Growth Hormone Treatment Prevents Loss of Lean Mass after Bariatric Surgery in Morbidly Obese Patients: Results of a Pilot, Open, Prospective, Randomized, Controlled Study (original) (raw)
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Clinical Endocrinology, 2008
Context GH secretion is reduced in obese subjects and increases after body weight loss. It is still unclear if changes in the GH/IGF-I axis after laparoscopic-adjustable silicone gastric banding (LASGB) are associated with changes of body composition. Objective To analyse the relationships between changes in the GH/IGF-I axis and those of body weight and composition before and after LASGB. Design Observational, prospective. Setting University 'Federico II' of Naples (Italy). Patients Seventy-two severely obese females (BMI: 44·9 ± 4·68; mean age: 33·1 ± 11·34 years) were studied. Main outcome measures GH peak after GHRH plus arginine test, IGF-I, IGFBP-3 and ALS levels, fat mass (FM) and free fat mass (FFM) (by Bioelectrical Impedance Analysis) at baseline and 6 months after LASGB. The change in percentage of individual variables was calculated as well as that of excess of body weight loss (EBWL%). The FM%, FFM% and EBWL% were correlated with peak GH and IGF-I levels changes. Results At baseline, GH deficiency (GHD) (GH peak = 4·1 μ g/l) was found in 22 patients (31%), 16 of them also had IGF-I deficiency (< -2SDS). IGF-I levels were inversely correlated with waist circumference ( r = -0·72, P < 0·001) and FM% ( r = -0·75, P < 0·001). Post-LASGB the patients were classified as follows: group (1) GH and IGF-I sufficient ( n = 44; 61·1%); group (2) GH and IGF-I deficient ( n = 14; 19·4%) and group (3) GH sufficient and IGF-I deficient ( n = 14; 19·4%). The percentage changes of EWBL ( P < 0·05, P = 0·051, respectively) and FM ( P < 0·001, P < 0·01, respectively) were lower in groups (2) and (3) than in group (1). At the stepwise linear regression analysis, postoperative IGF-I levels were the strongest determinant of percent changes of FM ( P < 0·0001), of FFM ( P = 0·009) and of EBWL ( P < 0·0001). Conclusions IGF-I levels is the most sensitive to unfavourable changes in body composition 6 months after LASGB making investigation of the somatotropic axis useful in the evaluation of bariatric surgery outcomes.
International Journal of Obesity, 2001
OBJECTIVE: To evaluate the effects of low-dose growth hormone (GH) therapy combined with diet restriction on changes in body composition and the consequent change in insulin resistance in newly-diagnosed obese type 2 diabetic patients. DESIGN: Double-blind and placebo-controlled trial of 25-kcalakg IBW diet daily with GH (n 9; rhGH, 0.15 IUakg body weightaweek) or placebo (n 9) for 12 weeks. SUBJECTS: Eighteen newly-diagnosed obese type 2 diabetic patients (age 42 ± 56 y, body mass index 28.1 AE 2.7 kgam 2 ). MEASUREMENTS: Body composition and fat distribution parameters (by bioelectrical impedance analyzer and CT scans), serum IGF-1; serum glucose, insulin and free fatty acid (FFA) during oral glucose tolerance test (OGTT); HbA 1c ; serum lipid pro®les; and glucose disposal rate (GDR) by euglycemic hyperinsulinemic clamp at baseline and after treatment. RESULTS: The fraction of body weight lost as fat lost was signi®cantly greater (0.98 AE 0.39 vs 0.52 AE 0.32 kgakg, P`0.05) and visceral fat area was decreased more in the GH-treated group compared to the placebo-treated group (27.9 vs 21.6%, P`0.05). Lean body mass and muscle area were reduced in the placebo-treated group, whereas an increase in both was observed in the GH-treated group. GDR the was signi®cantly increased in only the GH-treated group (4.67 AE 1.05 vs 6.95 AE 0.91 mgakgamin, P`0.05). The GH-induced increase in GDR was positively correlated with the decrease in the ratio of visceral fat areaamuscle area (r 0.588, P 0.001). Serum glucose levels and insulin-and FFA-area under the curve during OGTT and HbA 1c were signi®cantly decreased after GH treatment. LDL-cholesterol level was decreased in only the GH-treated group. CONCLUSION: Low-dose GH treatment combined with dietary restriction resulted not only in a decrease of visceral fat but also in an increase of muscle mass with a consequent improvement of the insulin resistance observed in obese type 2 diabetic patients.
The Journal of Clinical Endocrinology & Metabolism, 2002
This study was designed to explore whether low doses of recombinant human (rh)GH affect lipid, glucose, or protein metabolism in men with visceral obesity. Four different studies were performed in six, otherwise healthy, obese men (age, 42 ؎ 3; body mass index, 33 ؎ 1 kg/m 2 ; waist circumference, 111 ؎ 3 cm; mean ؎ SEM). Lipid, glucose, and protein kinetics was estimated by infusing stable isotopes (glycerol, glucose, leucine) in the basal state and after 1 wk of treatment with sc bedtime injections of either placebo, 2.5 (GH2.5), or 3.3 (GH3.3) g rhGH/kg body weight per day. When compared with baseline, placebo had no effect on lipid, glucose, or protein fluxes. In contrast, GH2.5 and GH3.3 increased lipolysis by approximately 25% (P < 0.04) without changing glucose and protein turnover rates. The two rhGH treatments increased within the normal range serum IGF-I (by ϳ30%; P < 0.01), whereas they augmented insulin secretion (P < 0.04) in a dose-dependent manner (GH2.5 by 19%, GH3.3 by 37%). C-peptide secretion was increased (P ؍ 0.01) only by GH3.3 (by 28%). In conclusion, 1 wk of treatment with low doses of rhGH is sufficient to increase lipolysis in visceral obese men, but it does not modify glucose and protein turnover rates. The results of this study provide the rationale to design clinical trials using low doses of rhGH to attempt to reduce fat mass.
Abstract Journal Bariatric Surgery
ANZ Journal of Surgery, 2017
Substantial weight loss in the setting of obesity has considerable metabolic benefits. Yet some studies have shown improvements in obesity-related comorbidities with more modest weight loss. By closely monitoring patients, we aimed to determine the effects of weight loss on the metabolic syndrome, and determine the target weight loss required for its resolution. Methodology: We performed a prospective observational study of obese participants with metabolic syndrome (ATPIII) who underwent gastric banding. Participants were assessed for all criteria of the metabolic syndrome each month for nine months, then three-monthly until 24 months. Results: There were 89 participants recruited, with baseline BMI 42.4AE6.2kg and age 48.2AE10.7years. Resolution of the metabolic syndrome occurred in 60 of 89 participants (67%) at 12 months and 60 of 75 participants (80%) at 24 months. The mean weight loss when metabolic syndrome resolved was 10.9AE7.7% total body weight loss (TBWL). Median weight loss at which prevalence of disease was halved was 7.0% TBWL for hypertriglyceridemia; 11% TBWL for HDL cholesterol and hyperglycaemia; 20% TBWL for hypertension; 29% TBWL for waist circumference. Achieving 10-12.5% TBWL correlated with a 2.09 (p=0.025) odds of resolution of the metabolic syndrome with increasing probability of resolution with more substantial weight loss. Conclusion: In obese participants, a weight loss target of 10-12.5% TBWL (25-30% EWL) is a reasonable initial goal for metabolic benefits. Further metabolic improvement could be expected with additional weight loss. These findings can help inform weight loss efforts, in counselling patients, determining targets and assessing success of weight loss strategy.
European Journal of Clinical Investigation, 2004
Plasma ghrelin, an orexigenic peptide derived from the stomach and duodenum, increases following weight loss and might contribute to weight regain. The aim of the present study was to evaluate the effect of laparoscopic adjustable gastric banding (LAGB) on body weight and body composition as well as plasma ghrelin in relation to eating behaviour in morbidly obese patients. This study was performed in 23 morbidly obese subjects who underwent standardized LAGB. Fasting plasma ghrelin was measured before and 6 months after surgery and was correlated with body weight, body composition, and eating behaviour. Six months after LAGB, body weight decreased significantly by -15.7 +/- 1.4 kg (mean +/- SEM, P = 0.0001) which was accompanied by an increased cognitive restraint of eating (P = 0.001), and by a decreased disinhibition of eating and susceptibility to hunger (P = 0.0001). Plasma ghrelin increased (P = 0.016) by 27.2% from 100.39 +/- 12.90 to 127.22 +/- 13.15 fmol mL(-1). The change in plasma ghrelin correlated with changes in body weight (r = -0.49, P = 0.02), BMI (r = -0.42, P = 0.048) and fat mass (r = -0.519, P = 0.013), but not with changes of fat-free mass and of the three dimensions of eating behaviour. Weight loss following LAGB leads to an increase in fasting plasma ghrelin and is accompanied by a decrease in hunger, disinhibition of eating and an increase in cognitive restraint. Thus, changes in eating behaviour, which promote reduction of food intake and not fasting ghrelin, determines weight loss achieved by LAGB.
LSG - a First Step for Rapid Weight Loss in Morbidly Obese Patients.pdf
Background Laparoscopic sleeve gastrectomy is a viable option that is becoming common in the management of morbid obesity. The aim of this study was to examine the effectiveness and safety of laparoscopic sleeve gastrectomy as a primary step for rapid weight loss in patients who required a second non-bariatric procedure. Methods After Internal Review Board approval and with adherence to HIPAA guidelines, we conducted a retrospective review of a prospectively collected database of all patients who underwent laparoscopic sleeve gastrectomy as a primary procedure for a second non-bariatric operation from November 2004 to September 2008 at the Bariatric and Metabolic Institute at Cleveland Clinic Florida. The data was reviewed for age, gender, percentage of excess weight loss (%EWL), preoperative and postoperative body mass index (BMI), morbidity, and mortality. Mean followup time was 7 months (range, 2 weeks–12 months). Results Laparoscopic sleeve gastrectomy was performed in 18 patients who needed a second non-bariatric procedure such as knee replacement surgery, recurrent incisional hernia repair, laminectomy of the lumbar spine, kidney transplant, anterior cervical discectomy, and nephrectomy. Mean preoperative weight and BMI were 124.9 kg (range, 95.5–172.3 kg) and 44.87 kg/m2 (range, 33.36–58.87 kg/m2), respectively. Mean postoperative weight and BMI were 99.2 kg (range, 68.2–132.2 kg) and 35.79 kg/m2 (range, 23.46–48.97 kg/m2), respectively. There were no conversions to an open procedure in this series. There was no morbidity or mortality in this series. Conclusions In this small group, laparoscopic sleeve gastrectomy appears to be an effective and safe first surgical approach for rapid weight loss in high-risk patients that require a second non-bariatric procedure.
PloS one, 2011
Weight loss in metabolically healthy obese (MHO) subjects may result in deterioration of cardio-metabolic risk profile. We analyzed the effects of weight loss induced by laparoscopic adjustable gastric banding (LAGB) on cardio-metabolic risk factors in MHO and insulin resistant obese (IRO) individuals. This study included 190 morbidly obese non-diabetic subjects. Obese individuals were stratified on the basis of their insulin sensitivity index (ISI), estimated from an OGTT, into MHO (ISI index in the upper quartile) and IRO (ISI in the three lower quartiles). Anthropometric and cardio-metabolic variables were measured at baseline and 6-months after LAGB. Six months after LAGB, anthropometric measures were significantly reduced in both MHO and IRO. Percent changes in body weight, BMI, and waist circumference did not differ between the two groups. Fasting glucose and insulin levels, triglycerides, AST, and ALT were significantly reduced, and HDL cholesterol significantly increased, in both MHO and IRO subjects with no differences in percent changes from baseline. Insulin sensitivity increased in both MHO and IRO group. Insulin secretion was significantly reduced in the IRO group only. However, the disposition index significantly increased in both MHO and IRO individuals with no differences in percent changes from baseline between the two groups. The change in insulin sensitivity correlated with the change in BMI (r = 20.43; P,0.0001). In conclusion, our findings reinforce the recommendation that weight loss in response to LAGB intervention should be considered an appropriate treatment option for morbidly obese individuals regardless of their metabolic status, i.e. MHO vs. IRO subjects.
Journal of Clinical …, 2002
Weight loss ameliorates arterial hypertension and glucose metabolism in obese patients, but the dietary approach is unsatisfactory because obesity relapses. Durable reduction of body weight, obtained through major nonreversible surgical procedures, such as jejunal and gastric bypass, allows improvement of glucose metabolism and arterial blood pressure in morbid (grade 3) obesity. Laparoscopic adjustable gastric banding (LAGB) is a minimally invasive and reversible surgical procedure that yields a significant reduction of gastric volume and hunger sensation. In this study, 143 patients with grade 3 obesity [27 men and 116 women; age, 42.9 ؎ 0.83 yr; body mass index (BMI), 44.9 ؎ 0.53 kg/m 2 ; normal glucose tolerance (NGT; n ؍ 77); impaired glucose tolerance (IGT; n ؍ 47); type 2 diabetes mellitus (T2DM; n ؍ 19)] underwent LAGB and a 3-yr follow-up for clinical (BMI, waist circumference, waist to hip ratio, and arterial blood pressure) and metabolic variables (glycosylated hemoglobin, fasting insulin and glucose, insulin and glucose response to oral glucose tolerance test, homeostasis model assessment index, total and highdensity lipoprotein cholesterol, triglycerides, uric acid, and transaminases). At baseline and 1 yr after LAGB, patients underwent computerized tomography and ultrasound evaluation of visceral and sc adipose tissue. One-year metabolic results were compared with 120 obese patients (51 men and 69 women; age, 42.9 ؎ 1.11 yr; BMI, 43.6 ؎ 0.46 kg/m 2 ; NGT, n ؍ 66; IGT, n ؍ 8; T2DM, n ؍ 46) receiving standard dietary treatment. LAGB induced a significant and persistent weight loss and decrease of blood pressure. Greater metabolic effects were observed in T2DM patients than in NGT and IGT patients, so that at 3 yr glycosylated hemoglobin was no longer different in NGT and T2DM subjects. Clinical and metabolic improvements were proportional to the amount of weight loss. LAGB induced a greater reduction of visceral fat than sc fat. At 1-yr evaluation, weight loss and metabolic improvements were greater in LAGB-treated than diet-treated patients. We conclude that LAGB is an effective treatment of grade 3 obesity in inducing long-lasting reduction of body weight and arterial blood pressure, modifying body fat distribution, and improving glucose and lipid metabolism, especially in T2DM. (J Clin Endocrinol Metab 87: 3555-3561, 2002) TABLE 3. One-year changes of metabolic variables as a function of decrease of BMI (⌬ BMI, kg/m 2 ) in patients with grade 3 obesity undergoing LAGB (n ϭ 71) and in patients treated with conventional diet (n ϭ 58) Pontiroli et al. • LAGB Treatment of Morbid Obesity