Abstract
BackgroundWhile obesity and overweight status are firmly established risk factors for Type 2 diabetes mellitus (T2DM), a substantial proportion of diabetic individuals, especially in Africa and Asia, are often underweight or normal weight. However, very little is known about the immunological and metabolic profiles of these individuals.MethodsThis study aimed to assess the relationship between malnutrition and Type 2 diabetes mellitus (T2DM). We examined a variety of analytes associated with the immunological and metabolic profiles of T2DM individuals with low (< 18.5 kg/m2) or normal (18.5–24.9 kg/m2) body mass index (BMI). To this end, we measured plasma levels of HbA1c, glucose, insulin, glucagon, adipocytokines and Type 1, Type 2, Type 17, pro-inflammatory and regulatory cytokines in T2DM individuals with low BMI (LBMI) or normal BMI (NBMI) with small sample size n = 44 in each group.ResultsLBMI individuals exhibited significantly higher levels of HbA1c, random blood glucose, insulin and glucagon compared to NBMI individuals. Similarly, LBMI individuals exhibited significantly higher levels of adiponectin and adipsin and significantly lower levels of leptin in comparison to NBMI individuals. LBMI individuals also exhibited significantly lower levels of the Type 1, Type 2, Type 17, pro-inflammatory and regulatory cytokines in comparison to NBMI individuals. Finally, while the metabolic parameters exhibited a significant negative correlation with BMI, the immunological parameters exhibited a significant positive correlation with BMI.ConclusionsMalnutrition is associated with a significant modulation of glycemic, hormonal and cytokine parameters in T2DM. Hence, the biochemical and immunological profiles of T2DM is significantly influenced by BMI.
Highlights
While obesity and overweight status are firmly established risk factors for Type 2 diabetes mellitus (T2DM), a substantial proportion of diabetic individuals, especially in Africa and Asia, are often underweight or normal weight
It has been proposed that impairment in insulin secretion, in utero undernutrition and epigenetic alterations to the genome might contribute to the pathogenesis of diabetes in the low body mass index (BMI) group [5]
Since there is a paucity of information about the link between malnutrition and metabolic diseases of inflammatory origin, we studied the relationship between undernutrition and T2DM and assessed the influence of malnutrition on factors which are essential in glycemic control
Summary
While obesity and overweight status are firmly established risk factors for Type 2 diabetes mellitus (T2DM), a substantial proportion of diabetic individuals, especially in Africa and Asia, are often underweight or normal weight. Malnutrition (undernutrition) in those with diabetes leads to impaired muscle function and wound healing, decreased bone mass, immune dysfunction, and general functional decline [7, 8]. Undernutrition/ malnutrition is typically defined by the presence of both low BMI and low serum albumin levels [13]. It is associated with a variety of metabolic abnormalities, including steatosis, increased lipolysis and fatty acid oxidation, decreased circulating amino acids, decreased peroxisome number and function and impaired mitochondrial function [13, 14]. Malnutrition can lead to immune dysfunction and enhanced mortality from infections [15,16,17]
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