Insulin-like growth factor I response during nutritional rehabilitation of persistent diarrhoea
a Department of
Paediatrics, The Aga Khan University Medical Center, PO Box 3500, Stadium Road, Karachi 74800, Pakistan, b Paediatric Endocrinology Unit, Department
of Woman and Child Health, Karolinska Institute, Stockholm S171 77, Sweden
Correspondence to: Professor Bhutta. email: zulfiqar.bhutta{at}aku.edu
Accepted 5 December
1998
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 DESIGNOpen
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.
RESULTSOf 63 children, 48 (group A) recovered within seven days of dietary
treatment. These children had a significant increase in serum IGF-I
(
IGF-I%) and, in contrast to serum prealbumin and retinol binding
protein, IGF-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 (0240) mg/l) at admission. There was a negative correlation between admission CRP
concentration and IGF-I%
(r = 0.45).
CONCLUSIONSIn
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.
Keywords: diarrhoea; insulin-like growth factor; C reactive protein; nutrition
© 1999 by Archives of Disease in Childhood
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