Serum levels of insulin-like growth factor-1 in the three months followingsurgery for a hip fracture in elderly: relationship with nutritional status and inflammatory reaction
B. Campillo et al., Serum levels of insulin-like growth factor-1 in the three months followingsurgery for a hip fracture in elderly: relationship with nutritional status and inflammatory reaction, CLIN NUTR, 19(5), 2000, pp. 349-354
Background and aims: Serum IGF-I level declines with advancing age and is a
reliable index of protein-energy undernutrition in elderly patients in a m
etabolically stable condition. We have examined the value of IGF-1 as an in
dicator of malnutrition in elderly patients during recovery within 1 month
after surgery for a hip fracture and we have studied the relationship betwe
en changes in IGF-I levels, nutritional status and inflammatory reaction du
ring 2 month follow up.
Study design: Forty elderly patients (mean age 84.0 +/- 1.9) were nutrition
ally assessed upon admission to our rehabilitation unit (D0) then monthly (
D30-D60) by measurement of anthropometric and biological parameters. Two gr
oups of patients were defined on the basis of mid-arm circumference (MAC) a
nd tricipital skinfold thickness (TST) measurement at D0: group 1, undernou
rished (n = 13) and group 2, normally nourished (n = 27). Changes in anthro
pometric and biological parameters during the study were compared between t
hese two groups of patients.
Results: IGF-1 level was significantly lower in group 1 (79.5 +/- 9.1 vs 10
8 +/- 8.6 ng/ml, P < 0.05) while usual serum protei n levels were in the sa
me range in the two groups. Orosomucoid level significantly decreased durin
g 2 month follow-up in group 2 (P < 0.01), CRP level decreased but not sign
ificantly TST and MAC decreased in group 2 (respectively P < 0.02 and P < 0
.05) while anthropometric parameters tended to slightly increase in group I
in relation with an increase in caloric intake (P < 0.05). IGF-1 level inc
reased significantly during the study in group 2 (P < 0.05) and was signifi
cantly lower in patients with complications occurring between D0 and D30 in
comparison with patients without complications (respectively P < 0.05 at D
0, P< 0.02 at D30). IGF-1 level correlated with body mass index, MAC, TST,
muscle midarm circumference, albumin and transthyretin levels. Changes in I
GF-1 levels positively correlated with those in transthyretin levels and ne
gatively with those in orosomucoid levels.
Conclusion: IGF-1 level seems a reliable index of protein-energy under-nutr
ition in elderly patients in the recovery period after surgery for a hip fr
acture. This marker is influenced by the inflammatory reaction. Decline of
inflammatory reaction, rather than change in nutritional status, is respons
ible for the variation in IGF-I level during a 2 month follow-up. (C) 2000
Harcourt Publishers Ltd.