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Prior undernutrition and insulin production several years later in Tanzanian adults

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BACKGROUND: The prevalence, pathology, and existence of malnutrition-associated diabetes remain uncertain, especially with respect to adult-acquired undernutrition.

OBJECTIVE: 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).

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

TidsskriftAmerican Journal of Clinical Nutrition
Udgave nummer6
Sider (fra-til)1600-1608
Antal sider9
StatusUdgivet - 1 jun. 2021

Bibliografisk note

Funding Information:
This Chronic Infections, Comorbidities, and Diabetes in Africa study was funded by the Ministry of Foreign Affairs of Denmark and administered by the Danida Fellowship Centre (grant 16-P01-TAN). SF, GP, and DFJ received funding from the UK Medical Research Council (MRC), grant MR/T006285/1. AMR is also funded by the UKMRC and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement, which is also part of the EDCTP2 program supported by the European Union, grant MR/R010161/1. RP is funded from the NIH (TW010281 and MH118107).

Publisher Copyright:
© 2021 The Author(s). Published by Oxford University Press on behalf of the American Society for Nutrition.

Copyright 2021 Elsevier B.V., All rights reserved.

ID: 66495861