Nutritional status, insulin-like growth factor-1 and quality of life in elderly women with hip fractures

Aim: To evaluate nutritional status and its relation to cognitive and physical function and quality of life in elderly female patients with hip fractures. Methods: Nutritional status was assessed in 42 women (80+/-7 years old) using the body mass index (BMI), triceps skin fold, arm muscle circumference and serum levels of insulin-like growth factor (IGF-1) and its binding protein (BP) IGFBP-1. Handgrip strength was measured. The Short Portable Mental Status Questionnaire was used to assess cognitive function and the Nottingham Health Profile to asses quality of life. Results: Low BMI (less than or equal to 20) and reduced IGF-1 and IGFBP-1 levels were detected in 50% of the patients. BMI correlated with IGF-1 (P < 0.02) and with hand grip strength (P < 0.001). Hand grip strength correlated with arm muscle circumference (P < 0.05). Cognitive dysfunction was detected in 18% of the patients, and a correlation was found between cognitive function and BMI (P < 0.01). The Nottingham Health Profile assessment indicated a lower quality of life in underweight patients as compared to others (P < 0.05). Conclusions: Half of the elderly women with hip fractures displayed signs of protein-energy malnutrition. Underweight was associated with reduced serum levels of IGF-1, muscle fatigue, cognitive dysfunction and a low quality of life rating, i.e. a cluster of factors which may unfavourably influence the postoperative course in a large proportion of hip fracture patients.