Association of postnatal severe acute malnutrition with pancreatic exocrine and endocrine function in children and adults: a systematic review

Ferdous, Farzana; Filteau, Suzanne; Schwartz, Nanna Buhl; Gumede-Moyo, Sehlulikile; Cox, Sharon E.

doi:10.1017/s0007114522001404

Cited by 10 publications

(10 citation statements)

References 85 publications

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“…Similarly, nutritional exposure may be important. Early-life (in-utero and/or early childhood) chronic malnutrition is highly prevalent in most parts of SSA, and this has been associated with the long-term risk of early-onset diabetes which has led to the concept of developmental origins of health and disease (DOHaD) [38, 39].…”

Section: Discussionmentioning

confidence: 99%

Differential manifestation of type 2 diabetes in Black Africans and White Europeans with recently diagnosed type 2 diabetes: A systematic review

Kibirige,

Olum,

Kyazze

et al. 2024

Preprint

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Aims The clinical manifestation of type 2 diabetes (T2D) varies across populations. We compared the phenotypic characteristics of Black Africans and White Europeans with recently diagnosed T2D to understand the ethnic differences in the manifestation of T2D. Methods We searched Medline, EMBASE, CINAHL, Google Scholar, African Index Medicus, and Global Health for studies reporting information on phenotypic characteristics in Black Africans and White Europeans with recently diagnosed T2D. Results A total of 26 studies were included in this systematic review. Of these, 12 studies and 14 studies were conducted on 2,586 Black Africans in eight countries and 279,621 White Europeans in nine countries, respectively. Compared with White Europeans, Black Africans had a lower pooled mean age (49.4 [4.4] years vs. 61.3 [2.7] years), body mass index (26.1 [2.6] kg/m2 vs. 31.4 [1.1] kg/m2), and a higher pooled median glycated haemoglobin (9.0 [8.0-10.3]% vs. 7.1 [6.7-7.7]%). Ugandan and Tanzanian participants had lower markers of beta-cell function and insulin resistance when compared with four White European populations. Conclusion These findings provide evidence of the ethnic differences in the manifestation of T2D, underscoring the importance of understanding the underlying genetic and environmental factors influencing these phenotypic differences and formulating ethnic-specific approaches for managing and preventing T2D.

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Section: Discussionmentioning

confidence: 99%

Differential manifestation of type 2 diabetes in Black Africans and White Europeans with recently diagnosed type 2 diabetes: A systematic review

Kibirige,

Olum,

Kyazze

et al. 2024

Preprint

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“…For example, a history of malnutrition early in life ( in utero and/or in early childhood) is associated with reduced pancreatic beta-cell insulin secretion and increased risk of diabetes. 20 – 23 …”

Section: Discussionmentioning

confidence: 99%

Phenotypic characterization of nonautoimmune diabetes in adult Ugandans with low body mass index

Kibirige,

Sekitoleko,

Lumu

et al. 2024

Therapeutic Advances in Endocrinology

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Background: Type 2 diabetes is common in relatively lean individuals in sub-Saharan Africa. It is unclear whether phenotypic differences exist between underweight and normal-weight African patients with type 2 diabetes. This study compared specific characteristics between underweight (body mass index <18.5 kg/m2) and normal-weight (body mass index of 18.5–24.9 kg/m2) adult Ugandans with new-onset nonautoimmune diabetes. Methods: We collected the demographic, clinical, anthropometric, and metabolic characteristics of 160 participants with nonobese new-onset type 2 diabetes (defined as diabetes diagnosed <3 months, body mass index <25 kg/m2, and absence of islet-cell autoimmunity). These participants were categorized as underweight and normal weight, and their phenotypic characteristics were compared. Results: Of the 160 participants with nonobese new-onset type 2 diabetes, 18 participants (11.3%) were underweight. Compared with those with normal weight, underweight participants presented with less co-existing hypertension (5.6% versus 28.2%, p = 0.04) and lower median visceral fat levels [2 (1–3) versus 6 (4–7), p < 0.001], as assessed by bioimpedance analysis. Pathophysiologically, they presented with a lower median 120-min post-glucose load C-peptide level [0.29 (0.13–0.58) versus 0.82 (0.39–1.50) nmol/l, p = 0.04] and a higher prevalence of insulin deficiency (66.7% versus 31.4%, p = 0.003). Conclusion: This study demonstrates that nonautoimmune diabetes occurs in underweight individuals in sub-Saharan Africa and is characterized by the absence of visceral adiposity, reduced late-phase insulin secretion, and greater insulin deficiency. These findings necessitate further studies to inform how the prevention, identification, and management of diabetes in such individuals can be individualized.

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“…Evidence from a recent systematic review suggests pancreatic endocrine and exocrine functions may not recover fully after childhood or adult wasting malnutrition. 5 Such long-term effects on the pancreas may contribute to the different phenotype of diabetes common in LMICs with prevalent malnutrition, compared with the diabetes phenotype in high-income countries. Diabetes in LMICs often has a relatively early disease onset (<50 years) and may occur at a low or normal body mass index (BMI).…”

Section: Introductionmentioning

confidence: 99%

Long-term health after Severe Acute Malnutrition in children and adults- the role of the Pancreas (SAMPA): Protocol

et al. 2022

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Background: Prenatal growth retardation may increase the risk of later chronic non-communicable diseases (NCDs), including diabetes; however, long-term effects of wasting malnutrition in childhood or adulthood are less studied. Pancreatic exocrine and endocrine functions, both critical for nutrition and NCD aetiology, may not fully recover following malnutrition. However, the evidence and mechanistic information is piecemeal. We hypothesise that wasting malnutrition at any age has long-term detrimental effects on endocrine and exocrine pancreatic structure and function. Methods: The SAMPA international research programme will assess pancreatic structure and function in 3700 participants from ongoing observational nutrition cohorts, two adolescent and four adult, in Zambia, Tanzania, Philippines, and India. Pancreas size, structure, and calcification will be assessed by ultrasound and computed tomography (CT) scan; exocrine function by faecal elastase and serum lipase; and endocrine function by haemoglobin A1c (HbA1c) and blood glucose, insulin and C-peptide concentrations during an oral glucose tolerance test (OGTT). In-depth hormonal analyses of incretins, glucagon, proinsulin and trypsinogen during OGTT and intravenous glucose tolerance tests will be done in subsets of adult participants. Pancreatic size and function outcomes will be compared between people with and without prior wasting malnutrition. Analyses will investigate effect modification by sex, current age, time since malnutrition, current body mass index and dietary patterns. Mathematical modelling of OGTT data will be used to estimate the relative contribution to glucose dysregulation of decreased insulin production, changes in insulin clearance and increased insulin resistance. Proinsulin/insulin ratio will be analysed in archived samples from the Tanzanian cohort using a nested case-control design to investigate whether abnormal values precede diabetes. Conclusions: SAMPA, a large-scale multi-centre research programme using data from people with or without prior wasting malnutrition to assess several aspects of pancreatic phenotype, will provide coherent evidence for future policies and programmes for malnutrition and diabetes.

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Association of postnatal severe acute malnutrition with pancreatic exocrine and endocrine function in children and adults: a systematic review

Cited by 10 publications

References 85 publications

Differential manifestation of type 2 diabetes in Black Africans and White Europeans with recently diagnosed type 2 diabetes: A systematic review

Differential manifestation of type 2 diabetes in Black Africans and White Europeans with recently diagnosed type 2 diabetes: A systematic review

Phenotypic characterization of nonautoimmune diabetes in adult Ugandans with low body mass index

Long-term health after Severe Acute Malnutrition in children and adults- the role of the Pancreas (SAMPA): Protocol

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