Glucagon-like peptide-2 (GLP-2) response to enteral intake in children during anti-cancer treatment.
BACKGROUND
Intestinal dysfunction is frequent in cancer and during anti-cancer treatment. Glucagon-like peptide-2 (GLP-2) is secreted in a nutrition-dependent manner from the intestinal enteroendocrine L-cells. It accelerates crypt cell proliferation and nutrient absorption, inhibits enterocyte apoptosis and decreases mucosal permeability. Lack of GLP-2 may increase the risk of malabsorption and intestinal bacterial translocation. The aim of this study is to evaluate meal stimulated secretion of GLP-2 in children with cancer undergoing anti-cancer treatment.


METHODS
Plasma-GLP-2 analysis after an overnight fast and 1 hour after intake of a mixed test meal. Data on gastrointestinal toxicity, blood neutrophile counts and food records were included in the analysis.


RESULTS
Forty-four meal stimulation tests were performed in 25 children (median age, 6.0 years; range, 2.5-19) during anti-cancer treatment. Median GI toxicity score was 5 (range, 0-15), and mean energy intake was 62.4% of recommended values. P-GLP-2 values increased from mean (SD) 38 (18) to 63 (51) pmol/l (P < 0.0001). Twelve of the meal stimulation tests (28%) resulted in a p-GLP-2 increase >2 fold, which is assumed to be the lower limit of normal values. The increase was strongly dependent on the energy intake (r = 0.62, P < 0.0001), while toxicity score and neutrophile count had no significant influence (multiple regression).


CONCLUSIONS
In children treated with anti-cancer therapy, GLP-2 secretion seems to be normal if the enteral energy intake is sufficient. Insufficient GLP-2 secretion could influence the gastrointestinal problems seen in the children with a low enteral energy intake.
Andreassen
B U
BU
Paediatric Nutrition Unit, Rigshospitalet, Coppenhagen, Denmark. bua@dadlnet.dk
Paerregaard
A
A
Schmiegelow
K
K
Rechnitzer
C
C
Heilman
C
C
Hartmann
B
B
Holst
J J
JJ
Michaelsen
K F
KF
D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015930:Diet Records; D002149:Energy Intake / Q000502:physiology; D004750:Enteral Nutrition; D005260:Female; D053767:Glucagon-Like Peptide 2; D004763:Glucagon-Like Peptides; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000188:drug therapy; D009504:Neutrophils / Q000166:cytology; D009751:Nutritional Requirements; D009752:Nutritional Status; D010455:Peptides / Q000097:blood / Q000378:metabolism*
D053767:Glucagon-Like Peptide 2; D010455:Peptides; D004763:Glucagon-Like Peptides