The influence of alanine infusion on glucose production in 'malnourished' African children with falciparum malaria

Abstract

By US standards, about half of African children are malnourished, although most appear clinically normal. It is possible that precursor supply for gluconeogenesis is limited to a greater extent in these seemingly malnourished African children than in healthy children, consequently limiting glucose production. Since in malaria peripheral glucose utilization is increased, precursor supply could play an even more critical role in maintaining glucose production in African children suffering from falciparum malaria. We studied the effect of alanine infusion (1.5mg/kg/min) on glucose production (measured by infusion of [6,6-2H2]glucose) and plasma glucose concentration in 10 consecutive children with acute, uncomplicated falciparum malaria. By US standards, six children were below the 10th percentile of weight for height and seven were below the 10th percentile of height for age. Plasma concentrations of alanine increased during alanine infusion from 153 ± 21 to 468 ± 39 μmol/l, whereas plasma lactate concentrations did not change (1.4 ± 0.2 vs. 1.3 ± 0.2 mmol/l). Plasma glucose concentration and glucose production did not change during alanine infusion: 4.6 ± 0.3 vs. 4.5 ± 0.3 mmol/l and 5.8 ± 0.4 vs. 5.7 ± 0.3 mg/kg/min, respectively. Gluconeogenic precursor supply is sufficient for maintainance of glucose production in African children with uncomplicated malaria who are malnourished by US standards.