THERAPY IN ENDOCRINE DISEASE: Body composition and quality of life in adults treated with GH therapy: a systematic review and meta-analysis

Hazem, Ahmad; Elamin, Mohamed B.; Bancos, Irina; Málaga, Germán; Prutsky, Gabriela; Domecq, Juan Pablo; Elraiyah, Tarig; Elnour, Nisrin O. Abu; Prevost, Yolanda; Almandoz, Jaime P.; Zeballos-Palacios, Claudia; Velasquez, Edgar R; Erwin, Patricia J.; Natt, Neena; Montori, Víctor M.; Murad, M. Hassan

doi:10.1530/eje-11-0558

Cited by 80 publications

(64 citation statements)

References 67 publications

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“…The elevated VAT in this population is consistent with the previously reported phenotype of patients with GHD, having a higher ratio of visceral to subcutaneous fat compared with controls matched for BMI. Furthermore, in those patients given GHR, improvements in body composition were seen with significant reductions in both subcutaneous and visceral fat in keeping with recent data from Eggar et al (34) and the recent meta-analysis by Hazem et al (35). Our primary outcome measure was IHCL.…”

Section: Discussionsupporting

confidence: 76%

Hepatic steatosis, GH deficiency and the effects of GH replacement: a Liverpool magnetic resonance spectroscopy study

Gardner

Irwin

Daousi

et al. 2012

European Journal of Endocrinology

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Objective: Non-alcoholic fatty liver disease (NAFLD) is reported to be more common in patients with GH deficiency (GHD) than in the general population. We aimed to determine: i) liver fat in patients with GHD compared with age and body mass index (BMI)-matched controls; and ii) effect of 6 months of GH replacement (GHR) on liver fat. Participants and methods: The study included 28 GHD patients and 24 controls. 12 patients were studied before and after 6 months of GHR. Anthropometry, liver enzymes and lipid profiles were measured, and body composition and intrahepatocellular lipid (IHCL) were determined by magnetic resonance imaging and spectroscopy. Results: Age and BMI (median (inter-quartile range)) of patients and controls were 52.6 (14) vs 52.6 (12) years (PZ0.9) and 27.8 (24.7, 34.7) vs 27.9 (25.1, 32.1) kg/m 2 (PZ0.9). IGF1 was lower in the patients (11.5 vs 16.0 nmol/l, PZ0.002). There was no difference in liver transaminases, lipids or IHCL between patients and controls (2.8 (1.3, 8.6) vs 5.0 (1.5, 12.7), PZ0.72), despite significantly higher visceral fat in GHD patients. Thirty-two percent of patients and 50% of controls had NAFLD (defined as IHCL O5.6%), and the relationship between IHCL and BMI was the same in each group. GHR significantly reduced abdominal subcutaneous and visceral fat in all patients; however, GHR did not reduce liver fat. Conclusions: NAFLD is equally common in patients with GHD and matched controls. GHR is associated with a hierarchical reduction in fat deposition (fat loss: visceral O subcutaneous O liver). Further studies involving GHD patients with NAFLD are required to conclude the role of GHR in treating NAFLD.

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Section: Discussionsupporting

confidence: 76%

Hepatic steatosis, GH deficiency and the effects of GH replacement: a Liverpool magnetic resonance spectroscopy study

Gardner

Irwin

Daousi

et al. 2012

European Journal of Endocrinology

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“…Consistent beneficial effects of GHT were variously reported on body composition, metabolism and cardiovascular risk factors [29][30][31][32], although the prevalence of the metabolic syndrome in GHD patients was found to be increased when compared to healthy controls even after GHT, likely due to the discordant data about anthropometric parameters and glucose metabolism [32][33][34]. Therefore, if the beneficial effect of GHT on lipid profile is well established, other cardiovascular risk factors may continue to deteriorate during GHT, leading to a concern about the net beneficial effects of GHT.…”

Section: Discussionsupporting

confidence: 60%

The visceral adiposity index is associated with insulin sensitivity and IGF-I levels in adults with growth hormone deficiency

2016

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The visceral adiposity index, based on anthropometric and metabolic parameters, has been shown to be related to adipose tissue function and insulin sensitivity. We aimed to evaluate the performance of the visceral adiposity index in adult patients with growth hormone deficiency. We enrolled 52 patients(mean age 51 ± 13 years) with newly diagnosed growth hormone deficiency and 50 matched healthy subjects as controls at baseline. At baseline and after 12 and 24 months of treatment we evaluated anthropometric measures, lipid profile, glucose and insulin during an oral glucose tolerance test, hemoglobin A1c, homeostasis model assessment estimate of insulin resistance, quantitative insulin sensitivity check index, insulin sensitivity index Matsuda, insulin-like growth factor-I and visceral adiposity index. At baseline growth hormone deficiency patients showed higher waist circumference (p < 0.001), low-density lipoprotein cholesterol (p < 0.001) and visceral adiposity index (p = 0.003) with lower insulin sensitivity index (p = 0.007) and high-density lipoprotein cholesterol (p = 0.001) than controls. During growth hormone treatment we observed a significant increase in insulin-like growth factor-I (p < 0.001), high-density lipoprotein (p < 0.001) with a trend toward increase in insulin sensitivity index (p = 0.055) and a significant decrease in total cholesterol (p < 0.001) and visceral adiposity index (p < 0.001), while no significant changes were observed in other clinical and metabolic parameters. The visceral adiposity index was the only parameter that significantly correlated with growth hormone peak at diagnosis (p < 0.001) and with insulin-like growth factor-I and insulin sensitivity index both at diagnosis (p = 0.009 and p < 0.001) and after 12 (p = 0.026 and p = 0.001) and 24 months (p < 0.001 and p = 0.001) of treatment. The visceral adiposity index, which has shown to be associated with both insulin-like growth factor-I and insulin sensitivity, proved to be the most reliable index of metabolic perturbation, among the most common indexes of adiposity assessment and a marker of benefit during treatment in adult growth hormone deficiency patients.

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“…However, in patients with adult-onset GH deficiency, GH therapy has only been found to have a positive effect on QOL if disease-specific questionnaires are used. In studies that use generic QOL questionnaires, as we used in this study, the positive effect of GH therapy on QOL in GH-deficient patients is much more controversial and most studies that did find a positive effect of QOL only found this in a few dimensions of the generic QOL questionnaires (40). Therefore, the presence of untreated GH deficiency can certainly not account for the obvious impairment of QOL of the total patient group.…”

Section: Discussionmentioning

confidence: 90%

Impaired quality of life in patients in long-term remission of Cushing's syndrome of both adrenal and pituitary origin: a remaining effect of long-standing hypercortisolism?

Wagenmakers¹,

Netea‐Maier²,

Prins³

et al. 2012

European Journal of Endocrinology

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Objective: The determinants that cause impaired quality of life (QOL) in patients in long-term remission of Cushing's syndrome (CS) are unknown. The aim of this study was to get more insight into the patient and disease characteristics related to impaired QOL in these patients. Design: Cross-sectional study. Methods: The QOL of 123 patients in remission of CS (age 52.2G12.0 years, 106 women, duration of remission 13.3G10.4 years, 80% pituitary CS), assessed with seven validated questionnaires, was compared with the QOL of an age-and sex-matched control group (nZ105). To investigate the influence of the aetiology of CS on QOL, patients in remission of pituitary and adrenal CS were compared. Furthermore, the influence of hormonal deficiencies, treatment strategy, duration of remission, gender and age on QOL was investigated. Results: QOL in the total patient group and each patient subgroup was significantly worse on practically all dimensions of questionnaires compared with the control group (P!0.05), except for patients in remission of pituitary CS without hormonal deficiencies who had an impaired QOL on 50% of the QOL dimensions. Subgroup analysis revealed no difference in QOL between different patient groups, especially no difference between patients in remission of adrenal and pituitary CS. Female gender and a shorter duration of remission had a negative influence on QOL in the patient group. Conclusions: QOL remains impaired in patients in long-term remission of CS regardless of aetiology, presence of hormonal deficiencies and treatment strategies. More research is needed to establish the causes.

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THERAPY IN ENDOCRINE DISEASE: Body composition and quality of life in adults treated with GH therapy: a systematic review and meta-analysis

Cited by 80 publications

References 67 publications

Hepatic steatosis, GH deficiency and the effects of GH replacement: a Liverpool magnetic resonance spectroscopy study

Hepatic steatosis, GH deficiency and the effects of GH replacement: a Liverpool magnetic resonance spectroscopy study

The visceral adiposity index is associated with insulin sensitivity and IGF-I levels in adults with growth hormone deficiency

Impaired quality of life in patients in long-term remission of Cushing's syndrome of both adrenal and pituitary origin: a remaining effect of long-standing hypercortisolism?

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