Twenty ICU patients, with varying diagnoses and degrees of catabolism, were studied prospectively to determine whether somatomedin-C/insulin-like growth factor I (SMC/IGFI) is related to the conventional nutritional indices, plasma prealbumin, transferrin and albumin, and nitrogen balance (NB) in critical illness. Mean SMC/IGFI concentration in these critically ill patients was below the lower limit of the reference range. SMC/IGFI concentrations correlated with NB for the 24 h before measurement (r = .38, p less than .01) and with cumulative NB for the previous 2 (r = .50, p less than .01), 3 (r = .34, p less than .05), and 5 days (r = .46, p less than .05). Prealbumin correlated with cumulative 5-day NB (r = .39, p less than .05). Plasma albumin and transferrin concentrations did not correlate with NB for any of these time periods. SMC/IGFI concentrations correlated with cumulative protein (r = .59, p less than .01), carbohydrate (r = .63, p less than .01), and energy intake (r = .64, p less than .01). SMC/IGFI was the only index which consistently correlated with NB. We conclude it is a useful index of nutritional status in critically ill patients.