Advertisement

Obesity Surgery

, Volume 20, Issue 2, pp 211–220 | Cite as

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

  • Silvia Savastano
  • Luigi Angrisani
  • Carolina Di Somma
  • Francesca Rota
  • Maria Cristina Savanelli
  • Teresa Cascella
  • Francesco Orio
  • Gaetano Lombardi
  • Annamaria Colao
Clinical Research

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.

Keywords

Obesity Fat mass Fat-free mass GH IGF-I LAGB 

Notes

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.

References

  1. 1.
    Veldhuis JD, Iranmanesh A, Ho KK, et al. Dual defects in pulsatile growth hormone secretion and clearance subserve the hyposomatotropism of obesity in man. J Clin Endocrinol Metab. 1991;72:51–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Johannsson G, Bengtsson BA. Growth hormone and the metabolic syndrome. J Endocrinol Invest. 1999;22(5 Suppl):41–6.PubMedGoogle Scholar
  3. 3.
    Giustina A, Veldhuis JD. Pathophysiology of the neuroregulation of growth hormones secretion in experimental animals and the human. Endocr Rev. 1998;19:717–97.CrossRefPubMedGoogle Scholar
  4. 4.
    Scacchi M, Pincelli AI, Cavagnini F. Growth hormone in obesity. Int J Obes Relat Metab Disord. 1999;23:262–71.CrossRefGoogle Scholar
  5. 5.
    Maccario M, Tassone F, Grottoli S, et al. Neuroendocrine and metabolic determinants of the adaptation of GH/IGF-1 axis to obesity. Ann Endocrinol (Paris). 2002;63:140–4.Google Scholar
  6. 6.
    Savastano S, Di Somma C, Mentone A, et al. Growth hormone insufficiency in obese patients. J Endocrinol Invest. 2006;29:536–44.PubMedGoogle Scholar
  7. 7.
    de Boer H, Blok GJ, Van der Veen EA. Clinical aspects of growth hormone deficiency in adults. Endocr Rev. 1995;16:63–86.CrossRefPubMedGoogle Scholar
  8. 8.
    Carroll PV, Christ ER, Bengtsson BA. Growth hormone deficiency in adulthood and the effects of growth hormone replacement: a review. Growth Hormone Research Society Scientific Committee. J Clin Endocrinol Metab. 1998;83:382–95.CrossRefPubMedGoogle Scholar
  9. 9.
    Colao A, Cerbone G, Pivonello R, et al. The growth hormone (GH) response to arginine plus GH releasing hormone test is correlated to the severity of lipid profile abnormalities in adult patients with GH deficiency. J Clin Endocrinol Metab. 1999;84:1277–82.CrossRefPubMedGoogle Scholar
  10. 10.
    Colao A, Di Somma C, Cuocolo A, et al. The severity of growth hormone deficiency correlates with the severity of cardiac impairment in 100 adult patients with hypopituitarism: an observational, case-control study. J Clin Endocrinol Metab. 2004;89:5998–6004.CrossRefPubMedGoogle Scholar
  11. 11.
    Gola M, Bonadonna S, Doga M, et al. Clinical review: growth hormone and cardiovascular risk factors. J Endocrinol Invest. 2005;90:1864–70.CrossRefGoogle Scholar
  12. 12.
    Abs R, Feldt-Rasmussen U, Mattsson AF, et al. Determinants of cardiovascular risk in 2589 hypopituitary GH-deficient adults—a KIMS database analysis. Eur J Endocrinol. 2006;155:79–90.CrossRefPubMedGoogle Scholar
  13. 13.
    Pasquali R, Vicennati V, Gambineri A, et al. Hormones and pathophysiology of obesity. Eat Weight Disord. 2001;6(3 Suppl):9–20.PubMedGoogle Scholar
  14. 14.
    Franco C, Bengtsson BA, Johannsson G. Visceral obesity and the role of the somatotropic axis in the development of metabolic complications. Growth Horm IGF Res. 2001;11(Suppl A):S97–102.CrossRefPubMedGoogle Scholar
  15. 15.
    Biller BM, Samuels MH, Zagar A, et al. Sensitivity and specificity of six tests for the diagnosis of adult GH deficiency. J Clin Endocrinol Metab. 2002;87:2067–79.CrossRefPubMedGoogle Scholar
  16. 16.
    Qu X, Gonzalo TGI, Al Sayed MY, et al. Influence of body mass index and gender on GH responses to GHRH plus arginine and insulin tolerance test. J Clin Endocrinol Metab. 2005;90:1563–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Corneli G, Di Somma C, Baldelli R, et al. The cut-off limits of the GH response to GH-releasing hormone-arginine test related to body mass index. Eur J Endocrinol. 2005;153:257–64.CrossRefPubMedGoogle Scholar
  18. 18.
    Rasmussen MH, Hviderbg A, Juul A. Massive weight loss restores 24-hour growth hormone release profiles and serum insulin-like growth factor-I levels in obese patients. J Clin Endocrinol Metab. 1995;80:1407–15.CrossRefPubMedGoogle Scholar
  19. 19.
    Edén Engström B, Burman P, Holdstock C, et al. Effects of gastric bypass on the GH/IGF-1 axis in severe obesity—and a comparison with GH deficiency. Eur J Endocrinol. 2006;154:53–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Savastano S, Di Somma C, Belfiore A, et al. Growth hormone status in obese patients and correlation with body composition. J Endocrinol Invest. 2006;29:536–43.PubMedGoogle Scholar
  21. 21.
    Di Somma C, Angrisani L, Rota F, et al. Growth hormone and insulin-like growth factor-i deficiency are associated with reduced loss of fat mass after laparoscopic-adjustable silicone gastric banding. Clin Endocrinol (Oxf). 2008;69:393–9.CrossRefGoogle Scholar
  22. 22.
    Frystyk J. Free insulin-like growth factors: measurements and relationships to growth hormone secretion and glucose homeostasis. Growth Horm IGF Res. 2004;14:337–75.CrossRefPubMedGoogle Scholar
  23. 23.
    Maccario M, Ramunni J, Oleandri SE, et al. Relationships between IGF-1 and age, gender, body mass, fat distribution, metabolic and hormonal variables in obese patients. Int J Obes Relat Metab Disord. 1999;23:612–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Anonymous. NIH Conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel 1991. Ann Intern Med. 1991;115:956–61.Google Scholar
  25. 25.
    Lamberts SW, de Herder WW, van der Lely AJ. Pituitary insufficiency. Lancet. 1998;352:127–34.PubMedGoogle Scholar
  26. 26.
    Kotler DP, Burastero S, Wang J, et al. Prediction of body cell mass, fat-free mass, and total body water with bioelectrical impedance analysis: effect of race, sex, and disease. Am J Clin Nutr. 1996;64:489S–97S.PubMedGoogle Scholar
  27. 27.
    Piccoli A, Brunani A, Savia G, et al. Discriminating between body fat and fluid changes in the obese adult using bioimpedance vector analysis. Int J Obes. 1998;22:97–104.CrossRefGoogle Scholar
  28. 28.
    Ghigo E, Aimaretti G, Gianotti L, et al. New approach to the diagnosis of growth hormone deficiency in adults. Eur J Endocrinol. 1996;134:352–6.CrossRefPubMedGoogle Scholar
  29. 29.
    Colao A, Di Somma C, Cascella T, et al. Relationships between serum IGF1 levels, blood pressure, and glucose tolerance: an observational, exploratory study in 404 subjects. Eur J Endocrinol. 2008;159:1–10.CrossRefGoogle Scholar
  30. 30.
    Ho KK, GH Deficiency Consensus Workshop Participants. Consensus guidelines for the diagnosis and treatment of adults with GH deficiency II: a statement of the GH Research Society in association with the European Society for Pediatric Endocrinology, Lawson Wilkins Society, European Society of Endocrinology, Japan Endocrine Society, and Endocrine Society of Australia. Eur J Endocrinol. 2007;157:695–700.CrossRefPubMedGoogle Scholar
  31. 31.
    Hu FB, Rimm E, Smith-Warner SA, et al. Reproducibility and validity of dietary patterns assessed with a food-frequency questionnaire. Am J Clin Nutr. 1999;69:243–9.PubMedGoogle Scholar
  32. 32.
    Kuzmak LI. A review of seven years' experience with silicone gastric banding. Obes Surg. 1991;1:403–8.CrossRefPubMedGoogle Scholar
  33. 33.
    Angrisani L, Lorenzo M, Esposito G, et al. Laparoscopic adjustable silicone gastric banding: preliminary results of Naples experience. Obes Surg. 1997;7:19–21.CrossRefPubMedGoogle Scholar
  34. 34.
    Busetto L, Pisent C, Segato G, et al. The influence of a new timing strategy of band adjustment on the vomiting frequency and the food consumption of obese women operated with laparoscopic adjustable silicone gastric banding (LAP-BAND®). Obes Surg. 1997;7:505–12.CrossRefPubMedGoogle Scholar
  35. 35.
    Oi Y, Okuda T, Koishi H, et al. Effects of low energy diets on protein metabolism studies with [15N]glycine in obese patients. J Nutr Sci Vitaminol. 1987;33:227–37.PubMedGoogle Scholar
  36. 36.
    Micic DD, Cubrilo KM. Obesity and male reproduction function. Obes Metabol. 2006;2:13–27.Google Scholar
  37. 37.
    della Valle E, Stranges S, Trevisan M, et al. Self-rated measures of physical activity and cardiovascular risk in a sample of Southern Italian male workers: the Olivetti heart study. Nutr Metab Cardiovasc Dis. 2004;14:143–9.CrossRefPubMedGoogle Scholar
  38. 38.
    Adams TD, Heath EM, LaMonte MJ, et al. The relationship between body mass index and per cent body fat in the severely obese. Diabetes Obes Metab. 2007;9:498–505.CrossRefPubMedGoogle Scholar
  39. 39.
    De Marinis L, Bianchi A, Mancini A, et al. Growth hormone secretion and leptin in morbid obesity before and after biliopancreatic diversion: relationships with insulin and body composition. J Clin Endocrinol Metab. 2004;89:74–80.Google Scholar
  40. 40.
    Lukanova A, Soderberg S, Stattin P, et al. Nonlinear relationship of insulin-like growth factor (IGF)-I and IGF-1/IGF-binding protein-3 ratio with indices of adiposity and plasma insulin concentrations (Sweden). Cancer Causes Control. 2002;13:509–16.CrossRefPubMedGoogle Scholar
  41. 41.
    Mauras N, Haymond MW. Are the metabolic effects of GH and IGF-1 separable? Growth Horm IGF Res. 2005;15:19–27.CrossRefPubMedGoogle Scholar
  42. 42.
    Iranmanesh A, Lizarralde G, Veldhuis JD. Age and relative adiposity are specific negative determinants of the frequency and amplitude of growth hormone (GH) secretory bursts and the half-life of endogenous GH in healthy men. J Clin Endocrinol Metab. 1991;73:1081–8.CrossRefPubMedGoogle Scholar
  43. 43.
    Veldhuis JD. Gender differences in secretory activity of the human somatotropic (growth hormone) axis. Eur J Endocrinol. 1996;134:287–95.CrossRefPubMedGoogle Scholar
  44. 44.
    van den Berg G, Veldhuis JD, Frölich M, et al. An amplitude-specific divergence in the pulsatile mode of growth hormone (GH) secretion underlies the gender difference in mean GH concentrations in men and premenopausal women. J Clin Endocrinol Metab. 1996;81:2460–7.CrossRefPubMedGoogle Scholar
  45. 45.
    Colao A, Di Somma C, Pivonello R. Bone loss is correlated to the severity of growth hormone deficiency in adult patients with hypopituitarism. J Clin Endocrinol Metab. 1999;84:1919–24.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2009

Authors and Affiliations

  • Silvia Savastano
    • 1
  • Luigi Angrisani
    • 2
  • Carolina Di Somma
    • 1
    • 4
  • Francesca Rota
    • 1
  • Maria Cristina Savanelli
    • 1
  • Teresa Cascella
    • 1
  • Francesco Orio
    • 3
  • Gaetano Lombardi
    • 1
  • Annamaria Colao
    • 1
  1. 1.Division of Endocrinology, Department of Molecular and Clinical Endocrinology and OncologyUniversity of Naples Federico IINaplesItaly
  2. 2.Department of SurgeryS. Giovanni Bosco Hospital of NaplesNaplesItaly
  3. 3.EndocrinologyParthenope University of NaplesNaplesItaly
  4. 4.SDN Foundation IRCCSNaplesItaly

Personalised recommendations