Increased energy intake in hip fracture patients affects nutritional biochemical markers

Scand J Surg. 2012;101(3):204-10. doi: 10.1177/145749691210100311.


Background and aims: We have previously shown that nutritional guidelines decreased the incidence of pressure ulcers in hip fracture patients. In the present study, we evaluate whether the nutritional biochemical markers S-IGF-1 (Insulin-like Growth Factor 1), S-Transthyretin and S-Albumin are affected by patients' energy intake, and whether the markers are useful as predictors of postoperative complications.

Material and methods: Quasi-experimental design, with one intervention and one control group, as well as pre- and post-study measurements. Eighty-eight hip fracture patients were included: 42 in the control group and 46 in the intervention group. The control group received regular nutritional support pre- and postoperatively, while the intervention group received nutritional support that followed new, improved clinical guidelines from admission to five days postoperatively. S-Albumin, S-Transthyretin, C-Reactive Protein (S-CRP) and S-IGF-1 were analysed at admission and five days postoperatively as well as complications like pressure ulcer and infection.

Results: The intervention group had a significantly higher energy intake; for example, 1636 kcal versus 852 kcal postoperative day 1. S-IGF-1 levels decreased significantly in the control group, while no decrease in the intervention group. S-Albumin and S-Transthyretin decreased and S-CRP increased significantly in both groups, indicating that those markers were not affected short-term by a high-energy intake. There was no correlation between short-term post-operative complications and S-IGF-1, S-Transthyretin or S-Albumin at admission.

Conclusion: The results of our study showed that S-IGF-1 can be used as a short-term nutritional biochemical marker, as it was affected by a five-day high-energy regimen. However, neither S-IGF-1, S-Transthyretin or S-Albumin were useful in predicting postoperative complications within five days postoperatively.

Publication types

  • Controlled Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Hip
  • Biomarkers / blood
  • C-Reactive Protein / metabolism
  • Dietary Supplements
  • Energy Intake / physiology*
  • Female
  • Fracture Fixation
  • Hip Fractures / blood
  • Hip Fractures / surgery*
  • Humans
  • Insulin-Like Growth Factor I / metabolism*
  • Male
  • Middle Aged
  • Nutritional Status / physiology
  • Nutritional Support / methods*
  • Perioperative Care / methods*
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control
  • Practice Guidelines as Topic
  • Prealbumin / metabolism
  • Serum Albumin / metabolism*


  • Biomarkers
  • Prealbumin
  • Serum Albumin
  • Insulin-Like Growth Factor I
  • C-Reactive Protein