Low-dose growth hormone in adult home parenteral nutrition-dependent short bowel syndrome patients: a positive study.
OBJECTIVE
Controversy surrounds a 3-week treatment with a high-dose (0.14 mg. kg(-1). day(-1)) growth hormone (GH), glutamine, and high carbohydrate diet in home parenteral nutrition (HPN)-dependent patients with short-bowel syndrome (SBS). This study assessed treatment with low-dose GH in these patients.


METHODS
Twelve adult HPN-dependent (duration, 7 +/- 1 years; mean +/- SEM) patients with SBS (small-bowel remnant length, 48 +/- 11 cm) who were on an unrestricted hyperphagic diet were randomized in a double-blind, placebo-controlled, crossover study. Patients received daily low-dose GH (0.05 mg. kg(-1). day(-1)) and placebo for two 3-week periods separated by a 1-week washout period. Net intestinal absorption of macronutrients was assessed using a duplicate diet; nutritional assessment and blood tests were performed. Data from each group were compared using Wilcoxon rank sum test.


RESULTS
Treatment with GH increased intestinal absorption of energy (15% +/- 5%, P < 0.002), nitrogen (14% +/- 6%, P < 0.04), carbohydrates (10% +/- 4%, P < 0.04), and fat (12% +/- 8%, NS). The increased food absorption represented 37% +/- 16% of total parenteral energy delivery. Body weight (P < 0.003), lean body mass (P < 0.006), D-xylose absorption (P < 0.02), insulin-like growth factor 1 (P < 0.002), and insulin-like growth factor binding protein 3 (P < 0.002) increased, whereas uptake of GH binding protein decreased (P < 0.01), without any major adverse effect.


CONCLUSIONS
Three weeks of low-dose GH significantly improved intestinal absorption in HPN-dependent SBS patients who were on a hyperphagic western diet.
Seguy
David
D
Department of Nutrition, University Hospital, Lille, France.
Vahedi
Kouroche
K
Kapel
Nathalie
N
Souberbielle
Jean-Claude
JC
Messing
Bernard
B
D000328:Adult; D001823:Body Composition; D001835:Body Weight; D018592:Cross-Over Studies; D004032:Diet; D004040:Dietary Carbohydrates / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D004734:Energy Metabolism / Q000187:drug effects; D005223:Fats / Q000378:metabolism; D005260:Female; D013006:Growth Hormone / Q000008:administration & dosage*; D006801:Humans; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000378:metabolism; D007408:Intestinal Absorption / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D009584:Nitrogen / Q000378:metabolism; D016331:Parenteral Nutrition, Home; D011446:Prospective Studies; D011986:Receptors, Somatotropin / Q000378:metabolism; D012778:Short Bowel Syndrome / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D014994:Xylose / Q000493:pharmacokinetics
D004040:Dietary Carbohydrates; D005223:Fats; D018972:Insulin-Like Growth Factor Binding Protein 3; D011986:Receptors, Somatotropin; D013006:Growth Hormone; D014994:Xylose; D009584:Nitrogen