jc.2013-3511. Epub 2014 Feb 11.


Context and objectives: The clinical syndromes of severe acute malnutrition may have early life origins because children with marasmus have lower birth weight than those with kwashiorkor. We hypothesized that resultant metabolic effects may persist into adulthood. We investigated whether marasmus survivors (MS) are more insulin resistant and glucose intolerant than kwashiorkor survivors (KS).

Research design and setting: This was a case-control study in Jamaican adults.

Subjects: We performed oral glucose tolerance tests on 191 adults (aged 17-50 y; 52% male; body mass index 24.2 ± 5.5 kg/m(2)). There were 43 MS; 38 KS; 70 age-, sex-, and body mass index-matched community controls; and 40 age- and birth weight-matched controls.

Measurements: We measured insulin sensitivity with the whole-body insulin sensitivity index, and β-cell function with the insulinogenic index and the oral disposition index.

Results: Fasting glucose was comparable across groups, but glucose intolerance was significantly more common in MS (19%) than in KS (3%), community controls (11%), and birth weight-matched controls (10%). The whole-body insulin sensitivity index was lower in MS than KS (P = .06) but similar between MS and controls. The insulinogenic index and oral disposition index were lower in MS compared with all three groups (P < .01).

Conclusions: Marasmus survivors tend to be less insulin sensitive, but have significantly lower insulin secretion and are more glucose intolerant compared with kwashiorkor survivors and controls. This suggests that poor nutrition in early life causes β-cell dysfunction, which may predispose to the development of diabetes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Case-Control Studies
  • Female
  • Glucose / metabolism*
  • Humans
  • Insulin Resistance
  • Jamaica / epidemiology
  • Male
  • Malnutrition / metabolism*
  • Malnutrition / mortality
  • Middle Aged
  • Severity of Illness Index
  • Survivors* / statistics & numerical data
  • Young Adult


  • Glucose