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)

The loss of lean body mass (LBM) negatively influences the outcome in bariatric surgery. Impaired GH secretion is frequent in obese patients. Objective: Our objective was to investigate if GH treatment prevents LBM loss in the early postoperative period. Design: This was an open, prospective, randomized, and controlled study. Patients: A total of 24 women (body mass index: 44.4 Ϯ 7.6 kg/m 2 , aged 36.8 Ϯ 11.7 yr) undergoing laparoscopic-adjustable silicone gastric banding (LASGB) and with GH deficiency after LASGB was included in the study. Treatment Protocol: Group A (n ϭ 12) included a standardized diet regimen and exercise program plus recombinant human GH (0.5 Ϯ 0.13 mg every day), and group B (n ϭ 12) included a standardized diet regimen and exercise program. The follow-up duration was 6 months. Results: The excess of body weight loss did not differ between groups A and B after 3 and 6 months. At 3 months, LBM loss was lower (P Ͻ 0.0001) and fat mass (FM) loss was higher (P ϭ 0.02) in group A than group B. At 3 and 6 months, appendicular skeletal muscle mass loss was lower (P ϭ 0.000) in group A than group B. At 3 (P ϭ 0.0003 and 0.0005, respectively) and 6 months (P Ͻ 0.0001 and 0.0002, respectively), the percent changes of FM and lean body mass were significantly higher in group A than group B. In both groups fasting and postglucose area under the plasma concentrationtime curve insulin significantly reduced. The homeostasis model assessment of insulin and insulin sensitivity indexes and total to high-density lipoprotein cholesterol ratio improved only in group A. Conclusions: GH treatment for 6 months after LASGB reduces loss in LBM and appendicular skeletal muscle mass during a standardized program of low-calorie diet and physical exercise program, with improvement of lipid profile and without a deterioration of glucose tolerance. (J Clin Endocrinol Metab 94: 817-826, 2009) O besity should be considered an onerous worldwide problem because of the impressive number of associated complications (1). The subgroup of individuals with class III or morbid obesity, defined as body mass index (BMI) more than 40 kg/m 2 , is a particular concern due to both health risk concerns and resistance to medical therapy (2). In the United States, it is