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Adiposity linked to better response to GH treatment in small for gestational age children
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In short children born small for gestational age, higher body fat percentage appears to have a positive effect on growth hormone treatment response and glucose metabolism, according to recent findings.
Researchers evaluated 89 prepubescent small for gestational age children (mean age, 6.2 years; 55 boys) enrolled in the North European Small for Gestational Age Study, a multicenter analysis of GH treatment in short preadolescent small for gestational age children in four northern European countries.
Participants underwent treatment with a standard high dose of GH (67 µg/kg per day) during the first year to promote catch-up growth. DXA estimated body fat percentage at baseline and 1 year.
At baseline, participants had lower mean body fat percentage (P = .045) and BMI (P < .0001) compared with healthy white children.
Increases in lean body mass (P < .0001) and bone mineral content (P < .0001) accompanied catch-up growth during the first year of treatment. However, there were declines in total body fat mass and limb fat mass (P < .0001 for both). Trunk fat mass remained stable and resulted in an increased trunk-limb fat ratio at 1 year. Increases in height standard deviation scores, BMI standard deviation scores, insulin-like growth factor I standard deviation scores, fasting insulin and C-peptide levels were associated with GH treatment. Insulin sensitivity decreased significantly, whereas an offsetting increase in insulin secretion led to an unaltered disposition index. Positive associations were found between baseline body fat percentage and the following: IGF-I responses (P for trend = .042), first-year height gains (P < .0001), baseline insulin secretion (P for trend = .02), 1-year insulin secretion (P for trend = .004) and disposition index at 1 year (P for trend = .04). At baseline, genetic scores for lower insulin sensitivity was negatively associated with BMI (P = .04), body fat (P = .047) and limb fat (P = .049).
Genetic scores for lower insulin sensitivity was linked to an attenuated decrease in trunk fat (P = .001) and higher trunk-limb fat ratio at 1-year (P = .008) during GH treatment. A positive association was found between genetic scores for lower insulin secretion and truncal fat (P = .009).
“Our findings suggest that greater adiposity has beneficial effects on responses to GH treatment and glucose metabolism in short [small for gestational age] children,” the researchers wrote. “Mechanisms associated with insulin resistance link lower adiposity and reduced response to GH treatment in these children. While the association between genetic susceptibility to insulin resistance and lower adiposity appears to be generalizable across adults and children, the conclusions linking these factors to GH treatment responses are limited to the population studied here.” – by Jennifer Byrne
Disclosure: The study was funded in part by the Danish Council for Independent Research/Medical Sciences and Novo Nordisk A/S. The researchers report no relevant financial disclosures.
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