title: IGF-I, IGF-I-binding proteins and GH-binding protein in malnourished elderly patients with inflammation receiving refeeding therapy.
abstract: OBJECTIVE
  To investigate the mechanisms determining the success or failure of refeeding therapy in malnourished elderly patients with inflammation by studying changes in plasma IGF-I, GH-binding protein (GHBP) and IGF-binding protein (IGFBP) levels and IGFBP-3 proteolysis.
  
  
  METHODS
  We studied 15 severely malnourished hospitalized elderly patients. Weight, food intake, plasma albumin, transthyretin, C-reactive protein (CRP), orosomucoid, interleukin-6 (IL-6), IGF-I, intact and proteolytically degraded IGFBP-3 and GHBP levels were determined on admission and during refeeding therapy designed to increase food intake to 40 kcal/kg body weight per day (15% protein).
  
  
  RESULTS
  Plasma IGF-I, IGFBP-3 and GHBP levels were significantly low for age on admission in all malnourished elderly patients. They increased in nine patients as nutritional status improved (albuminemia >30 g/l; transthyretinemia >200 mg/l or weight gain >5% of initial body weight) and levels of inflammation markers decreased (group 1). In contrast, plasma IGF-I, IGFBP-3 and GHBP levels remained low in six patients in whom nutritional status failed to improve and levels of inflammation markers increased (group 2). IGF-I showed greater variations than IGFBP-3 or GHBP with respect to nutritional status. High plasma CRP and IL-6 levels were associated with high levels of IGFBP-3 proteolysis.
  
  
  CONCLUSIONS
  Efficient refeeding therapy was associated with a significant increase in IGF-I plasma levels. In patients with severe and persistent inflammation, high levels of proteolysis of IGFBP-3 may have contributed to the low plasma IGF-I levels, persistence of hypercatabolism and lack of improvement in nutritional status.
authors: Unite de Nutrition Gériatrique, Hôpital Charles Foix AP-HP, F-94205 Ivry sur Seine, France. agathe.raynaud-simon@cfx.ap-hop-paris.fr
authors: A
authors: A
authors: Raynaud-Simon
authors: L
authors: L
authors: Perin
authors: S
authors: S
authors: Meaume
authors: B
authors: B
authors: Lesourd
authors: R
authors: R
authors: Moulias
authors: M C
authors: MC
authors: Postel-Vinay
authors: Y
authors: Y
authors: Le Bouc
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis; D002352:Carrier Proteins / Q000097:blood*; D005260:Female; D005502:Food; D006801:Humans; D007249:Inflammation / Q000150:complications*; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000378:metabolism; D018969:Insulin-Like Growth Factor Binding Proteins / Q000097:blood*; D007334:Insulin-Like Growth Factor I / Q000032:analysis*; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D009748:Nutrition Disorders / Q000097:blood* / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D009752:Nutritional Status; D010447:Peptide Hydrolases / Q000378:metabolism
chemical_list: D002352:Carrier Proteins; D018972:Insulin-Like Growth Factor Binding Protein 3; D018969:Insulin-Like Growth Factor Binding Proteins; D015850:Interleukin-6; D007334:Insulin-Like Growth Factor I; D002097:C-Reactive Protein; D010447:Peptide Hydrolases; C051815:somatotropin-binding protein