RELATIONSHIP BETWEEN USE OF PROTON PUMP INHIBITORS AND INSULIN LIKE-GROWTH FACTOR 1 SYSTEM IN OLDER SUBJECTS

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 109-133-GHRH, GH & IGF Biology & Signaling
Bench to Bedside
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-113
Marcello Maggio*1, Chiara Cattabiani2, Fulvio Lauretani3, Francesca De Vita4, Stefania Bandinelli5, Giuliana Bondi6, Eleonora Sutti7, Marco Mantovani6, Andrea Corsonello8, Fabrizia Lattanzio9, Luigi Ferrucci10 and Gianpaolo Ceda1
1University of Parma, Parma, Italy, 2University of Parma, Italy, Parma, Italy, 3University-Hospital of Parma, 4University of Parma, Italy, 5Geriatric Unit, Azienda Sanitaria Firenze, Florence, Italy, 6University of Parma, Italy, PARMA, Italy, 7University of Parma, Italy, PARMA, 8Italian National Research Centres on Aging (INRCA) Cosenza Italy., 9Italian National Research Centres on Aging (INRCA), 10NIA/NIH, Baltimore, MD
The use of proton pump inhibitors (PPI) is increased worldwide and has been associated with poor clinical outcomes in older subjects (1-3), where PPI may affect adsorption of nutrients, exacerbating the risk of malnutrition (1). In vitro studies show that PPI may interfere with insulin like-growth factor 1 (IGF-1) (4). However the relationship between PPI use and IGF system in humans is unknown.

Objective. We investigate the relationship between use of proton pump inhibitors and IGF system in the elderly.

Subjects and Methods. Our series consisted of 938 older subjects (536 women, 402 men, mean age 75.7 ± 7.4 years) enrolled in the InCHIANTI study for which complete data on IGF-1, IGF-binding protein-1 and -3 (IGFBP-1, IGFBP-3) and medications were available. IGF-1, IGFBP-1 and IGFBP-3 were measured by immunoradiometric assay. Multivariate linear regression  analysis adjusted for age, sex, BMI, liver function, number of drugs, caloric intake and IGFBP-1 and -3 was used to estimate the association between PPI use and IGF-1.

Results The mean age of whole population was 75.7 ± 7.4 years ± SD.  Participants were categorized by PPI use, identifying 903 PPI non users and 35  PPI users. PPI users and non users differed by BMI, number of medications and IGF-1 levels. PPI users had lower IGF-1 levels than non-users. After adjusting for age, male PPI users (107.0±69.6 vs 127.1±55.8, p<0.001) and female PPI users (87.6±29.1 vs 107.6±52.3, p=0.03) had lower levels of IGF-1 than non users. IGFBP-1 levels were similar in 2 groups in both men and women. In whole population, after adjustment for age and sex. PPI  users  had lower IGF-1 levels 81.9 [61.1-113.8]  than non users 110 [77.8-148.6], p=0.02.After  further adjustment  for BMI, liver function, number of drugs, caloric intake and IGFBP-1, the relationship between PPI use and IGF-1 was still negative and  statistically significant  (β±SE= -18.09±9.38, p=0.05).

Conclusions. Use of PPI is independently and negatively associated with IGF-1 levels, supporting the link between use of PPI and malnutrition observed in older subjects.

1)  McCarthy DM. Adverse effects of proton pump inhibitor drugs: clues and conclusions. Curr Opin Gastroenterol. Nov 2010;26(6):624-631. 2)  Bell JS, Strandberg TE, Teramura-Gronblad M, Laurila JV, Tilvis RS, Pitkala KH. Use of proton pump   inhibitors and mortality among institutionalized older people. Arch Intern Med. Sep 27 2010;170(17):1604-1605. 3) Maggio M, Corsonello A, Ceda GP, Cattabiani C, Lauretani F, Buttò V,181 Ferrucci L, Bandinelli S, Abbatecola AM, Spazzafumo L, Lattanzio F 2013. Proton pump inhibitors and risk of 1-year mortality and rehospitalization in older patients discharged from acute care hospitals. JAMA Internal Medicine 2013 in press. 4) Murray IA, Perdew GH. Omeprazole stimulates the induction of human insulin-like growth factor binding protein-1 through aryl hydrocarbon receptor activation. J Pharmacol Exp Ther. 2008 Mar;324(3):1102-10

Nothing to Disclose: MM, CC, FL, FD, SB, GB, ES, MM, AC, FL, LF, GC

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

Sources of Research Support: The InCHIANTI Study was supported as a “targeted project” (ICS 110.1/RS97.71) by the Italian Ministry of Health and in part by the US National Institute on Aging (Contracts N01-AG-916413 and N01-AG-821336), and by the Intramural Research Program of the US National Institute on Aging (Contracts 263 MD 9164 13 and 263 MD 821336). This analysis was  also supported in part by grant RF-INR-2010-2312659  from the Italian Ministry of Health  and Emilia Romagna Region