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022			_2American Society for Nutrition _a Online ISSN 1938-3207
022			_2American Society for Nutrition _aPrint ISSN 0002-9165
028			_b Phone: +255 28 298 3384
028			_b Fax: +255 28 298 3386
028			_b Email: vc@bugando.ac.tz
028			_bWebsite: www.bugando.ac.tz
040			_bEnglish _cDLC
041			_aEnglish
100			_aSuzanne Filteau _946724
222			_amalnutrition-associated diabetes, HIV, Tanzania, insulin, glucose tolerance _bmalnutrition-associated diabetes, HIV, Tanzania, insulin, glucose tolerance
222			_a hiv body mass index procedure diabetes mellitus diabetes mellitus, type 2 glucose adult malnutrition insulin oral glucose tolerance test
222			_a Original Research Communications
245			_aPrior undernutrition and insulin production several years later in Tanzanian adults
260			_aMwanza, Tanzania: _bOxford University Press & _b Catholic University of Health and Allied Sciences [CUHAS – Bugando] _c2021/6
300			_aPages 1600-1608
490			_v The American journal of clinical nutrition Volume 113 Issue 6
520			_aABSTRACT: Background: The prevalence, pathology, and existence of malnutrition-associated diabetes remain uncertain, especially with respect to adult-acquired undernutrition. Objective: The aim was to investigate the association of prior undernutrition (low BMI, in kg/m2), acquired in adulthood and insulin during an oral glucose tolerance test (OGTT). Methods: We followed up 630 adults recruited 7–14 y previously for other studies. Plasma insulin was measured fasting and at 30 and 120 min during an OGTT. The main exposure was BMI measured 7–14 y prior. The main outcome of interest was plasma insulin, controlling for time during the OGTT using generalized estimating equations, and exploratory outcomes were early insulin response (relative change in insulin and glucose from 0–30 min) and relative insulin and glucose AUCs from 0 to 120 min. Current confounding factors were age, sex, BMI, HIV, socioeconomic status, and physical activity. Results: In unadjusted analyses, increasing severity of prior malnutrition was associated with lower insulin concentration. In multivariate adjusted analyses, only current BMI was a strong predictor of overall insulin concentration. Associations with prior BMI of insulin responses accounting for glucose were also seen in unadjusted but not adjusted analyses. For insulin concentration but not the outcomes accounting for glucose, there was a sex interaction with prior BMI such that only men had lower insulin if previously malnourished: insulin (pmol/L) at 120 min was 311 (95% CI: 272, 351) for prior BMI ≥18.5, 271 (95% CI: 221, 321) for prior BMI 17.0–18.5, and 237 (95% CI: 194, 297) for prior BMI <17.0; P = 0.03. HIV status showed limited and variable associations with insulin. Conclusions: Insulin concentration, fasting and during an OGTT, was normalized in women more than in men several years after adult malnutrition. Chronic malnutrition, as indicated by low prior and current BMI, may contribute to diabetes through low insulin secretion.
700			_a Daniel Faurholt-Jepsen _946773
700			_a Rikke Krogh-Madsen _946774
700			_aKidola Jeremiah _946775
700			_a Robert Peck _922817
700			_aAndrea M Rehman _946776
700			_a George PrayGod _923081
856			_uhttps://doi.org/10.1093/ajcn/nqaa438
942			_2ddc _cVM
999			_c19941 _d19941