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This version published online on December 9, 2008
Journal of Clinical Endocrinology & Metabolism , doi:10.1210/jc.2008-1476
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Submitted on July 10, 2008
Accepted on November 26, 2008

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

Silvia Savastano, Carolina Di Somma, Luigi Angrisani, Francesco Orio, Salvatore Longobardi, Gaetano Lombardi, and Annamaria Colao*

Department of Molecular and Clinical Endocrinology and Oncology, Division of Endocrinology, University Federico II of Naples, via S. Pansini 5, 80131 Naples; Department of Surgery, S.Giovanni Bosco Hospital of Naples, via F.M. Briganti 255, 80144 Naples Italy; Endocrinolgy University Parthenope Naples, Via Acton 38, 80133 Naples Italy; Department of Medical Affairs Merck-Serono Italia, Via Casilina 125, 00176 Rome Italy

* To whom correspondence should be addressed. E-mail: colao{at}unina.it.

Context: The loss of lean body mass (LBM) negatively influences outcome in bariatric surgery. Impaired Growth Hormone (GH) secretion is frequent in obese patients.

Objective: To investigate if GH treatment prevents LBM loss in the early post-operative period.

Design: Open, prospective, randomized, controlled.

Patients: 24 women (BMI: 44.4±7.6 kg/m2, aged 36.8±11.7 yrs) undergoing laparoscopic-adjustable silicone gastric banding (LASGB) and with GH deficiency after LASGB.

Treatment protocol: Group A (n=12): standardized diet regimen and exercise program plus recombinant human GH (0.5±0.13 mg every day); Group B (n=12) standardized diet regimen and exercise program. Follow-up duration 6 months.

Results: Excess of body weight loss did not differ between group A and B after 3 and 6 months. At 3 months, LBM loss was lower (p<0.0001) and FM loss was higher (p=0.02) in group A than in group B. At 3 and 6 months, appendicular skeletal muscle mass (ASMM) loss was lower (p=0.000) in group A than in 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 FFM were significantly higher in group A than in group B. In both groups fasting and post-glucose AUC insulin significantly reduced. The HOMA and the ISI indexes and total/HDL cholesterol ratio improved only in group A.

Conclusions: GH treatment for 6 months after LASGB reduces loss in LBM and ASMM during a standardized program of low calorie diet and physical exercise program, with improvement of lipid profile and without a deterioration of glucose tolerance.
Key words: Morbid Obesity • Body Composition • GH treatment • LASGB






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