Growth hormone, alone and in combination with insulin, increases whole body and skeletal muscle protein kinetics in cancer patients after surgery

Objective To investigate the impact of growth hormone, alone and in combina tion with insulin, on the protein kinetics of patients with upper gastroint estinal (GI) tract cancer who have undergone surgery and are receiving tota l parenteral nutrition (TPN). Summary Background Data Patients with malignancies of the upper GI tract ar e at increased risk for malnutrition and perioperative death and complicati ons, Standard nutritional support has not significantly altered outcome, Gr owth hormone (GH) and insulin have been shown to have some benefit in patie nts with cancer; however, their action in patients undergoing resection has not previously been studied. Methods Thirty patients undergoing surgery for upper GI tract malignancies were prospectively randomized into one of three nutritional support groups after surgery: 10 patients received standard TPN, 10 received TPN plus dail y injections of GH, and 10 received daily GH, systemic insulin, and TPN. Th e patients underwent a protein kinetic radiotracer study on the fifth day a fter surgery to determine whole body and skeletal muscle protein kinetics. Results Patients who received standard TPN only were in a state of negative skeletal muscle protein net balance. Those who received GH and insulin had improved skeletal muscle protein net balance compared with the TPN only gr oup. Whole body protein net balance was improved in the GH and the GH and i nsulin groups compared with the TPN only group. GH and insulin combined did not improve whole body net balance more than GH alone. GH administration s ignificantly increased serum IGF-1 and GH levels. Insulin infusion signific antly increased serum insulin levels and the insulin/glucagon ratio. Conclusion rowth hormone and GH plus insulin regimens improve protein kinet ic parameters in patients with upper GI tract cancer who are receiving TPN after undergoing surgery.