Nutritional and prognostic significance of insulin-like growth factor 1 in patients with liver cirrhosis

Caregaro, L.; Alberino, F.; Amodio, Piero; Merkel, Carlo; Angeli, Paolo; Plebani, Mario; Bolognesi, Massimo; Gatta, Angelo

doi:10.1016/s0899-9007(96)00399-1

Cited by 59 publications

(48 citation statements)

References 26 publications

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“…28,29 Nevertheless, to our knowledge, no published study has evaluated serum IGF-I levels in the osteoporosis associated with chronic liver disease. Like others, [30][31][32] we found low serum IGF-I levels, which were related to the severity of the liver disease. In our study, BMD in LS was positively correlated with serum IGF-I levels, and patients with osteoporosis had serum IGF-I concentrations lower than patients without osteoporosis.…”

Section: Discussionsupporting

confidence: 86%

Bone mineral density, serum insulin-like growth factor I, and bone turnover markers in viral cirrhosis

et al. 1998

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Previous studies suggest that low bone mass is a complication of alcoholic liver disease. Nevertheless, little is known about bone mass and bone metabolism in viral cirrhosis. To evaluate the prevalence and magnitude of hepatic osteopenia in these patients, bone remodeling status, and its relationship with the severity of liver disease and serum levels of insulin-like growth factor I (IGF-I), we studied 32 consecutive patients with viral cirrhosis and no history of alcohol intake. Bone mineral density (BMD) was measured by dual x-ray absorptiometry in the lumbar spine (LS) and femoral neck (FN), and the values were expressed as the z score. Bone metabolism markers and hormone profiles were measured. Patients with viral cirrhosis showed reduced BMD in all sites (LS: ؊1.27 ؎ 1.06, P F .001; FN: ؊0.48 ؎ 0.96; P F .01). Of the 32 patients, 53% met the diagnostic criteria for osteoporosis. In patients, urine deoxypyridinoline (D-Pyr) as a marker of bone resorption and serum bone alkaline phosphatase (b-AP) as a marker of bone formation were significantly higher than in control subjects (P F .001 and P F .01, respectively). Serum IGF-I was lower than in control subjects (P F .001), and significant differences were also found between patients with and without osteoporosis (P F .05). BMD in LS correlated with severity of the disease, with serum levels of IGF-I, and with urine D-Pyr. Our findings show that viral cirrhosis is a major cause of osteoporosis in men, and that low serum IGF-I levels seem to play a role in the bone mass loss in these patients. The biochemical markers of bone remodeling suggest high-turnover osteoporosis in patients with viral cirrhosis. (HEPATOLOGY 1998;28:695-699.)

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Section: Discussionsupporting

confidence: 86%

Bone mineral density, serum insulin-like growth factor I, and bone turnover markers in viral cirrhosis

et al. 1998

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“…This finding is supported by previous studies in patients with severe liver disease, showing significant correlations of IGF-I [5, 6, 11], IGFBP-3 [6, 7, 8, 10, 13]and IGF-II [9]with parameters of liver function as Child-Pugh classification [5, 6, 7, 8, 10, 11], aminopyrine breath test values [5], cholinesterase [6, 9], total serum proteins [6]and albumin [7, 9, 13]. Because of the possible prognostic value of basal and GH-induced IGF-I and IGFBP-3 serum levels in patients with severe liver disease [19, 20, 21], further prospective studies should evaluate the role of IGF-I and IGFBP-3 serum levels as biochemical markers for the assessment of liver function post-LTX.…”

Section: Discussionmentioning

confidence: 99%

“…Hepatic growth hormone receptor (GHR) expression [14]and serum growth hormone-binding protein (GHBP) levels [6, 15, 16, 17]– generated by proteolytic cleavage of membrane-bound GHR and therefore reflecting the abundance of liver GHR [18]– are reduced in patients with liver cirrhosis. Recent studies have characterized serum levels of basal IGF-I [19, 20], basal IGFBP-3 [20]and GH-induced IGF-I [21]as good predictors of residual liver function and survival in patients with liver cirrhosis. In children with severe liver disease, the dearrangement of the GH-IGF-IGFBP axis has been shown to be corrected after orthotopic liver transplantation (LTX) [22, 23, 24, 25, 26, 27], with normalization of GH [23, 24], IGF-I [22, 23, 24, 25, 26, 27]and IGFBP-3 [22, 23, 25, 26, 27]levels.…”

Section: Introductionmentioning

confidence: 99%

Insulin-Like Growth Factors and Insulin-Like Growth Factor Binding Proteins in Adult Patients with Severe Liver Disease before and after Orthotopic Liver Transplantation

et al. 2002

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Introduction: The liver is the main source of serum insulin-like growth factors (IGFs) and IGF-binding proteins (IGFBPs) and the concentration of these proteins might reflect liver function. Methods: In a retrospective longitudinal study we examined serum levels of total and free IGF-I, IGF-II, IGFBP-1, IGFBP-2, IGFBP-3 and IGFBP-6 in 21 adult patients with end-stage liver disease before and after orthotopic liver transplantation (LTX) by sensitive and specific RIAs. In each patient, the mean value of at least three measurements before and after LTX was calculated. Results: Before LTX, serum levels of total and free IGF-I, IGF-II, IGFBP-3 were low and showed a rapid and significant increase in almost all patients after successful LTX (total IGF-I: 30 ± 7 vs. 256 ± 30 ng/ml, p < 0.001; free IGF-I: 1.3 ± 0.3 vs. 3.5 ± 0.6 ng/ml, p < 0.01; IGF-II: 177 ± 28 vs. 618 ± 30 ng/ml, p < 0.001; IGFBP-3: 1,230 ± 136 vs. 3,665 ± 264 ng/ml, p < 0.001). In contrast, IGFBP-1 was found to be high immediately before LTX, and declined to normal levels after LTX (210 ± 40 vs. 90 ± 15 ng/ml, p < 0.01), while IGFBP-2 did not show any significant changes (1,154 ± 296 vs. 1,303 ± 192 ng/ ml). Positive correlations were found between IGF-I, IGF-II or IGFBP-3, and serum pseudocholinesterase (R = 0.50, 0.72 and 0.61 respectively, p < 0.001). Negative correlations were found between IGF-I, IGF-II or IGFBP-3, and prothrombin time (R = 0.50, 0.59 and 0.51 respectively, p < 0.001). Conclusion: Patients with severe liver disease show decreased levels of total and free IGF-I, IGF-II and IGFBP-3, and increased levels of IGFBP-1. These abnormalities are promptly normalized after successful LTX. Thus, serum levels of IGF-I, IGF-II and IGFBP-3 might be useful parameters for the assessment of liver function.

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“…It is a proven early marker of hepatocellular functional capacity [15,16] , and shows a marked decline in the early stages of cirrhosis (Child-Pugh class A). It starts decreasing before other liver-function parameters such as albumin, bilirubin and prothrombin become involved [15] . GH levels are increased correspondingly, which creates a state of IGF resistance [17] .…”

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confidence: 99%

Bone mineral density and disorders of mineral metabolism in chronic liver disease

George¹,

Ganesh²,

Acharya³

et al. 2009

WJG

103

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AIM:To estimate the prevalence and identify the risk factors for metabolic bone disease in patients with cirrhosis. METHODS:The study was performed on 72 Indian patients with cirrhosis (63 male, 9 female; aged < 50 years). Etiology of cirrhosis was alcoholism (n = 37), hepatitis B (n = 25) and hepatitis C (n = 10). Twenty-three patients belonged to Child class A, while 39 were in class B and 10 in class C. Secondary causes for metabolic bone disease and osteoporosis were ruled out. Sunlight exposure, physical activity and dietary constituents were calculated. Complete metabolic profiles were derived, and bone mineral density (BMD) was measured using dual energy X ray absorptiometry. Low BMD was defined as a Z score below -2. RESULTS:Low BMD was found in 68% of patients. Lumbar spine was the most frequently and severely affected site. Risk factors for low BMD included low physical activity, decreased sunlight exposure, and low lean body mass. Calcium intake was adequate, with unfavorable calcium: protein ratio and calcium: phosphorus ratio. Vitamin D deficiency was highly prevalent (92%). There was a high incidence of hypogonadism (41%). Serum estradiol level was elevated significantly in patients with normal BMD. Insulin-like growth factor (IGF) 1 and IGF binding protein 3 levels were below the age-related normal range in both groups. IGF-1 was significantly lower in patients with low BMD. Serum osteocalcin level was low (68%) and urinary deoxypyridinoline to creatinine ratio was high (79%), which demonstrated low bone formation with high resorption. INTRODUCTIONMetabolic bone disease is a common complication of long-standing liver disease, ranging from cholestatic disorders to alcoholic, autoimmune and post-viral cirrhosis [1] . Often known as hepatic osteodystrophy (HO), Bone mineral density and disorders of mineral metabolism in chronic liver diseaseJoe George, Hosahithlu K Ganesh, Shrikrishna Acharya, Tushar R Bandgar, Vyankatesh Shivane, Anjana Karvat, Shobna J Bhatia, Samir Shah, Padmavathy S Menon, Nalini Shah BRIEF ARTICLESwww.wjgnet.com it is well-recognized among individuals with chronic liver disease (CLD). Its etiology is poorly understood and is thought to vary according to the type, severity and progression of the liver disease, along with a multitude of other contributing factors including the ethnicity of the population studied. It can result in spontaneous low-trauma fractures that significantly impact on the morbidity, quality of life, and even survival, through pain, deformity and immobility. With liver transplantation steadily taking the center stage in treatment of end-stage cirrhosis of varying etiology and offering long-term survival, bone disease has snowballed into one of the major determinants of survival and quality of life in this cohort [1] . Keeping in view the numerous therapeutic options for bone disease [2] already available and those under development, it is prudent to characterize this condition in order to give these patients a better chance of survival. The medical...

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Nutritional and prognostic significance of insulin-like growth factor 1 in patients with liver cirrhosis

Cited by 59 publications

References 26 publications

Bone mineral density, serum insulin-like growth factor I, and bone turnover markers in viral cirrhosis

Bone mineral density, serum insulin-like growth factor I, and bone turnover markers in viral cirrhosis

Insulin-Like Growth Factors and Insulin-Like Growth Factor Binding Proteins in Adult Patients with Severe Liver Disease before and after Orthotopic Liver Transplantation

Bone mineral density and disorders of mineral metabolism in chronic liver disease

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