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

Bhutta, Zulfiqar Ahmed; Bang, Peter; Karlsson, Ewa; Hagenäs, Lars; Nizami, Shaikh Qamaruddin; Söder, Olle

doi:10.1136/adc.80.5.438

Cited by 16 publications

(11 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Bhutta and others described severely depressed IGF-1 concentrations in young children hospitalized for persistent diarrhea in Pakistan, but rapid increases after nutritional recovery, with increments in IGF-1 correlating well with weight gain. 33 Low concentrations of IGF-1 have previously been described in children with acute shigellosis 34,35 and severe acute malnutrition, 36,37 with increases in IGF-1 seen upon nutritional recovery. 37,38 IGF-1 and IGF-2 were also found to be lower in patients with viral infections compared with healthy controls in a cohort of European adults 20-75 years of age.…”

Section: Discussionmentioning

confidence: 91%

“…32 Moreover, zinc supplementation in young children has been shown to increase plasma concentrations of IGF-1 while also reducing the risk of diarrhea episodes and increasing linear growth velocity. 33 Alternatively, zinc deficiency may cause reduced concentrations of serum IGF-1 while also increasing risk of diarrhea. Unfortunately, we did not have data on zinc or IGF-1 status in children before their acute illness so cannot establish the extent or direction through which this mechanism may have contributed to the observed associations.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Acute Illness is Associated with Suppression of the Growth Hormone Axis in Zimbabwean Infants

Jones¹,

Rukobo²,

Chasekwa³

et al. 2015

The American Society of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

Abstract. Frequent infections contribute to childhood stunting in developing countries but the causal pathways are uncertain. We tested the hypothesis that intercurrent illnesses suppress the growth hormone axis through reductions in insulin-like growth factor 1 (IGF-1). In a birth cohort of 202 HIV-unexposed Zimbabwean infants, we analyzed data on 7-day illness recall and measured plasma interleukin-6, C-reactive protein, alpha-1-acid glycoprotein, and IGF-1 by enzyme-linked immunosorbent assay, at age 6 weeks, and then 3, 6, 12, and 18 months. Children with recent acute illness had lower IGF-1 concentrations than healthy children and IGF-1 correlated inversely (P 0.05) with inflammatory biomarkers at most time points between 3 and 18 months. Using path analysis, we showed that cough and fever had a predominantly indirect effect on suppressing IGF-1, through the acute-phase response, whereas diarrhea had a predominantly direct effect on IGF-1. Acute illness may therefore impact the growth hormone axis through both direct and indirect pathways.

show abstract

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Acute Illness is Associated with Suppression of the Growth Hormone Axis in Zimbabwean Infants

Jones¹,

Rukobo²,

Chasekwa³

et al. 2015

The American Society of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

show abstract

“…Enteric infections involving poor growth have been linked to subclinical infections and may exhibit both systemic inflammation and elevations in stool inflammatory markers such as myeloperoxidase, α1 antitrypsin, and neopterin without overt diarrheal symptoms [8]. The presence of systemic inflammation during infection may play a role in growth suppression, as similar linear growth deficits have been noted in other conditions with high levels of systemic inflammation, such as Crohn's disease and juvenile idiopathic arthritis, in which poor growth is associated with high levels of inflammatory markers, low levels of important growth factors such as insulin-like growth factor (IGF)-1, and poor responsiveness of the growth plate [9], [10], [11], [12].…”

Section: Introductionmentioning

confidence: 89%

Systemic inflammation, growth factors, and linear growth in the setting of infection and malnutrition

et al. 2017

View full text Add to dashboard Cite

ObjectivesDeficits in weight gain and linear growth are seen frequently among children in areas where malnutrition and recurrent infections are common. Although both inflammation and malnutrition can result in growth hormone (GH) resistance, the interrelationships of infection, inflammation, and growth deficits in developing areas remain unclear. The aim of this study was to evaluate relationships between low levels of systemic inflammation, growth factors, and anthropometry in a case–control cohort of underweight and normal weight children in northern Brazil.MethodsWe evaluated data from 147 children ages 6 to 24 mo evaluated in the MAL-ED (Interactions of Malnutrition and Enteric Disease) case–control study following recruitment from a nutrition clinic for impoverished families in Fortaleza, Brazil. We used nonparametric tests and linear regression to evaluate relationships between current symptoms of infections (assessed by questionnaire), systemic inflammation (assessed by high-sensitivity C-reactive protein [hsCRP]), the GH insulin-like growth factor-1 (IGF-1) axis, and measures of anthropometry. All models were adjusted for age and sex.ResultsChildren with recent symptoms of diarrhea, cough, and fever (compared with those without symptoms) had higher hsCRP levels; those with recent diarrhea and fever also had lower IGF-1 and higher GH levels. Stool myeloperoxidase was positively associated with serum hsCRP. hsCRP was in turn positively associated with GH and negatively associated with IGF-1 and IGF-binding protein-3 (IGFBP-3), suggesting a state of GH resistance. After adjustment for hsCRP, IGF-1 and IGFBP-3 were positively and GH was negatively associated with Z scores for height and weight.ConclusionsInfection and inflammation were linked to evidence of GH resistance, whereas levels of GH, IGF-1, and IGFBP-3 were associated with growth indices independent of hsCRP. These data implicate complex interrelationships between infection, nutritional status, GH axis, and linear growth in children from a developing area.

show abstract

“…A study of malnourished children with persistent diarrhoea from Pakistan found that in comparison with other markers of nutritional recovery (e.g. serum albumin, prealbumin and retinol‐binding protein), serum insulin‐like growth factor‐1 response during recovery provided an important and sensitive measure of nutritional and diarrhoeal recovery 7 …”

Section: Resultsmentioning

confidence: 99%

“…serum albumin, prealbumin and retinol-binding protein), serum insulin-like growth factor-1 response during recovery provided an important and sensitive measure of nutritional and diarrhoeal recovery. 7 In assessing the nutritional status of severe malnutrition in hospital, the use of EpiNut (Epi Info 2002) allows assessment of the severity of underweight (WAZ), wasting (WHZ), stunting (HAZ), thinness (MUAC) and microcephaly (head circumference) with the use of zscores in severe malnutrition. 8 Centiles and z-scores have the advantage of simplicity because the numbers mean the same for each index, whereas the per cent of the median does not, and is no longer available with the CDC 2000 reference data in EpiNut.…”

Section: Resultsmentioning

confidence: 99%

Critical appraisal of the management of severe malnutrition: 1. Epidemiology and treatment guidelines

Brewster

2006

J Paediatrics Child Health

View full text Add to dashboard Cite

Hospital case-fatality rates for severe malnutrition in the developing world remain high, particularly in Africa where they have not changed much over recent decades. In an effort to improve case management, WHO has developed treatment guidelines. The aim of this review is to critically appraise the evidence for the guidelines and review important recent advances in the management of severe malnutrition. We conclude that not only is the evidence base deficient, but also the external generalisability of even good-quality studies is seriously compromised by the great variability in clinical practice between regions and types of health facilities in the developing world, which is much greater than between developed countries. The diagnosis of severe wasting is complicated by the dramatic change in reference standards (from CDC/WHO 1978 to CDC 2000 in EpiNut) and also by difficulties in accurate measurement of length. Although following treatment guidelines has resulted in improved outcomes, there is evidence against the statement that case-fatality rates (particularly in African hospitals) can be reduced below 5% and that higher rates are proof of poor practice, because there is wide variation in severity of illness factors. The practice of prolonged hospital treatment of severe malnutrition until wasting and/or oedema has resolved is being replaced by shorter hospital stays combined with outpatient or community follow-up because of advances in dietary management outside of hospital.

show abstract

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

Abstract: (Arch Dis Child 1999;80:438-442)

Cited by 16 publications

References 28 publications

Acute Illness is Associated with Suppression of the Growth Hormone Axis in Zimbabwean Infants

Acute Illness is Associated with Suppression of the Growth Hormone Axis in Zimbabwean Infants

Systemic inflammation, growth factors, and linear growth in the setting of infection and malnutrition

Critical appraisal of the management of severe malnutrition: 1. Epidemiology and treatment guidelines

Contact Info

Product

Resources

About