Insulin-like growth factor-1 as a nutritional monitoring factor in patients with chronic intestinal failure

Abstract

Background & aims: Nutritional monitoring plays an important role in optimizing nutritional support in patients with chronic intestinal failure (CIF) receiving long-term supplementation. Unlike initial nutritional assessment, however, there are no recommended guidelines for establishing a nutritional monitoring index. This study is to evaluate the suitability of insulin-like growth factor-1 (IGF-1) as a nutritional monitoring factor in CIF patients.

Methods: We retrospectively analyzed the correlation between serum nutritional indicators, including IGF-1 levels, and nutritional assessment, nutritional monitoring, and lean body mass in 197 patients with CIF.

Results: The mean age of the 197 enrolled patients was 47.22 ± 18.87 years old and; the mean BMI was 16.83 ± 3.31. The mean NRS-2002 score was 3.49 ± 0.83; and moreover, 76.3% of the patients were malnourished. The median length of hospital stay in hospital (LOS) was 18.5 days. IGF-1 was positively correlated with body mass index, hemoglobin, albumin, pre-albumin, retinol-binding protein (RBP), transferrin, serum creatinine (Scr) and cholesterol (p < 0.05 for all). Testing performed over 3 weeks post-admission showed that significantly different weekly changes were observed only in IGF-1, RBP, and Scr during the period of nutritional support (p < 0.05 for each). Multivariate linear regression analysis showed that IGF-1 and body mass index were independent factors influencing fat-free mass, skeletal muscle mass, and body protein mass (p < 0.05 for each).

Conclusions: IGF-1 is suitable for monitoring short-term changes in the nutritional status in CIF patients. This may be attributed to its shorter half-life, greater sensitivity, and better correlation with lean body mass. ClinicalTrials.gov number, NCT03277014.

Keywords: Chronic intestinal failure; Insulin-like growth factor-1; Lean body mass; Nutritional assessment; Nutritional monitoring.