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a freshwater fish Ophiocephalus striatus or known locally to Indonesian as haruan, can potentially increases IGF-1 and albumin levels in elderly patients with hypoalbuminemia due to the contents of amino acids, fatty acids, vitamins, and minerals. This study was conducted to investigate the effect of Ophiocephalus striatus extract on the level of IGF-1 and albumin in elderly patients with hypoalbuminemia. the study is a double-blind randomized controlled trial involving malnourished elderly inpatients (≥ 60 years old) recovering from acute condition before hospital discharge, with Mini Nutritional Assessment score≤ 23.5 and albumin level< 3.5 g/dL. A total of 109 subjects were randomly divided into two groups: one group received 10 g Ophiocephalus striatus extract per day for 14 days and another group received placebo. Albumin and IGF-1 levels were obtained before and after intervention. ninety subjects completed the study (extract group= 45 subjects; placebo group= 45 subjects) for 14 days. The median of age were 69 (64; 75)