Progressive changes in serum cortisol, insulin and growth hormone concentrations and their relationship to the distorted amino acid pattern during the development of kwashiorkor

Abstract

I . During the initial stages of the development of hypoalbuminaemia, with concentrations between 25 and 30 g,J, fasting serum cortisol and growth hormone values remained normal. Corresponding fasting serum insulin concentrations were, however, significantly above normal. During the same period, called phase H, valine concentrations were moderately low hut alanine Concentrations mere raised.2. In more severe hypoalbuminaemia, culminating in kwashiorkor, a marked switch in hormonal balance occurred. Tnsulin concentrations fell to subnormal levels whereas cortisol became raised. Eventually growth hormone concentrations also increased rapidly to values similar to those found in acromegaly. By this time, phase C, alanine concentrations as well as those oE valine were fzlllirig to very low levels.3. Thepossible causes of these changes in hormonal balance, their role in the development of the distorted fasting serum amino acid pattern and their consequent effect on serum albumin synthesis and the appearance of clinical kwashiorltor are discussed.4. Information is also presented on the differences between these components in kwashiorkor and marasmus. Attempts have been made to ratiorialize apparent inconsistencies in the literature.There is growing interest in the changes which occur in the function of various endocrine organs during the pathogenesis of protein-energy malnutrition. However, most reports so far have been restricted to the measurement of a single hormone rather than to changes among a series of metabolically interrelated hormones. Moreover, they have only dealt with the acute situation, although it is becoming increasingly clear that the general metabolic pattern seen in cascs on admission to hospital can be quite different from that which has existed during most of thc earlier stages of chronic malnutrition, before the acute episode.In this investigation we have studied simultaneously three hormones which arc important in the regulation of protein and amino acid metabolism, insulin, cortisol, and growth hormone (GH). These have been measured both in patients in hospital and, serially, in children attending an out-patient clinic in an area of TJganda where kwashiorkor is endemic. The concentrations of certain plasma amino acids have also been measured and an attempt has been made to correlate the changes observed with those found in the hormone levels.https://www.cambridge.org/core/terms. https://doi

Effect of low-protein diets on free amino acids in plasma of young men: Effect of protein quality with maintenance or excess energy intake.

“…This discrepancy needs further study . LUNN et al (8) observed that the plasma alanine concentration in infants with kwashiorkor was increased by high-carbohydrate food . Moreover, ADIBI (17) observed a high concentration of plasma alanine in adults fed a protein-free diet , but a low concentration in starved subjects.…”

“…The decrease in concentration of plasma EAA was primarily due to reduced supply of these amino acids but it was also related to energy supply, because addition of extra energy to the low-egg-protein diet resulted in reduction of plasma EAAs. Further evidence that decrease in the levels of plasma EAAs in protein deficiencies may be intensified by supply of excess energy is as MA FREE AMINO ACIDS IN MEN 305 follows: (i) LUNN et al (8) observed hyperinsulinemia resulting from ingestion of high-carbohydrate meals during the early stage of kwashiorkor and suggested that utilization of amino acids in tissues was enhanced in this condition; (ii) We found previously (9) that the nitrogen balance and NPU observed with submaintenance N intakes were greatly affected by the protein sparing effect of energy intake; (iii) MUNRO et al (20) showed that the lowered levels of plasma amino acids observed in subjects loaded with glucose were due to enhanced utilization of the amino acids in the muscle through the action of insulin; and (iv) recently, GRIMBLE and WHITEHEAD (7) also reported similar findings to (iii), in patients with kwashiorkor after administration of glucose.…”

“…GRIMBLE and WHITEHEAD (7) examined the effect of glucose adminis tration on plasma-free amino acids in kwashiorkor. LUNN et al (8) showed that the plasma amino acid pattern was affected by the changes in hormone balance that resulted from decrease in food intake.…”

Serum Cortisol Concentrations in Children with Protein-Energy Malnutrition

“…15,16 No significant correlation was found between serum albumin and Cortisol levels in the malnourished children before treatment. This finding, in concert with observations that the serum Cortisol concentration was elevated in marasmic children despite their normal circulating albumin levels, casts doubt on the proposed relationship between the decrement in albumin and the elevation of Cortisol levels in the basal state in PEM.…”

“…Some report lower responses in children with kwashiorkor than in those with marasmus, 12 although others have reported the opposite. 13 Hypoglycemia, hypoalbuminemia, infections, and the stress of dietary restriction are proposed by different authors to correlate with the Cortisol levels in PEM, 10,[14][15][16][17] but further information of the role played by these factors is needed.…”