Abstract
SummaryBackgroundInsulin and insulin-like growth factor (IGF) activities are disturbed during critical illness. Time-course changes in the concentrations of insulin, IGF-I and IGF-binding proteins (IGFBPs) were monitored in this study and their correlation with interleukin (IL)-6 was assessed in patients subjected to total gastrectomy and specific nutritional regime.MethodsPatients were fed post-operatively according to the following scheme: parenteral nutrition on day 1, enteral nutrition combined with parenteral form from day 2 to 7, peroral nutrition from day 8 and full oral nutrition from day 14. Blood samples were taken periodically and the levels of IL-6, insulin, IGF-I and IGFBP-1 to -4 were determined.ResultsOn day 1 post-operatively, the concentration of IL-6 reached its maximum and decreased afterwards. The concentration of insulin increased until day 3 and then started to fall. The concentration of IGF-I, already low preoperatively, continued to decrease. The concentration of IGFBP-1 peaked on day 1 post-operatively, whereas the concentration of IGFBP-3 decreased on that day. The concentration of IL-6 correlated positively with the concentration of IGFBP-1 and negatively with IGFBP-3. On day 14, the concentrations of IL-6, insulin and IGFBP-1 returned to or were close to their basal levels, whereas the concentrations of IGF-I and IGFBP-3 remained reduced.ConclusionsA 14-day post-operative recovery, which included specific nutritional support, was suitable to restore insulin concentration and re-establish IGFBP-1 regulation primarily by nutrition. Very low IGF-I level on day 14 after surgery and IGFBP-3 concentration still lower than before surgery indicated that the catabolic condition was not compensated.
Highlights
Very low insulin-like growth factor (IGF)-I level on day 14 after surgery and IGFbinding proteins (IGFBPs)-3 concentration still lower than before surgery indicated that the catabolic condition was not compensated
Three patients died within days 3–7 post-operatively due to septic complications, the entire follow-up was done for 26 individuals who recovered and left the hospital after day 14
IL-6 is the major stimulator of hepatocytes to synthesize acute phase proteins, whose concentrations increase within several hours after inflammatory onset [24, 25]
Summary
One of the hallmarks in the treatment of patients, both pre-operatively and post-operatively, is the nutrition. Nutritional support, both immunological and pharmacological, was shown to be an important tool in the management of critical illness [1, 2]. Numerous clinical studies have documented lower mortality rates in critically ill patients subjected to nutritional support adjusted to their clinical and biochemical status [1]. Chen et al [6] have shown that enteral nutrition, and enteral immunonutrition, was effective in restoring defense capacity in patients with gastric cancer who underwent major surgery, measured by several parameters including pro-inflammatory cytokine interleukin (IL)-6. The concentration of IL-6 on day 1 post-operatively correlates with morbidity in gastric cancer patients [10]
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