Prior undernutrition and insulin production several years later in Tanzanian adults.
Prior undernutrition and insulin production several years later in Tanzanian adults.
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DOI：
10.1093/ajcn/nqaa438
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发表时间：
2021-06-01
期刊：
影响因子：
--
通讯作者：
Faurholt-Jepsen D
中科院分区：
文献类型：
--
作者：
Filteau S;PrayGod G;Rehman AM;Peck R;Jeremiah K;Krogh-Madsen R;Faurholt-Jepsen D
营养不良相关糖尿病的患病率、病理学和存在性仍不确定，尤其是在成人获得性营养不良方面。目的是调查成年后获得的既往营养不良（低BMI，单位为kg/m2）与口服葡萄糖耐量试验（OGTT）期间胰岛素的相关性。我们随访了630名7-14岁的成年人，这些人以前曾参加过其他研究。在空腹和OGTT期间30和120分钟测量血浆胰岛素。主要暴露是7-14年前测量的BMI。主要关注的结果是血浆胰岛素，使用广义估计方程控制OGTT期间的时间，探索性结果是早期胰岛素反应（0-30 min胰岛素和葡萄糖的相对变化）和0 - 120 min胰岛素和葡萄糖的相对AUC。当前混杂因素是年龄、性别、BMI、HIV、社会经济状况和体力活动。在未校正的分析中，既往营养不良的严重程度增加与胰岛素浓度降低相关。在多变量校正分析中，只有当前BMI是总体胰岛素浓度的强预测因子。在未校正但未校正的分析中也观察到胰岛素反应与既往BMI的相关性。对于胰岛素浓度，而不是解释葡萄糖的结果，与先前的BMI存在性别相互作用，例如，如果先前营养不良，则只有男性的胰岛素较低：120分钟时的胰岛素（pmol/L）为311（95% CI：272，351），既往BMI 17.0-18.5为271（95% CI：221，321），既往BMI <17.0为237（95% CI：194，297）; P = 0.03。HIV状态与胰岛素的相关性有限且可变。胰岛素浓度，空腹和OGTT期间，正常化的女性比男性在成人营养不良后几年。慢性营养不良，如先前和当前BMI低所示，可能通过低胰岛素分泌导致糖尿病。
The prevalence, pathology, and existence of malnutrition-associated diabetes remain uncertain, especially with respect to adult-acquired undernutrition. The aim was to investigate the association of prior undernutrition (low BMI, in kg/m2), acquired in adulthood and insulin during an oral glucose tolerance test (OGTT). We followed up 630 adults recruited 7–14 y previously for other studies. Plasma insulin was measured fasting and at 30 and 120 min during an OGTT. The main exposure was BMI measured 7–14 y prior. The main outcome of interest was plasma insulin, controlling for time during the OGTT using generalized estimating equations, and exploratory outcomes were early insulin response (relative change in insulin and glucose from 0–30 min) and relative insulin and glucose AUCs from 0 to 120 min. Current confounding factors were age, sex, BMI, HIV, socioeconomic status, and physical activity. In unadjusted analyses, increasing severity of prior malnutrition was associated with lower insulin concentration. In multivariate adjusted analyses, only current BMI was a strong predictor of overall insulin concentration. Associations with prior BMI of insulin responses accounting for glucose were also seen in unadjusted but not adjusted analyses. For insulin concentration but not the outcomes accounting for glucose, there was a sex interaction with prior BMI such that only men had lower insulin if previously malnourished: insulin (pmol/L) at 120 min was 311 (95% CI: 272, 351) for prior BMI ≥18.5, 271 (95% CI: 221, 321) for prior BMI 17.0–18.5, and 237 (95% CI: 194, 297) for prior BMI <17.0; P = 0.03. HIV status showed limited and variable associations with insulin. Insulin concentration, fasting and during an OGTT, was normalized in women more than in men several years after adult malnutrition. Chronic malnutrition, as indicated by low prior and current BMI, may contribute to diabetes through low insulin secretion.
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