Insulin like growth factor-I, insulin like growth factor binding protein-1, and insulin in childhood Crohn's disease.

Abstract

Twenty nine children with Crohn's disease were studied before and after treatment with steroids or an elemental diet to assess the effect of disease activity and treatment on serum insulin like growth factor I (IGF-I), insulin like growth factor binding protein (IGFBP-1), and insulin concentrations. The median serum IGF-I concentration was lower in patients with active disease than in matched controls, and lower in stunted than well grown patients, but insulin and IGFBP-1 concentrations were not significantly different between any group. After four weeks of either treatment there was an increase in the median serum IGF-I concentration; this was greater in the steroid group than the elemental diet group. The median serum insulin concentration increased and median serum IGFBP-1 concentration decreased in the steroid treated group but not in the elemental diet group. These changes were accompanied by a greater and more sustained increase in energy intake in the steroid group. Despite this the median height velocity SD score was greater in the elemental diet group than in the steroid group. (Gut 1993; 34: 944-947)

Growth in Paediatric Crohn’s Disease

“…Low plasma IGF-1 levels have also been reported, but these are reversed by refeeding [20, 21, 22]. We found significantly lower IGF-1 concentrations in the group with growth failure > –2.0 SD and in the group with altered growth velocity (> –1.0) during follow-up.…”

“…Short-term (<1 year) comparative studies of enteral nutrition and steroids favour nutritional therapy rather than steroids as a way to improve growth velocity or biological markers of growth such as IGF1, IGF1 BP3 or collagen propeptides [22, 27, 28]. However, long-term studies taking into account ultimate height are lacking.…”

“…This report reviews the data concerning growth failure in paediatric CD [1, 2, 3, 4, 5, 6], how it comes about [3, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21]and the effect of new therapeutic strategies [22, 23, 24, 25, 26, 27, 28, 29, 30, 31]. …”

Insulin-Like Growth Factor-I Regulation of Immune Function: A Potential Therapeutic Target in Autoimmune Diseases?

“…Altered nutrition, such as reduced caloric intake, is frequently encountered in patients with active Crohn's disease and could account for the low IGF-I levels (Kirschner and Sutton, 1986). Twenty-nine children with active disease were examined before and after treatment with either systemic steroids or an elemental diet (Thomas et al, 1993). Median serum IGF-I levels, as determined by radioimmunoassay, were lower among this cohort with disease than those found in matched healthy control subjects and lower than those in children with growth-stunting from other causes.…”

Improving Growth in Children with Inflammatory Bowel Disease

“…Stimulated GH levels may be low in some children and some may have low serum IGF-I but normal levels of stimulated or physiological GH secretion [42,43,44,45]. The link between systemic GH levels either from stimulation tests or physiological sampling, as well as serum IGF-I levels and linear growth in IBD, is still unclear, although one group has reported an association between systemic IGF-I level and height velocity in children with IBD [46].…”