Beneficial Effects Of Growth Hormone Therapy On Body Composition and Quality of Life
Growth hormone (GH) and its effector Insulin-Like Growth Factor I (IGF-I) serve mainly in regulating growth during childhood, while in adults it is thought to contribute to the regulation of weight, fat mass and muscle mass. Adult growth hormone deficiency has been increasingly described as a syndrome, causing weight gain, decreased muscle mass, decreased bone mineral density, increased fat mass, impaired physical activity, and poor quality of life and life expectancy.
Currently, the FDA-approved indications for GH replacement include short stature associated with Turner syndrome, renal failure, small size for gestational age, Prader-Willi syndrome, idiopathic short stature, and for substitution in hypothalamic-pituitary disease. Availability of recombinant human growth hormone provides a potential benefit to patients with GH deficiency but also carries disadvantages as there are safety and cost concerns related to long-term therapy.
Previously published recommendations of GH use in adult GH deficiency were based on GH effects on physical function and quality of life. The evaluation of the efficacy of this intervention would not be complete without consideration of the potential adverse effects. Of those, the most commonly described are hyperglycemia, hypertension, dyslipidemia, edema, and joint complaints. More recently, concerns have been raised about the effect of GH use and the emergence or recurrence of cancer, and concerns about pituitary and craniopharyngioma tumor growth or recurrence.
In 1989, research published the efficacy of using growth hormone replacement therapy in deficient adults. The trial found that GH had several potential benefits in the patient population, including decrease in adipose volume, increase in muscle volume, increase in strength and exercise capacity of the quadriceps muscle and recovery of glomerular filtration rate and renal plasma flow. The trial concluded by encouraging future long-follow up trials to further investigate the effects of GH.
Since then, there have been several trials with varying durations of follow up assessing the effects of GH on body composition, exercise capacity, strength and quality of life. This systematic review aims to summarize the available randomized trial evidence in adults with GH deficiency treated with GH focusing on body composition (weight, body fat, lean body mass, bone mineral density (BMD) and body mass index (BMI)), functional outcomes and quality of life, and adverse effects including edema, joint stiffness and carpal tunnel syndrome. Included trials in this review were restricted -by a priori protocol- to trials that enrolled patients with confirmed diagnosis of GH deficiency. Researchers excluded trials that used GH on patients with other conditions that are reportedly associated with GH deficiency including but not limited to obesity and the healthy elderly age group.
Growth hormone therapy in adults with GH deficiency reduces weight and body fat, increases lean body mass; but increases edema and joint stiffness. Most trials demonstrated improvement in quality of life measures.
Hazem A, Elamin M, Bancos I, et al. Body Composition and Quality of Life in Adults Treated with Growth Hormone Therapy: A Systematic Review and Meta-analysis. European Journal of Endocrinology. http://www.eje-online.org/content/early/2011/08/24/EJE-11-0558.abstract
Objective: To summarize the evidence about the efficacy and safety of using GH in adults with GH deficiency focusing on quality of life and body composition.
Data Sources: We searched MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science and Scopus through April 2011. We also reviewed reference lists and contacted experts to identify candidate studies.
Study Selection: Reviewers, working independently and in duplicate, selected randomized controlled trials (RCTs) that compared GH to placebo.
Data Synthesis: We pooled the relative risk (RR) and weighted mean difference (WMD) using the random-effects model and assessed heterogeneity using the I2 statistic.
Results: Fifty-four RCTs were included enrolling over 3400 patients. The quality of the included trials was fair. GH use was associated with statistically significant reduction in weight (WMD, 95% CI: -2.31 kg, -2.66, -1.96) and body fat content (WMD, 95% CI: -2.56 kg, -2.97, -2.16); increase in lean body mass (WMD, 95% CI: 1.38, 1.10, 1.65), the risk of edema (RR, 95% CI: 6.07, 4.34, 8.48) and joint stiffness (RR, 95% CI: 4.17, 1.4, 12.38); without significant changes in body mass index, bone mineral density or other adverse effects. Quality of life measures improved in 11 of 16 trials although meta-analysis was not feasible.
Conclusion: Growth hormone therapy in adults with confirmed GH deficiency reduces weight and body fat, increases lean body mass and increases edema and joint stiffness. Most trials demonstrated improvement in quality of life measures.
Growth hormone (GH) and its effector Insulin-Like Growth Factor I (IGF-I) serve mainly in regulating growth during childhood, while in adults it is thought to contribute to the regulation of weight, fat mass and muscle mass. Adult growth hormone deficiency has been increasingly described as a syndrome, causing weight gain, decreased muscle mass, decreased bone mineral density, increased fat mass, impaired physical activity, and poor quality of life and life expectancy.
Currently, the FDA-approved indications for GH replacement include short stature associated with Turner syndrome, renal failure, small size for gestational age, Prader-Willi syndrome, idiopathic short stature, and for substitution in hypothalamic-pituitary disease. Availability of recombinant human growth hormone provides a potential benefit to patients with GH deficiency but also carries disadvantages as there are safety and cost concerns related to long-term therapy.
Previously published recommendations of GH use in adult GH deficiency were based on GH effects on physical function and quality of life. The evaluation of the efficacy of this intervention would not be complete without consideration of the potential adverse effects. Of those, the most commonly described are hyperglycemia, hypertension, dyslipidemia, edema, and joint complaints. More recently, concerns have been raised about the effect of GH use and the emergence or recurrence of cancer, and concerns about pituitary and craniopharyngioma tumor growth or recurrence.
In 1989, research published the efficacy of using growth hormone replacement therapy in deficient adults. The trial found that GH had several potential benefits in the patient population, including decrease in adipose volume, increase in muscle volume, increase in strength and exercise capacity of the quadriceps muscle and recovery of glomerular filtration rate and renal plasma flow. The trial concluded by encouraging future long-follow up trials to further investigate the effects of GH.
Since then, there have been several trials with varying durations of follow up assessing the effects of GH on body composition, exercise capacity, strength and quality of life. This systematic review aims to summarize the available randomized trial evidence in adults with GH deficiency treated with GH focusing on body composition (weight, body fat, lean body mass, bone mineral density (BMD) and body mass index (BMI)), functional outcomes and quality of life, and adverse effects including edema, joint stiffness and carpal tunnel syndrome. Included trials in this review were restricted -by a priori protocol- to trials that enrolled patients with confirmed diagnosis of GH deficiency. Researchers excluded trials that used GH on patients with other conditions that are reportedly associated with GH deficiency including but not limited to obesity and the healthy elderly age group.
Growth hormone therapy in adults with GH deficiency reduces weight and body fat, increases lean body mass; but increases edema and joint stiffness. Most trials demonstrated improvement in quality of life measures.
Hazem A, Elamin M, Bancos I, et al. Body Composition and Quality of Life in Adults Treated with Growth Hormone Therapy: A Systematic Review and Meta-analysis. European Journal of Endocrinology. http://www.eje-online.org/content/early/2011/08/24/EJE-11-0558.abstract
Objective: To summarize the evidence about the efficacy and safety of using GH in adults with GH deficiency focusing on quality of life and body composition.
Data Sources: We searched MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science and Scopus through April 2011. We also reviewed reference lists and contacted experts to identify candidate studies.
Study Selection: Reviewers, working independently and in duplicate, selected randomized controlled trials (RCTs) that compared GH to placebo.
Data Synthesis: We pooled the relative risk (RR) and weighted mean difference (WMD) using the random-effects model and assessed heterogeneity using the I2 statistic.
Results: Fifty-four RCTs were included enrolling over 3400 patients. The quality of the included trials was fair. GH use was associated with statistically significant reduction in weight (WMD, 95% CI: -2.31 kg, -2.66, -1.96) and body fat content (WMD, 95% CI: -2.56 kg, -2.97, -2.16); increase in lean body mass (WMD, 95% CI: 1.38, 1.10, 1.65), the risk of edema (RR, 95% CI: 6.07, 4.34, 8.48) and joint stiffness (RR, 95% CI: 4.17, 1.4, 12.38); without significant changes in body mass index, bone mineral density or other adverse effects. Quality of life measures improved in 11 of 16 trials although meta-analysis was not feasible.
Conclusion: Growth hormone therapy in adults with confirmed GH deficiency reduces weight and body fat, increases lean body mass and increases edema and joint stiffness. Most trials demonstrated improvement in quality of life measures.