Cornu, André

Delpeuch, Francis

Papoz, L.

Simondon, François

Horizon / Pleins textes

I .  . 
7,O 
6.0 
5.0 - 
4 ,o 
3 . 0  
2.0 
- 
. .  
yLo*M MC3 
European Joitrnal of Clinical Nutrition (1990) 44, 249-250 
. .  . .  
. . 
I. *... t .... 
***t. 
t..... 
** *. 
1 '  
Glycosylated haemoglobin in children with protein-energy malnutrition 
Dear Editors, 
In the field of diabetes, the non-enzymatic 
glycosylation of proteins offers the possibility 
of reflecting the time-integrated glucose 
concentration. Determination of the glycated 
haemoglobin (HbAlc), widely used for 
diabetic control, is considered as an accurate 
index of the mean blood glucose concen- 
tration during the preceding 2 months. 
Although mostly concerned with hyper- 
glycaemia, it has been shown that HbAlc 
can also reflect hypoglycaemia as in patients 
suffering from insulinoma (Freedman, 
Dandona & Hobbs, 1980). 
We wanted to investigate whether HbAlc 
is lower in children with protein-energy 
malnutrition (PEM). The leading hypothesis 
is that children suffering from PEM have a 
higher probability of past low glycaemia. 
Several studies have shown hypoglycaemia 
in severe PEM (Kerr et al., 1973) and low 
glycaemia has been observed during fasting 
in moderate PEM (Kerpel-Fronius & Kaiser, 
1967). If such a relationship is observed, 
non-enzymatic glycosylation of proteins of 
different turnover times could be an 
interesting investigation tool for PEM and a 
reference criterion for validation of 
nutritional indicators used in public health, 
such as anthropometric indicators. 
The study has been performed on children 
aged 12-36 months in Brazzaville, Congo, in 
1987. Twenty-nine cases were hospitalized 
in the paediatric ward of the general hospital 
of Brazzaville or  in a nutritional re- 
habilitation center. They were defined by 
having weight for height lower than -2 
standard deviations (SD) of the mean of the 
NCHS reference population. The 60 healthy 
controls (weight for height greater than -2 
SD) were attending the well-baby clinics for 
routine growth monitoring. The two groups 
were matched for age. 
The HbAlc analyses were performed on 
whole blood by an ion exchange chroma- 
tography method on microcolumns (Biorad). 
Statistical analysis was done with analysis of 
variance test. 
The mean weight for height was -2.7 SD 
in the malnourished group and -0.43 in the 
control group. Good age matching has been 
obtained as mean age is 18.1 months (s.e.m. 
0.8 months) in both groups. 
Glycosylated haemoglobin was signific- 
antly lower in the malnourished group (4.6 
per cent, s.e.m. 0.2 per cent) than in the 
control group (5.3 per cent, s.e.m. 0.2 per 
cent). The difference observed is statistically 
significant, with a P value of 0.017 (Figure). 
As a conclusion to this preliminary work, 
if the initial hypothesis seems valid, further 
investigations should consider the two 
following points. 
Firstly, a more precise determination of 
HbAlc, such as with HPLC methods, could 
perhaps improve the discrimination between 
malnourished and healthy children. 
Secondly, the case control design of this 
study and the age adjustment between 
groups protect against possible confounding 
factors. But the influence of haemo- 
globinopathies and haemolysis on HbAlc 
levels lead to a noisy relation with PEM, 
especially in tropical areas. This should be 
' 
HMlC (I) 
10.0 - 1  
t .. 
t. 
...***. 
..** 
t....... .*..*..... 
s.... t... 
. I ( . .*  ,. 
a...* . 
tp5,Jt 
ir0.017 
CONTROLS m.mouRIsnEn 
Fig. 1. Glycosylated haemoglobin levels (HbAlc) in 
children suffering from protein energy malnutrition and 
in controls. Malnourished: weight for height !ewer than 
-2 SD. Controls: weight for height greater than -2 SD. 
QRSTSM: Fonds Documentaire 
250 Letter to the Editors 
improved by controlling for those’ factors. References 
Furthermore, additional insight could be Freedman DB, Dandona P & Hobbs KGF (1980): 
given by studyingotherglycosylatedproteins, Glycosylated hemoglobin (HbAI) in a case of in- 
sulinoma. N. Engl. J. Med. 302, 1420. 
Kerpel-Fronius E & Kaiser E (1967): Hypoglycemia in 
F. Simondon’ infantile malnutrition. Acta Paediatr. Scand. 172, 
F. Delpeuch2 119-127. 
L. papoz3 Kerr DS, Stevens CG, Robinson Hh4 & Picou DIM 
(1973): Hypoglycemia and the regulation of fasting *‘ ‘Ornu4 glucose metabolism in malnutrition. In Endocrine 
Tropical Nutrition Units of ‘ORSTOM, BP 1386, aspects of malnutrition, ed LI Gardner & P 
Dakar, Senegal, 20RSTOM, BP 5045,. Montpellier, Amacher, PP. 313-341. Santa Ynez: The Kroc 
France, “ORSTOM, BP 181, Brazzaville, Congo, and Foundation. 
’INSERM 1121, 94807 Villeju$ France 
. such as collagen. 
c 
r 
f 


Glycosylated haemoglobin in children with protein-energy malnutrition

Abstract

Similar works

Full text

Available Versions

Horizon / Pleins textes

Name not available