title: Preoperative prediction of growth hormone (GH)/insulin-like growth factor-1 (IGF-1) axis modification and postoperative changes in candidates for bariatric surgery.
abstract: BACKGROUND
  Several factors alter the growth hormone (GH)/insulin-like growth factor-1 (IGF-1) axis in obese patients, but GH/IGF-1 correlation with anthropometric parameters and lipid metabolism is still unclear. We evaluated this relationship and the postoperative axis modifications in candidates for bariatric surgery.
  
  
  METHODS
  Eighty-eight patients (males/females (M/F), 34/54) scheduled for bariatric surgery (biliopancreatic diversion or laparoscopic-adjustable gastric banding) between 2008 and 2010 were included in this observational, open, prospective study.
  
  
  RESULTS
  Preoperative serum GH concentrations were found near the lowest limit of normal range in both sexes, with males showing the lowest values (130 vs. 1,405 pg/ml; p < 0.01). Serum concentrations of IGF-1 were within the normal range (M/F, 179/168.5 ng/ml), whereas IGF-binding protein (BP)1 and 3 values were at the lowest limits of normal range in both sexes (M/F 1.8/3.1 μg/ml and M/F 4.1/4.2 μg/ml, respectively). A statistically significant inverse correlation was found between GH, IGF-1, and IGF-BP1-3 values and total cholesterol, LDL-cholesterol, and triglycerides values in both sexes. GH and IGF-BP1-3 values were also inversely related to waist circumference and waist/hip ratio (WHR). GH, IGF-1, and IGF-BP1 and 3 values (35 cases) increased 1 year postoperatively in both sexes, mainly after malabsorptive procedures.
  
  
  CONCLUSIONS
  Our results support the hypothesis that GH deficiency associated with low levels of binding proteins in obese patients may be an endocrine response to visceral fat and high levels of non-esterified fatty acids, assessable in daily clinical practice by WHR, total and LDL-cholesterol, and triglycerides. In these patients, malabsorptive procedures might be the treatment of choice due to the metabolic adaptations induced.
authors.affiliation: Department of Medical & Surgical Sciences, 1st Division of General Surgery, University of Brescia School of Medicine, Brescia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Mittempergher
authors.forename: Giacomo
authors.initials: G
authors.lastname: Pata
authors.forename: Nicola
authors.initials: N
authors.lastname: Crea
authors.forename: Ernesto
authors.initials: E
authors.lastname: Di Betta
authors.forename: Antonio
authors.initials: A
authors.lastname: Vilardi
authors.forename: Deborah
authors.initials: D
authors.lastname: Chiesa
authors.forename: Riccardo
authors.initials: R
authors.lastname: Nascimbeni
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002784:Cholesterol / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000706:statistics & numerical data; D018398:Homeodomain Proteins / Q000097:blood*; D019382:Human Growth Hormone / Q000097:blood*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood* / Q000453:epidemiology / Q000601:surgery; D018579:Patient Selection; D011184:Postoperative Period; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011446:Prospective Studies; D014157:Transcription Factors / Q000097:blood*; D014280:Triglycerides / Q000097:blood; D015431:Weight Loss
chemical_list: D015415:Biomarkers; C105304:DLX4 protein, human; D018398:Homeodomain Proteins; D014157:Transcription Factors; D014280:Triglycerides; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D002784:Cholesterol