Insulin-like growth factor I response during nutritional rehabilitation of persistent diarrhoea.
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).


METHODS
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.
Bhutta
Z A
ZA
Department of Paediatrics, The Aga Khan University Medical Center, PO Box 3500, Stadium Road, Karachi 74800, Pakistan. zulfiqar.bhutta@aku.edu
Bang
P
P
Karlsson
E
E
Hagenäs
L
L
Nizami
S Q
SQ
Söder
O
O
D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002675:Child, Preschool; D002908:Chronic Disease; D003967:Diarrhea / Q000097:blood / Q000178:diet therapy*; D003968:Diarrhea, Infantile / Q000097:blood / Q000178:diet therapy; D005260:Female; D006801:Humans; D007223:Infant; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D007413:Intestinal Mucosa / Q000378:metabolism; D008297:Male; D009748:Nutrition Disorders / Q000097:blood / Q000178:diet therapy*; D010539:Permeability; D011446:Prospective Studies; D016896:Treatment Outcome; D015430:Weight Gain
D015415:Biomarkers; D007334:Insulin-Like Growth Factor I; D002097:C-Reactive Protein