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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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.
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.
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).
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.
KeywordsObesity Fat mass Fat-free mass GH IGF-I LAGB
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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