Use of Insulin-Like Growth Factor I (IGF-I) and IGF-Binding Protein Measurements to Monitor Feeding of Premature Infants1
W. Jackson Smith2,
Louis E. Underwood,
Lynette Keyes and
David R. Clemmons
Divisions of Endocrinology, Departments of Pediatrics and Medicine
(W.J.S., L.E.U., D.R.C.), Design and Statistics Unit (L.K.), Frank
Porter Child Development Center, University of North Carolina, Chapel
Hill, North Carolina 27599
Address all correspondence and requests for reprints to: David R. Clemmons, M.D., CB #7170, University of North Carolina, Chapel Hill, North Carolina 27599.
To determine whether peptides of the insulin-like growth factor(IGF)
system might be useful indicators of nutritional adequacyin premature
infants, we studied 50 premature (25–34 weeksgestation) infants
prospectively to define the relationshipbetween nutrient intake
and serum concentrations of IGF-I, IGF-bindingprotein-2 (IGFBP-2), and
IGFBP-3. Each infant was monitoredfor at least 2 weeks. Nutrient
intake was quantified from dailylogs; weight was determined daily, and
measurements of IGF-I,IGFBP-2, and IGFBP-3 in serum were made
twice weekly.
Serum IGF-I correlated strongly with length of gestation, increasing
4.03± 0.95 ng/mL for each additional week of gestation
(P< 0.0001) and 0.36 ± 0.07 ng/mL·day
each daysince birth (P < 0.0001). A higher intake
of calories increasedIGF-I by 0.07 ± 0.01 ng/mL for each calorie
per kg ingestedover the previous 3 days (P <
0.0001). IGF-I increased quadraticallyas protein intake increased. For
each change of 1% in caloriesas protein squared, IGF-I increased
0.36 ± 0.11 ng/mL(P < 0.0001).
Serum IGFBP-3 concentrations also correlated with length ofgestation,
increasing 25.06 ± 11.83 µg/L·wk(P =
0.035) and 4.14 ± 1.33 µg/·day sincebirth
(P = 0.003). Unlike IGF-I, variation in the amount
ofprotein supplied did not change IGFBP-3. As calorie intake
increased,IGFBP-3 increased by 0.54 ± 0.17 µg/L for each
calorieper kg consumed over the previous 3 days (P
= 0.0015).
In contrast to IGF-I and IGFBP-3, IGFBP-2 declined as the lengthof
gestation increased (56.12 ± 16.92 ng/mL·week;
P= 0.001) and with each additional day of life
(7.57 ±2.44 ng/mL·day; P = 0.003). Dietary
protein, the predominantregulator of IGFBP-2, caused a decrease of
33.22 ± 9.00ng/mL with each percent increase in dietary calories
as protein(P < 0.0003). Calorie intake had less
effect on IGFBP-2 thanprotein intake.
These results indicate that each of the three peptides studiedis
regulated in premature infants by nutritional intake, andthat their
regulatory patterns are qualitatively similar tothose observed in
older individuals. Measurements of these peptidesin premature infants
may be useful indicators of nutritionalstatus and adequacy of nutrient
intake.
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