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Relationship Between Growth Hormone/Insulin-Like Growth Factor-1 Axis Integrity and Voluntary Weight Loss After Gastric Banding Surgery for Severe Obesity

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Abstract

Background

The aim of this observational study was to determine, in a retrospective analysis, whether growth hormone (GH) and insulin-like growth factor-1 (IGF-1) at baseline or changes in the GH/IGF-1 axis after laparoscopic adjustable gastric banding (LAGB) is associated with weight loss and body composition changes in severely obese nondiabetic patients.

Methods

Weight loss (expressed as percent excess weight loss [EWL%]), anthropometry, body composition by bioelectrical impedance analysis (BIA), serum IGF-1, and GH peak after GH-releasing hormone (GHRH) plus arginine (ARG) test were measured and expressed as standard deviation scores (SDS) of reference values in 104 women and 36 men, age (mean ± SD) 34 ± 11 and 30.2 ± 11 years, and BMI 44 ± 5.7 and 39 ± 3.2, respectively, before and 6 months after LAGB.

Results

After LAGB, 25% of women and 22.5% of men had GH deficiency, while 30.8% of women and 33.3% of men had IGF-1 deficiency or insufficiency. The median EWL was 36.8% in women and 40.0% in men. In both genders, percent decrease of waist circumference, EWL, and fat mass (FM) and percent increase of fat-free mass (FFM) was greater in patients with normal GH secretion and IGF-1 levels. The GH peak after GHRH + ARG, IGF-1 levels, and IGF-1 SDS were inversely correlated with EWL% (r = −0.50, r = −0.53, and r = −0.42, respectively; p < 0.0001) and percent FM (r = −0.41, r = −0.36, and r = −0.35, respectively; p < 0.0001). In stepwise linear regression analysis, the GH peak after GHRH + ARG was the major determinant of EWL% (p < 0.0001) and FM (p = 0.001).

Conclusions

The efficacy of LAGB was greater in the patients with a normal GH response to GHRH + ARG and with normal IGF-1 levels. The percent of FM, FFM, and EWL were significantly correlated with the GH response to GHRH + ARG and with IGF-1 levels.

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Acknowledgments

This study has been partially granted by the Ministry of University Research of Italy, PRIN, with the number 2007N4C5TY_005. We thank Dr. Emanuele Nicolai (SDN Foundation IRCCS, Naples – Italy) for kindly providing DXA analyses.

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Authors and Affiliations

  1. Division of Endocrinology, Department of Molecular and Clinical Endocrinology and Oncology, University of Naples Federico II, via S. Pansini 5, 80131, Naples, Italy

    Silvia Savastano, Carolina Di Somma, Francesca Rota, Maria Cristina Savanelli, Teresa Cascella, Gaetano Lombardi & Annamaria Colao

  2. Department of Surgery, S. Giovanni Bosco Hospital of Naples, via F.M. Briganti 255, 80144, Naples, Italy

    Luigi Angrisani

  3. Endocrinology, Parthenope University of Naples, via Ammiraglio F. Acton 38, 80133, Naples, Italy

    Francesco Orio

  4. SDN Foundation IRCCS, Naples, Italy

    Carolina Di Somma

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  1. Silvia Savastano
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  3. Carolina Di Somma
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  5. Maria Cristina Savanelli
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  9. Annamaria Colao
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Correspondence to Silvia Savastano.

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Savastano, S., Angrisani, L., Di Somma, C. et al. Relationship Between Growth Hormone/Insulin-Like Growth Factor-1 Axis Integrity and Voluntary Weight Loss After Gastric Banding Surgery for Severe Obesity. OBES SURG 20, 211–220 (2010). https://doi.org/10.1007/s11695-009-9926-3

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  • DOI: https://doi.org/10.1007/s11695-009-9926-3

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