title: Increased energy intake in hip fracture patients affects nutritional biochemical markers.
abstract: OBJECTIVE
  We have previously shown that nutritional guidelines decreased the incidence of pressure ulcers in hip fracture patients. In the present study, we evaluate whether the nutritional biochemical markers S-IGF-1 (Insulin-like Growth Factor 1), S-Transthyretin and S-Albumin are affected by patients' energy intake, and whether the markers are useful as predictors of postoperative complications.
  
  
  METHODS
  Quasi-experimental design, with one intervention and one control group, as well as pre- and post-study measurements. Eighty-eight hip fracture patients were included: 42 in the control group and 46 in the intervention group. The control group received regular nutritional support pre- and postoperatively, while the intervention group received nutritional support that followed new, improved clinical guidelines from admission to five days postoperatively. S-Albumin, S-Transthyretin, C-Reactive Protein (S-CRP) and S-IGF-1 were analysed at admission and five days postoperatively as well as complications like pressure ulcer and infection.
  
  
  RESULTS
  The intervention group had a significantly higher energy intake; for example, 1636 kcal versus 852 kcal postoperative day 1. S-IGF-1 levels decreased significantly in the control group, while no decrease in the intervention group. S-Albumin and S-Transthyretin decreased and S-CRP increased significantly in both groups, indicating that those markers were not affected short-term by a high-energy intake. There was no correlation between short-term post-operative complications and S-IGF-1, S-Transthyretin or S-Albumin at admission.
  
  
  CONCLUSIONS
  The results of our study showed that S-IGF-1 can be used as a short-term nutritional biochemical marker, as it was affected by a five-day high-energy regimen. However, neither S-IGF-1, S-Transthyretin or S-Albumin were useful in predicting postoperative complications within five days postoperatively.
authors.affiliation: Department of Orthopaedics, Uppsala University Hospital, Uppsala, Sweden. anna-karin.gunnarsson@akademiska.se
authors.forename: A-K
authors.initials: AK
authors.lastname: Gunnarsson
authors.forename: T
authors.initials: T
authors.lastname: Akerfeldt
authors.forename: S
authors.initials: S
authors.lastname: Larsson
authors.forename: L
authors.initials: L
authors.lastname: Gunningberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D019587:Dietary Supplements; D002149:Energy Intake / Q000502:physiology*; D005260:Female; D005592:Fracture Fixation; D006620:Hip Fractures / Q000097:blood / Q000601:surgery*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status / Q000502:physiology; D018529:Nutritional Support / Q000379:methods*; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D011228:Prealbumin / Q000378:metabolism; D012709:Serum Albumin / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D011228:Prealbumin; D012709:Serum Albumin; D007334:Insulin-Like Growth Factor I; D002097:C-Reactive Protein