Serum insulin-like growth factors I and II concentrations and growth hormone and insulin responses to arginine infusion in children with protein-energy malnutrition before and after nutritional rehabilitation

Serum insulin, growth hormone (GH), insulin-like growth factors (IGFs) I and II, Cortisol, and albumin concentrations were measured in 15 children with kwashiorkor, 15 with marasmic-kwashiorkor, and 21 with marasmus, before and in the survivors, after nutritional rehabilitation, as well as in 10 underweight and eight normal Egyptian children. We also evaluated arginine-induced insulin and GH secretion. IGF-I concentrations were reduced in the three severely malnourished groups (0.07 ± 0.03, 0.05 ± 0.03, and 0.09 ± 0.09 U/ml, respectively) but returned to normal after refeeding. IGF-II concentrations were low in the kwashiorkor (175 ± 79 ng/ml), marasmic-kwashiorkor (111 ± 57 ng/ml), and marasmic children (128 ± 70.9 ng/ml) and returned to normal after nutritional rehabilitation. Basal GH levels were high in the three severely malnourished groups (21.9, 28.8, and 16.6 ng/ml, respectively) and returned to normal after refeeding (8.1, 6.5, and 6.0 ng/ml, respectively). GH responses to arginine were depressed in the three malnourished groups and improved significantly in marasmic-kwashiorkor and marasmic children after nutritional rehabilitation. Insulin responses to arginine were impaired in kwashiorkor, and marasmic-kwashiorkor children and improved significantly after refeeding. IGF-I levels correlated significantly with percent of expected weight (r = 0.52, p < 0.001), percent of expected height (r = 0.42, p < 0.001), and weight/ (height)2 index (r = 0.34, p < 0.01). IGF-I levels correlated positively with insulin levels (r = 0.421, p < 0.001) and negatively with Cortisol concentrations (r = -0.400, p < 0.001). It is suggested that effective lipolysis mediated by high GH and possibly low IGF levels, is an important adaptive mechanism to assure fuel (fatty acids) supply for metabolism of brain and peripheral tissues during nutritional deprivation.