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. 1999 May;80(5):438–442. doi: 10.1136/adc.80.5.438

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

Z A Bhutta 1, P Bang 1, E Karlsson 1, L Hagenas 1, S Q Nizami 1, O Soder 1
PMCID: PMC1717936  PMID: 10208949

Abstract

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 DESIGN—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 7of 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 (ΔIGF-I%) and, in contrast to serum prealbumin and retinol binding protein, ΔIGF-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, 1.2to 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 ΔIGF-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.



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Selected References

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