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

Graham, George G.; Nakashima, Julio; Thompson, Robert G.; Blizzard, Robert M.

doi:10.1203/00006450-197610000-00005

Cited by 7 publications

(3 citation statements)

References 36 publications

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“…In adults, arterial insulin and most amino acids peaked simultaneously at 90 min after protein ingestion (16). In 6-day-old preterm infants and in 2-to 3-month-old infants the highest insulin levels were found as little as 30 min after the start of feeding (8,19). Both studies demonstrated a rapid decline in plasma insulin concentrations after the peaks, with a return to prefeeding values at 180 min.…”

Section: Discussionmentioning

confidence: 89%

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Plasma Amino Acids in Term Neonates After a Feed of Human Milk or Formula

Tikanoja

1982

Acta Paediatrica

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Human milk and formulas with different quantities and qualities of protein were compared by measuring sequential postprandial changes in total amino acids and glycine/valine ratios in plasma of 23 healthy term neonates who had previously been breast-fed ad libitum. At the mean age of 5.5 days the infants received from a bottle 1/36 of their body weight of banked human milk (true protein 0.8 g/100 ml), or formula (1.5 g/100 ml of protein, whey-to-casein ratio 60 : 40 (adapted) or 18 : 82 (non-adapted), or 3.0 g/ml of protein, 60 : 40) after a 3.5-4 hour fast. After the feed, the sum of plasma free amino acids rose and the glycine/valine ratio fell, these changes being significant as soon as 30 min after the start of feeding and maximal at 30 min after human milk but at 60 min after the formulas. Both values returned to prefeeding levels, after human milk in 2-3 hours and after the two 1.5 g/100 ml formulas in about 4 hours, but after the 3 g/100 ml formula were still notably altered at 3.5 hours. The postprandial changes measured seemed to reflect dietary protein intake, and to be unaffected by protein quality (adapted vs. non-adapted formulas). The results show that in studies of plasma amino acids in young infants sampling times should be standardized exactly with respect to type of previous feeding and duration of fasting.

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Section: Discussionmentioning

confidence: 89%

“…Further, this production seems to be most efficient after the bulk of amino acid absorption and peripheral uptake has already occurred. At that time insulin levels fall (8,19), protein catabolism is augmented (21), and more amino groups are available for alanine synthesis.…”

Section: Discussionmentioning

confidence: 99%

Plasma Amino Acids in Term Neonates After a Feed of Human Milk or Formula

Tikanoja

1982

Acta Paediatrica

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“…In malnutrition insulin output is low after intravenous glucose (4,5,20,27), glucagon (27), and arginine (14) and there is a poor insulin release after a protein-glucose meal in untreated marasmic and marasmic-kwashiorkor infants (1 5). These responses improve after partial rehabilitation (4,5,15,20,27). Whether or not abnormally low insulin release characteristic of protein energy malnutrition (PEM) persists after clinical recovery remains in doubt (5,12,20,24,27).…”

Section: Speculationmentioning

confidence: 99%

Hormonal Control of Weight Gain in Infants Recovering from Protein Energy Malnutrition. I. The Effect of Insulin and Metabolic Rate

et al. 1980

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SpeculationDuring recovery from protein energy malnutrition, the augmented insulin release and metabolic rate that occurs with increased energy intake induces rapid rates of weight gain.During recovery from protein energy malnutrition the rate of weight gain and the energy intake are closely related (1,2, 25,30,36). The rate of weight gain is also positively correlated with metabolic rate (3,7,30). However, the relationship of both rate of weight gain and metabolic rate to the output of plasma insulin has not been reported.In malnutrition insulin output is low after intravenous glucose (4, 5, 20, 27), glucagon (27), and arginine (14) and there is a poor insulin release after a protein-glucose meal in untreated marasmic and marasmic-kwashiorkor infants (1 5). These responses improve after partial rehabilitation (4,5,15, 20, 27). Whether or not abnormally low insulin release characteristic of protein energy malnutrition (PEM) persists after clinical recovery remains in doubt (5,12,20,24,27). Most studies so far have compared insulin status in malnourished and clinically recovered children, and little attention has been paid to the intermediate phases of recovery where rate of weight gain may be 10 or 15 times the normal. This phase of extremely rapid weight gain has been termed "catch up growth."In this study, therefore, the authors compared plasma insulin, metabolic rate, and other metabolic variables during the phase of rapid weight gain with those shown during malnutrition and aAer clinical recovery, using a physiologic stimulus-a high energy test meal. EXPERIMENTAL PROCEDUREInformed parental consent was obtained for all studies. Professional peer review and approval of the proposed investigation was obtained. An initial study was done on eight of the children when malnourished (M) and on maintenance diet. No initial study was done on the others because they were either febrile or had vomiting, diarrhea, or specific infection. Thirty-one studies were done in 15 children during the period of rapid weight gain (R) and seven studies were done in seven clinically recovered children (C). Those children who passed the expected weight for their height and continued to gain weight rapidly were included in the recovering group (R). All studies were conducted in the early afternoon after a 4-hr fast. One hr before the study, a slow iv infusion of saline was set up in order to obtain serial blood samples without disturbing the child and oral paraldehyde (0.5 ml/kg body weight) was administered via a nasogastric tube. A 4-hr fasting metabolic rate was estimated from oxygen consumption and carbondioxide production using a Kipp and Zonen Noyons diaferometer. The instrument was calibrated by combusting known amounts of alcohol in the hood for the child. Observations of respiratory exchange made for 5 successive min were averaged and the results for each interval combined. A blood sample was withdrawn immediately before the test meal (Table 2) was given by nasogastric tube. The meal provided 174 joules and 0.9 g protein/kg body...

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