Serum insulin like growth factor-1 (igf-i), insulin like growth factor binding protein-3 (igfbp-3) levels, anthropometric measurements and relationship between igf-i, igfbp-3 and anthropometric measurements in children with chronic liver disease before and after orthotopic liver transplantation

Malnutrition, occurring in chronic liver diseases, is the reason for complications influencing quality of life and survival, and has effects on the success of liver transplantation. The degree of liver function impairment raises parallel to severity of malnutrition. In children with chronic liver disease, height, skinfold thickness and mid-arm circumference measurements are known to be more reliable than the other measurements for evaluating malnutrition. Insulin like growth factor is synthesized in liver thorough mediation of growth hormone. Insulin like growth factor-1 (IGF-I), an anabolic protein which mediates the effects of growth hormone, mostly binds Insulin like growth factor binding protein-3 (IGFBP-3) in circulation. In chronic liver disease, the decrease in synthesis capacity secondary to hepatocellular dysfunction and malnutrition, cause rearrangement of growth axis. This situation increases growth retardation in children with chronic liver disease. A successful liver transplantation improves growth retardation due to chronic liver disease and growth axis. Aim of this study is to evaluate nutritional status of children with chronic liver diseases before and after orthotopic liver transplantation, determining serum IGF-I/IGFBP-3 levels and analyzing the relationship between IGF-I/IGFBP-3 levels and changing anthropometric measurements. In our study, 33 patients (20 male, 13 female, median age 34.24 months (five months-11 years) who undergone liver transplantation and 54 healthy children, forming the control group with matching ages and sexes and normal growth charts were evaluated. The anthropometric measurements, IGF-I and IGFBP-3 levels before and 1, 3, 6 and 12 months later after transplantation were compared. Control group's anthropometric measurements were taken once in the beginning of study and IGF-I and IGFBP-3 levels were evaluated. Anthropometric measurements were taken according to the standards by the same doctor. Serum IGF-I and IGFBP-3 levels were evaluated by enzyme linked chemiluminescent immunometric method. The severity of cirrhosis was determined by Child-Pugh scoring system. Before liver transplantation, in patients with chronic liver diseases acute malnutrition rate was 21% (7/33) and chronic malnutrition rate was 30 (10/33) malnutrition ratio was determined. 82% of our patients had several degrees of acute malnutrition according to triceps skinfold thickness. 30% of patients had severe malnutrition according to triceps skinfold thickness score. Malnutrition rate was 3% according to weight for height Z score. All anthropometric measurements except weight for height Z score were lower in chronic liver disease patients comparing the control group. The decrease in height for age, triceps skinfold thickness and mid-arm circumference Z scores were significant than the decrease of weight for height Z scores. In our study, skinfold thickness Z scores of patients in Child A+B group were detected higher than Z score of patients in Child C group. Also, a negative relationship was detected between Child-Pugh score with triceps skinfold thickness and mid-arm circumference Z scores. In our study, among anthropometric parameters for determining malnutrition in patients with chronic liver disease, triceps skinfold thickness was detected as a reliable parameter. Three months after liver transplantation a significant increase in mid-arm muscle area measurement, triceps skinfold thickness and mid-arm circumference measurement were detected. Six months after liver transplantation a significant increase in weight for age, height for age and weight for height Z scores were seen. A year after transplantation, no difference was detected between weight for age, weight for height and mid-arm circumference Z scores between study group and same aged control group. Triceps skinfold thickness score and mid-arm muscle area measurements were better in the study group. However, height for age Z scores (-0.7±1.46) of patients were lower than that of (0.025±1.12) children of the same age. As shorter as the patients' heights were before transplantation, the rate of growing was more rapid after liver transplantion. In our study, IGF-1 and IGFBP-3 levels were lower in chronic liver disease patients than the controls. No relationship was detected between these proteins and Child-Pugh score. IGF-1 levels were found to increase one month after liver transplantation, with a peak levels on third month and although decreasing gradually, after the end of a year, it was seen still to be higher than the control group. IGFBP-3 levels were found to have a similar pathway, reaching the same levels with the control group, at the end of the first year. No relationship was detected before transplantation between IGF-1 and IGFBP-3 levels and anthropometric measurements. Because of this, we these proteins did not reflect the presence and severity of malnutrition in cohort of chronic liver disease patients. Likewise, no relationship was detected after transplantation between IGF-1 and IGFBP-3 levels and anthropometric measurements. Because of this, we could not explain the improvement of nutrition parameters after liver transplantation only by growth factors.