NUTRITIONAL AND PROGNOSTIC-SIGNIFICANCE OF INSULIN-LIKE-GROWTH-FACTOR-1 IN PATIENTS WITH LIVER-CIRRHOSIS

Most of the traditional parameters for nutrition assessment have impor tant limitations in patients with chronic liver disease. Insulin-like growth factor 1 (IGF-1) has been found to be regulated by nutrition an d proposed as a nutritional marker. Its nutritional significance in pa tients with liver cirrhosis, however, has not been investigated. Serum IGF-1 as well as traditional anthropometric, visceral, and immunologi c parameters were evaluated in 64 hospitalized cirrhotics, followed up clinically for 2 y. IGF-1(z-score) averaged -2.16 +/- 1.08 and invers ely correlated with Child-Pugh score (P < 0.01), the most reliable com posite score reflecting the severity of liver disease. IGF-1(z-score) was not different in patients with or without signs of energy malnutri tion, as defined by Values of midarm muscle circumference (MAMC) and/o r triceps skinfold (TSF) <5th percentile. Moreover, IGF-1(z-score) did not correlate with MAMC or TSF. Despite its correlation with all visc eral proteins, the reduction of IGF-1 was much greater and more freque nt than that of visceral proteins. Patients with IGF-1(z-score) < medi an values (-2.5) showed lower long-term survival rates compared with p atients with IGF-1(z-score) > -2.5 (P < 0.01). These data indicate tha t serum IGF-1 is not related to energy malnutrition in cirrhotic patie nts, while it appears to be a good predictor of survival and an early marker of liver dysfunction. Multiple factors, most of which an relate d to the severity of the liver disease, may contribute to the reductio n of IGF-1. This multifactorial pathogenesis probably accounts for its prognostic significance. (C) Elsevier Science Inc. 1997.