Disordered pancreatic and gastrointestinal hormone responses to nutrient stimulation in Zambian children with severe acute malnutrition.

Nutrient sensing enables the body to detect and respond to nutrient availability through hormonal regulation. In this study, we examined nutrient-stimulated hormonal responses in children with severe acute malnutrition (SAM) compared with hospitalized (HC) and community (CC) child comparators. Basal and fed blood samples were collected from participants before and after consumption of a liquid meal. In the basal state, children with SAM showed significantly higher circulating concentrations of insulin, C-peptide, peptide tyrosine tyrosine (PYY), ghrelin, glucagon, glucagon-like peptide 1 (GLP-1) and glucagon like peptide 2 (GLP-2), in comparison to one or both comparators. After feeding, insulin, C-peptide, cholecystokinin, PYY and GLP-1 increased in all groups, indicating some level of preserved nutrient sensing. GLP-2 increased significantly in SAM and hospitalized children, and a reduction in ghrelin was observed in children with SAM. No significant changes were detected for glucagon, leptin or secretin in any group. Disordered responses, defined as zero or positive postprandial responses in ghrelin and zero or negative postprandial responses in the other hormones, were seen in all children. Significantly higher percentages of children with SAM had disordered responses compared with the non-malnourished children, particularly for insulin (23%) and C-peptide (16%), suggestive of altered pancreatic hormonal regulation in SAM. These findings highlight the need for improved nutritional interventions for affected children.