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Insulin-like growth factor I response during nutritional rehabilitation of persistent diarrhoea
Z A Bhutta1, P Bang, E Karlsson
1Department of Paediatrics, The Aga Khan University Medical Center, PO Box 3500, Stadium Road, Karachi 74800, Pakistan. zulfiqar.bhutta@aku.edu
Insights
Serum insulin-like growth factor I (IGF-I) is a better marker for nutritional recovery in malnourished children with persistent diarrhea. Systemic infections may impact IGF-I response and recovery outcomes.
Area of Science:
- Pediatric Nutrition
- Gastroenterology
- Infectious Diseases
Background:
- Persistent diarrhea in malnourished children is a significant clinical challenge.
- Nutritional recovery and associated biomarkers require further investigation.
- The role of systemic infections in modulating recovery is not fully understood.
Purpose of the Study:
- To evaluate nutritional recovery, intestinal permeability, and insulin-like growth factor I (IGF-I) response in malnourished children with persistent diarrhea.
- To determine the relationship between these parameters and concomitant systemic infections.
Main Methods:
- An open study involving 63 severely malnourished children (6-36 months) with persistent diarrhea (>14 days).
- Nutritional rehabilitation utilized a standardized rice-lentil and yogurt diet.
- Data on coexisting infections and serum C-reactive protein (CRP) were collected at admission.
Main Results:
- 48 children (76%) achieved successful recovery (weight gain >5 g/kg/day, reduced stool output by day 7).
- Recovered children showed a significant increase in serum IGF-I (DeltaIGF-I%), correlating with weight gain.
- Treatment failures were associated with higher rates of sepsis and elevated admission CRP levels, which negatively correlated with DeltaIGF-I%.
Conclusions:
- Serum IGF-I increment is a superior marker for nutritional recovery compared to albumin, prealbumin, and retinol binding protein in this population.
- Systemic infections may negatively influence IGF-I response and overall recovery.
- Further research is needed to explore the association between systemic infections, IGF-I response, and mucosal healing.
Objective:
Evaluation of nutritional recovery, intestinal permeability, and insulin-like growth factor I (IGF-I) response in malnourished children with persistent diarrhoea and their relation to concomitant systemic infection(s).
Study Design:
Open study of severely malnourished children (aged 6-36 months) with persistent diarrhoea (>/= 14 days) admitted for nutritional rehabilitation with a standardised rice-lentil and yogurt diet. Successful recovery was defined prospectively as overall weight gain (> 5 g/kg/day) with a reduction in stool output by day 7 of treatment. Data on coexisting infections and serum C reactive protein (CRP) were collected at admission.
Results:
Of 63 children, 48 (group A) recovered within seven days of dietary treatment. These children had a significant increase in serum IGF-I (DeltaIGF-I%) and, in contrast to serum prealbumin and retinol binding protein, DeltaIGF-I% correlated with weight gain (r = 0.41). There was no correlation between the IGF-I response and intestinal permeability as assessed by urinary lactulose/rhamnose excretion. Treatment failures (group B) included more children with clinical (relative risk, 4.8; 95% confidence interval, 1.2 to 19.7) and culture proven sepsis at admission and higher concentrations of serum CRP (median (range), 36 (0-182) v 10 (0-240) mg/l) at admission. There was a negative correlation between admission CRP concentration and DeltaIGF-I% (r = -0.45).
Conclusions:
In comparison with serum albumin, prealbumin, and retinol binding protein, serum IGF-I increment is a better marker of nutritional recovery in malnourished children with persistent diarrhoea. The possible association of systemic infections, serum IGF-I response, and mucosal recovery needs evaluation in future studies.