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 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 32  |  Issue : 1  |  Page : 36-40

Assessment of serum insulin-like growth factor 1 and serum insulin in children with congenital heart disease


1 Department of Pediatrics, Benha University Hospital, Banha, Egypt
2 Department of Pediatrics, Benha University Hospital, Banha; Department of Clinical Pathology, Benha Teaching Hospital, Banha, Egypt
3 Department of Pediatrics, Shebeen El Kanater Hospital, Kaliobeya, Egypt

Date of Submission25-May-2015
Date of Acceptance10-Jun-2015
Date of Web Publication26-Nov-2015

Correspondence Address:
Doaa A Elsaid
Depatement of Pediatric, Shebeen El Kanater Hospital, Kaliobeya
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-208X.170557

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  Abstract 

Introduction
Children with congenital heart disease (CHD) have been reported to show significant growth retardation both prenatally and postnatally. Different types of cardiac malformation can affect nutrition and growth to varying degrees.
Objectives
The aim of this study was to assess the relationship between insulin-like growth factor 1 (IGF-1) and age, height, weight, head circumference, and BMI of infants.
Materials and methods
This was a case-control study conducted on 45 infants and children. The study included 30 children with CHD attending the Pediatric Cardiology Unit in Benha University Hospital from December 2012 to May 2013 who constituted the diseased group (groups 1 and 2). Their ages exceeded the neonatal period. Fifteen healthy sex-matched and age-matched children served as the control group (group 3). The infants were subjected to history taking, complete clinical examination, and assessment of serum IGF-1, serum insulin, and random blood sugar. All data were recorded and analyzed in detail. Growth retardation in children with CHD was assessed.
Results
There was significant difference between cases of CHD and the healthy control group as regards weight and BMI. There was significant difference between infants with cyanotic and those with acyanotic CHD as regards the weight. The cyanotic group was underweight. A significant difference was found in the length between the cyanotic and the acyanotic group. Infants in the cyanotic group were of short stature. There was significant difference between the cyanotic group and the acyanotic group as regards IGF-1 concentration, with the cyanotic group having lower concentration compared with the acyanotic group.
Conclusion
In light of this study we found that infants with CHD had lower IGF-1 levels compared with controls. Cyanotic CHD in children caused more pronounced growth retardation in comparison with acyanotic CHD.

Keywords: children with congenital heart disease, insulin-like growth factor 1, serum insulin


How to cite this article:
Elwan SA, Assar EH, Essa EA, Elsaid DA. Assessment of serum insulin-like growth factor 1 and serum insulin in children with congenital heart disease. Benha Med J 2015;32:36-40

How to cite this URL:
Elwan SA, Assar EH, Essa EA, Elsaid DA. Assessment of serum insulin-like growth factor 1 and serum insulin in children with congenital heart disease. Benha Med J [serial online] 2015 [cited 2017 Jun 28];32:36-40. Available from: http://www.bmfj.eg.net/text.asp?2015/32/1/36/170557


  Introduction Top


Children with congenital heart disease (CHD) have been reported to show significant growth retardation both prenataly and postnatally [1] .

Normal growth depends on the complex interaction of genetic influences, adequate nutrition, intact endocrinal control, and tissue responsiveness. Over the last few years, there has been considerable development in our understanding of hypothalamic-pituitary growth hormone-insulin-like growth factor axis, both in health and disease [2] .

Insulin-like growth factors (IGFs) are a family of polypeptide that mediate the anabolic action of IGF-1, which is a well-known biochemical marker in the growth of mammals and is secreted in response to growth hormone to stimulate tissue growth. It also functions as a survival factor in the heart tissue. IGF-1 has shown to be involved in myocardial growth, remodeling, and inhibition of apoptosis [3] .


  Materials and methods Top


This was a case-control study conducted on 45 infants and children. The study included 30 children with CHD attending the Pediatric Cardiology Unit in Benha University Hospital from December 2012 to May 2013 who constituted the diseased group (groups 1 and 2). This research were under regulation of ethics committee in our place. Their ages exceeded the neonatal period. Fifteen healthy sex-matched and age-matched children served as the control group (group 3).

Methodology

Infants were subjected to complete history taking, anthropometric evaluation, evaluation of IGF-1 using enzyme-linked immunosorbent assay, evaluation of insulin using enzyme-linked immunosorbent assay, and evaluation of random blood sugar (RBS) with a Gluco lab test strip (Infopia and available from Neon diagnostic, UK) using a glucose test meter.

Specimen collection and preparation

Serum: For IGF-1 and insulin, blood samples not less than 5 ml were collected by means of venipuncture from an available vein after sterilization of the skin and then allowed to clot. The serum was separated by means of centrifugation at room temperature. Blood: RBS was assessed by placing a drop of blood from skin prick on a glucose test strip and then inserting the strip into a glucose meter, a small machine that provides a digital readout of blood glucose level.


  Results Top


Statistical study between-cases of congenital heart disease and the healthy control children regarding the anthropometric measurements and insulin like- growth factor 1 and insulin and random blood sugar ([Table 1], [Table 2], [Table 3], [Table 4], [Table 5]).
Table 1 Statistical distribution of cases with congenital heart disease as regards echo (echocardiography) finding


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Table 2 Statistical study of anthropometric measurement between cases with congenital heart disease (the diseased group) and the healthy control group


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Table 3 Statistical study between the cyanotic and the acyanotic group as regards anthropometric measurement


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Table 4 Statistical study between cases of congenital heart disease and healthy controls as regards insulin growth factor 1, insulin and random blood sugar


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Table 5 Statistical study between the cyanotic group and the acyanotic group (cases of congenital heart disease) as regards laboratory findings


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  Discussion Top


This work showed a statistically significant difference in weight between cyanotic patients, acyanotic patients, and controls (P < 0.05). The cyanotic and acyanotic groups were underweight, with more severe affection of the cyanotic group compared with the controls.

Our findings are in agreement with those of Hallioglu et al. [4] , who found a statistically significant difference in weight between the cyanotic, acyanotic, and control groups. On comparing the weight affection to height affection in CHD patients, both cyanotic and acyanotic patients were stunted and underweight. Vaidyanathan et al. [5] also reported that weight was statistically significantly lower in children with CHD. Moreover, our findings are in agreement with those of Jacobs et al. [6] , who stated that acyanotic infants were markedly underweight with less impairment of linear growth, and cyanotic infants showed equally impaired length and weight. As regards the height, both cyanotic and acyanotic patients were stunted compared with controls. The differences between cyanotic and acyanotic patients were statistically significant (P < 0.05). Cyanotic patients had the least height. Our findings were in accordance with those of Dündar et al. [7] , who stated that cyanotic heart diseases in children commonly cause pronounced growth retardation in comparison with acyanotic CHDs. Tsai et al. [8] found that the body weight of infants with isolated ventricular defect was statistically significantly lower compared with controls. Chen et al. [9] also stated that both weight and height were significantly lower in children with CHD than in normal children. Our results are in agreement with those of Yilmaz et al. [10] , who observed that infants and children with cyanotic heart disease presented with short stature. In a study conducted in Alexandria, Ashraf et al. [11] demonstrated that children with isolated ventricular septal defect are significantly shorter and that their statural growth rate is slower compared with normal age-matched children from the same regional background. The results of a study conducted in Qater, at Hamad general hospital, by El-Sisi et al. [12] are in agreement with ours. They reported that height and BMI were significantly lower in children with cyanotic CHD. In contrast to our results, Afify et al. [13] from El Minia University reported no significant difference between acyanotic and cyanotic patients with CHD as regards weight, height, and BMI. The study was conducted on 64 individuals, including 24 cyanotic, 21 acyanotic, and 19 healthy controls. The three groups were homogenous in terms of age and sex characteristics. However, Barton et al. [14] , in their study conducted on 62 infants (31 boys and 31 girls with a mean age of 1.06 years) presented within the first year of life with symptomatic CHD, found that acyanotic infants were markedly underweight with less impairment of linear growth, and cyanotic infants showed equally impaired length and weight gain. Our results are in disagreement with those of Dinleyici et al. [15] , who conducted a prospective randomized study on 94 CHD patients (36 girls and 58 boys) between 1 and 192 months of age, including 19 cyanotic, 75 acyanotic, and 54 age-matched children with no CHD. They found that height and body weight were similar between children with CHD and controls. In our study, we reported a statistically high significant difference between both cyanotic and acyanotic groups and controls based on the BMI (P > 0.001). This is in agreement with the findings of Ashraf et al. [11] , who found that children with isolated ventricular septal defect had a lower BMI compared with normal children; however, our results are in disagreement with those of Barton et al. [14] , who reported that the difference in BMI between cyanotic and acyanotic patients was statistically nonsignificant. Our present work showed that serum level of IGF-1 was statistically highly significantly lower in CHD patients compared with controls (P = 0.001), and a statistically significant difference was found between cyanotic and acyanotic patients (P < 0.05), with the cyanotic group having lower serum IGF-1 concentration compared with the acyanotic group. Our results are in accordance with those of Barton et al. [14] , who also found that infants with CHD had lower IGF-1 levels compared with controls, and Bernstein et al. [16] , who showed that serum IGF-1 level was decreased by almost half in experimental models with chronic hypoxemia secondary to CHD in the form of an intracardiac right-to-left shunt. Tsai et al. [8] also reported that serum IGF-1 concentration was reduced in infants with isolated ventricular septal defect versus normal age-matched control infants. Moreover, our result is in agreement with that of El-Sisi et al. [12] , who revealed that IGF-1 was significantly lower among patients with cyanotic CHD. Moreover, our result is in agreement with that of Dinleyici et al. [15] , who stated that serum IGF-1 levels were significantly lower in cyanotic CHD patients than in acyanotic patients and that serum IGF-1 levels were lower in both acyanotic and cyanotic CHD patients than in controls. Our results are in disagreement with the result of Barton et al. [14] , who conducted a study on 62 infants (31 boys and 31 girls, with a mean age of 1.06 years) presented within the first year of life with symptomatic CHD. They found that the difference between cyanotic and acyanotic patients as regards serum IGF-1 level was statistically nonsignificant. In contrast, our results are in agreement with those of Ashraf et al. [11] , who revealed that IGF-1 concentration was reduced in children with ventricular septal defect versus normal age-matched children. Moreover, correlation studies were made between IGF-1 and age, height, weight, HC, and BMI among all patients of cyanotic and acyanotic groups and controls, which revealed that there was a significant positive correlation between IGF-1 and age, height, weight, and HC. This is in agreement with the results of Shiva et al. [17] , who found a positive correlation between IGF-1 and age, BMI, height, and HC. Our result is in disagreement with that of Barton et al. [14] , who stated that serum IGF-1 level was unrelated to age in CHD children. The findings of El-Sisi et al. [12] are in agreement with ours in that IGF-1 concentration level was correlated significantly with height among patients with cyanotic CHD. In our study, we stated that the most important factor affecting serum IGF-1 levels was cyanosis. For this reason we believe that chronic hypoxia plays a significant role in the pathogenesis of growth failure. This is in agreement with the findings of Dündar et al. [7] and Dinleyici et al. [15] , who reported that chronic hypoxia and decreased IGF-1 could be the cause of increased growth failure in cyanotic CHD. It remains unclear whether the altered hormone level in-utero causes the congenital defective cardiac development or whether the hyperdynamic physiology of cardiac defects caused the altered serum growth factor level Tsai et al. [8] . Moreover, our study revealed that the serum insulin level was statistically significantly different between cases of CHD (both cyanotic and acyanotic) and the control group (P < 0.05), with low level of insulin found in cases of CHD; however, the difference was statistically nonsignificant between the cyanotic and acyanotic groups (P > 0.05), but the cyanotic group had the least level of plasma insulin. Our results are in agreement with those of Eren et al. [18] , who found that lower level of plasma insulin was found in patients with CHD compared with healthy controls, suggesting that lower insulin levels might be due to impairment in insulin secretion. Our findings are in disagreement with those of Gershon et al. [19] , who studied the alternation of glucose and insulin metabolism in CHD. This study was conducted on 54 patients ranging in age from 20 days to 16 years, and insulin and glucose levels were evaluated. They stated that children with cyanotic CHD had abnormally high insulin level. Our findings are in agreement with those of Vieira et al. [20] , who conducted a comparative study of glucose metabolism and insulin secretion between a group of acyanotic CHD patients and a group of healthy children of same age. They found that insulin levels in children with acyanotic lesions were lower compared with those in healthy children. They also reported that low insulin levels did not correlate with low insulin secretion rate. As regards RBS, our study revealed statistically nonsignificant difference between cases of CHD (both cyanotic and acyanotic) and the control group (P > 0.05); moreover, statistically nonsignificant difference was found between cyanotic and acyanotic patients, with the cyanotic group having lower insulin level compared with the acyanotic group. This explains the possible effect of cyanotic CHD on endocrine hormones as well as growth retardation and demonstrate that there is lower level of plasma insulin due to impaired insulin secretion. Authors concluded that patients with cyanotic CHD were prone to hypoglycemia [18] . Our results are in agreement with those of Wheat [21] , who stated that because disorder of carbohydrate metabolism are commonly seen in patient with CHD these patients were found to have lower fasting glucose level and elevated insulin secretion rates. Although we found that the reson of abnormal glucose and insulin levels in children with congenital heart disease was high level of circulating catecholamine, or switch from fatty acid β-oxidation to glycolytic metabolism which inefficient and using the available glucose raise the possibility that CHD patients are chronically hypoglycemic ([Figure 1], [Figure 2], [Figure 3], [Figure 4]).
Figure 1 Statistical study of anthropometric measurement between cases with congenital heart disease (the diseased group) and the healthy control group. CHD, congenital heart disease; HC, head circumference.



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Figure 2 Statistical study between the cyanotic and acyanotic groups as regards anthropometric measurement. CHD, congenital heart disease; HC, head circumference.



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Figure 3 Statistical study between cases of congenital heart disease (CHD) and healthy controls as regards insulin growth factor 1 (IGF-1), insulin and random blood sugar (RBS).



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Figure 4 Correlation between insulin-like growth factor 1 (IGF-1) and the studied variables. CHD, congenital heart disease.



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  Conclusion Top


Infants with CHD had lower IGF-1 levels compared with controls. Cyanotic CHD in children caused more pronounced growth retardation in comparison with acyanotic CHD. We concluded that the most important factor affecting serum IGF-1 levels is cyanosis. For this reason we believe that chronic hypoxia plays a significant role in the pathogenesis of growth failure.

Acknowledgements

Nil.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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