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Medium-chain fatty acids increase glucose production in normal and low birth weight newborns
P F Bougnères1, L Castaño, F Rocchiccioli
1U 188 Institut National de la Santé et de la Recherche Medicale, Hôpital Saint-Vincent-de-Paul, Paris, France.
Insights
Hypoglycemia in low birth weight infants stems from reduced glucose production. Supplementing with medium-chain triglycerides boosted ketone levels, improved blood sugar, and increased glucose output, highlighting fatty acid oxidation
Area of Science:
- Neonatology
- Endocrinology
- Metabolic Research
Background:
- Hypoglycemia is a common complication in low birth weight neonates.
- The precise mechanisms underlying hypoglycemia in these infants remain incompletely understood.
Purpose of the Study:
- To investigate the pathogenesis of hypoglycemia in low birth weight infants.
- To assess the role of impaired glucose production and the impact of lipid metabolism.
Main Methods:
- Measured hepatic glucose output and plasma ketone levels in hypotrophic, premature, and normal newborns.
- Administered medium-chain triglycerides (MCTs) to low birth weight infants and monitored changes in glycemia, ketones, and glucose production.
Main Results:
- Low birth weight infants exhibited significantly lower hepatic glucose output and ketone levels compared to normal newborns.
- Oral MCT administration increased ketone concentrations, normalized glycemia, and enhanced glucose production rates.
- Glucose production rates strongly correlated with circulating ketone concentrations.
Conclusions:
- Hypoglycemia in low birth weight neonates is primarily caused by impaired glucose production.
- Fatty acid oxidation plays a crucial glucoregulatory role in newborns, as evidenced by the positive effects of exogenous lipid administration.
Abstract:
To study the pathogenesis of hypoglycemia in low birth weight infants, glucose production was measured in five hypotrophic and four premature newborns with glycemia of 45 +/- 6 and 59 +/- 10 mg/dl, respectively. Hepatic glucose output averaged 5.7 +/- 0.4 and 5.3 +/- 0.5 mg.kg-1.min-1 in these neonates vs. 8.2 +/- 0.5 mg.kg-1.min-1 in five normal at term newborns and was correlated with glycemia (P less than 0.02). Despite normal plasma free fatty acids, the low birth weight infants had low ketone levels of 163 +/- 72 and 126 +/- 65 vs. 263 +/- 60 microM in normals. Oral administration of medium-chain triglycerides to the neonates increased their circulating ketones by two- to threefold and restored near-normal glycemia (51 +/- 9 and 76 +/- 8 mg/dl) and production of glucose (6.7 +/- 0.7 and 6.6 +/- 0.8 mg.kg-1.min-1) in the hypotrophic and premature vs. normals (8.7 +/- 0.7 mg.kg-1.min-1). Individual rates of glucose production correlated with ketone concentrations (P less than 0.02). We conclude that the hypoglycemia characterizing low birth weight neonates is primarily due to impaired glucose production. That exogenous lipids were able to increase glucose production indicates that fatty acid oxidation plays an important glucoregulatory role in the human newborn.