Growth hormone treatment prevents loss of lean mass after bariatric surgery in morbidly obese patients: results of a pilot, open, prospective, randomized, controlled study.

Author(s): Savastano S, Di Somma C, Angrisani L, Orio F, Longobardi S, Lombardi G, Colao A

Affiliation(s): Department of Molecular & Clinical Endocrinology and Oncology, Division of Endocrinology, University Federico II of Naples, 80131 Naples, Italy.

Publication date & source: 2009-03, J Clin Endocrinol Metab., 94(3):817-26. Epub 2008 Dec 9.

Publication type: Randomized Controlled Trial; Research Support, Non-U.S. Gov't

CONTEXT: The loss of lean body mass (LBM) negatively influences the outcome in bariatric surgery. Impaired GH secretion is frequent in obese patients. OBJECTIVE: Our objective was to investigate if GH treatment prevents LBM loss in the early postoperative period. DESIGN: This was an open, prospective, randomized, and controlled study. PATIENTS: A total of 24 women (body mass index: 44.4 +/- 7.6 kg/m(2), aged 36.8 +/- 11.7 yr) undergoing laparoscopic-adjustable silicone gastric banding (LASGB) and with GH deficiency after LASGB was included in the study. TREATMENT PROTOCOL: Group A (n = 12) included a standardized diet regimen and exercise program plus recombinant human GH (0.5 +/- 0.13 mg every day), and group B (n = 12) included a standardized diet regimen and exercise program. The follow-up duration was 6 months. RESULTS: The excess of body weight loss did not differ between groups A and B after 3 and 6 months. At 3 months, LBM loss was lower (P < 0.0001) and fat mass (FM) loss was higher (P = 0.02) in group A than group B. At 3 and 6 months, appendicular skeletal muscle mass loss was lower (P = 0.000) in group A than group B. At 3 (P = 0.0003 and 0.0005, respectively) and 6 months (P < 0.0001 and 0.0002, respectively), the percent changes of FM and lean body mass were significantly higher in group A than group B. In both groups fasting and postglucose area under the plasma concentration-time curve insulin significantly reduced. The homeostasis model assessment of insulin and insulin sensitivity indexes and total to high-density lipoprotein cholesterol ratio improved only in group A. CONCLUSIONS: GH treatment for 6 months after LASGB reduces loss in LBM and appendicular skeletal muscle mass during a standardized program of low-calorie diet and physical exercise program, with improvement of lipid profile and without a deterioration of glucose tolerance.