Metabolic and Hormonal Responses to a Protein-Glucose Meal in Normal Infants and in Marasmus and Marasmic Kwashiorkor

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Abstract
Extract: Blood sugar and plasma free fatty acids (FFA), immunoreactive insulin (IRI), and growth hormone (GH) responses to a protein-glucose meal were determined in normal infants and those with marasmus and marasmic kwashiorkor. Among the normal subjects, fasting blood sugar (BS), peak BS and IRI, and the IRI/BS ratio tended to decrease as age increased. Peak IRI was at least 13 μU/ ml above fasting in 21 of 24 infants. Fasting GH levels were high, 38.5 ± 13.6 (SD) and 26.3 ± 14.0 ng/ml, in the two youngest groups (under 1 year) and were comparable with those of the late newborn period. They were slightly lower, 20.8 ± 22.1, in those 12.5–18.5 months of age. Suppressions of FFA and subsequent rebounds were in close temporal relation to BS and IRI peaks and lows, but not the GH levels. GH was promptly suppressed by the meal, and in most infants secondary elevations were seen. Untreated marasmic infants had normal or low BS, correspondingly normal or low IRI, markedly elevated FFA (1,821 ± 588 μEq/liter), and GH levels comparable with those of the control subjects. There was some delay in BS elevation and disappearance and poor insulin release after the meal, with only two of nine having elevations of at least 13 μU/ml. The BS elevations and IRI responses, however, were adequate to block FFA release. GH levels were poorly suppressed by the meal but some infants had further elevations, possibly in response to protein. After partial rehabilitation, fasting BS and FFA and BS elevations after the meal were normal. A slight improvement in insulin release was apparent. Fasting GH levels and responses to the meal were normal. Fasting, minimally treated children with marasmic kwashiorkor (MK) had normal or low BS, normal or low IRI, normal FFA, and probably normal GH levels. There was considerable delay in BS elevation, moderately delayed glucose disappearance, and very poor or immeasurable insulin release after the test meal; FFA and GH were poorly suppressed. After partial rehabilitation, fasting BS was normal, FFA levels were low (630 ± 163 μEq/l), IRI was still low, BS elevations and disappearance improved, IRI responses modestly improved, and GH responses were normal. Speculation: Metabolic and hormonal responses of malnourished infants to a test meal may be appropriate for survival but not for renewed growth of lean body mass.