ABSTRACT
Protein energy malnutrition is a range of pathological conditions arising from coincident lack, in varying proportions, of protein and calories, occurring most frequently in infants and young children and commonly associated with infections. Protein-energy malnutrition [PEM] may range in severity from mild, through moderate to severe degree. Two distinct syndromes occur, at either end of the spectrum, marasmus and kwashiorkor, and in between, varying degrees of signs of each are found mixed together in what is sometimes termed "marasmic kwashiorkor". To clarify the influence of nutrition on the Growth hormone - Insulin-like growth factor-1 axis [GH-IGF1 axis] in protein-energy malnutrition, fifty children suffering from different degrees of protein-energy malnutrition and twenty normal children were recruited from outpatient clinic and inpatient pediatric wards of EI- Minia university Hospital, Egypt. Blood samples were collected from all patients for determination of CBC, total protein, serum albumin, growth hormone and insulin-like growth factor-1. Patients were classified on the basis of Welcome classification of PEM into three groups. Marasmic group included 28 children [16 of them were boys] ranging in age from 4 months to 2 years, kwashiorkor group included 14 children [6 of them were boys], ranging in age from 4 months to 2 years and marasmic-kwashiorkor group included 8 children [3 of them were boys] ranging in age from 4 months to 1.5 years. The results of the study showed that the mean GH serum levels were significantly higher in the three malnourished groups than in controls [p = 0.0001]. In contrast, IGF-1 serum concentration was lower and seemed to be related to high GH and to a reduction of GH receptors. Serum total protein and serum albumin were significantly lower in kwashiorkor than in marasmus and marasmic-kwo groups [p < 0.05], but in all groups they were lower than in controls. We concluded that the combination of low level of IGF-1 together with either normal or elevated level of basal growth hormone is very suggestive of protein - energy malnutrition and can help to distinguish growth failure due to growth hormone deficiency from that of PEM