Long-term follow-up of infant malnutrition in Barbados studies of glucose tolerance in well-adapted young adults - abstract

ABSTRACT

Childhood origins of adult disease may be important in the Caribbean, for instance in the later sequelae, if any, of under and malnutrition. Several such hypotheses can be tested for diabetes, including severity of the initial episode(s) leading to pancreatic fibrosis, and weight gain after puberty, causing further B-cell stress. The 1985 WHO criteria defined a malnutrition-related diabetes (MRDM) category, but causal evidence is slim. We examined a series from a chort (N=311) of survivors of infant marasmus (M), Kwashiorkor (K) and age-matched controls (C), all followed since presentation, for over 20 years. Cases were defined on infant weight for age < 2 SDs below expected. Of the first 90 subjects invited, 84 (93 percent) attended for a standardized portocol by trained observers, of a full 2-hour glucose tolerance test and anthropometric measures. (The results are shown in a table). These preliminary results show that average catch-up growth was complete in these previously severely malnourished young adults. While fasting blood glucose (FG) results were similar, following challenge the 2 hr values (2hr G) were significantly higher in female M than respective C(t=3.25, p<0.001) not accounted for by their greater weight, and higher in all M than C (p=0.02). Waist/Hip ratios were no different. Thus, despite these young people being well-adapted in a generally favourable socioeconomic setting, there is some evidence of glucose intolerance following challenge. This could be a prodrome for later development of diabetes. As they are also the first to have responded to the follow-up invitation, those who may not respond may be less well-adapted and hence at even greater risk of glucose intolerance and perhaps other problems (AU)