Severe
malnutrition is a major health problem in developing countries and can present itself as
kwashiorkor or
marasmus. Although
marasmus is characterized by clinical wasting,
kwashiorkor is associated with peripheral
edema, oxidative stress,
hypoalbuminemia, and
hypoglycemia. The etiology of the
hypoglycemia is poorly understood. We determined endogenous
glucose production (EGP) in children with severe
malnutrition. Children with
kwashiorkor,
marasmus, and controls received a primed constant infusion of [6,6H2]
glucose for 2 h. An i.v. bolus of 13C-ketoisocaproic
acid (KIC) was given, and breath samples were obtained during 2 h.
Isotope dilution was used to calculate EGP, and 13CO2/12CO2 production was determined. Mean EGP ± SEM was 5.5 ± 0.3 mg/kg/min in the
kwashiorkor group and 6.9 ± 0.4 mg/kg/min and 7.6 ± 0.7 mg/kg/min in the marasmic and control group, respectively, (p < 0.05
kwashiorkor versus
marasmus and controls). EGP correlated with
serum albumin concentration (r = 0.67; p < 0.001) and urinary
8-hydroxydeoxyguanosine as a marker of oxidative stress (r = -0.62; p < 0.005). 13CO2 secretion as a marker of hepatic mitochondrial function was significantly higher in the marasmic group compared with
kwashiorkor and controls. We conclude that decreased EGP in severely malnourished children is related to the degree of
hypoalbuminemia and oxidative stress but is not associated with a clear defect in hepatic mitochondrial function.