Effect of treatment with growth hormone on body composition and metabolic profile of short children born small for gestational age

Kühl, Adriana Masiero; Dias, Márcia Regina Messaggi Gomes; Pereira, Rosana Marques

doi:10.1590/1984-0462/2024/42/2023073

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Revista Paulista de Pediatria

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Original Article • Rev. paul. pediatr. 42 • 2024 • https://doi.org/10.1590/1984-0462/2024/42/2023073 copy

Effect of treatment with growth hormone on body composition and metabolic profile of short children born small for gestational age

Efeito do tratamento com hormônio de crescimento na composição corporal e no perfil metabólico de crianças nascidas pequenas para a idade gestacional com baixa estatura

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To assess the effect of recombinant growth hormone (rGH) on body composition and metabolic profile of prepubertal short children born small for gestational age (SGA) before and after 18 months of treatment.

Methods:

It is a clinical, non-randomized, and paired study. Children born SGA, with birth weight and/or length <-2 standard deviations (SD) for gestational age and sex, prepubertal, born at full term, of both genders, with the indication for treatment with rGH were included. The intervention was performed with biosynthetic rGH at doses ranging from 0.03 to 0.05 mg/kg/day, administered subcutaneously, once a day at bedtime. Total lean mass (LM) and total fat mass (FM) were carried out using dual-energy X-ray absorptiometry (DXA), and the metabolic profile was assessed for insulin, glycemia, IGF-1 levels and lipid profile.

Results:

Twelve patients (nine girls, 8.17±2.39 y) were evaluated; three patients dropped out of the study. There was an increase of LM adjusted for length (LMI) (p=0.008), LMI standard deviation score (SDS) adjusted for age and sex (p=0.007), and total LM (p<0.001). The percentage of body fat (BF%) and abdominal fat (AF) remained unaltered in relation to the beginning of treatment. Among the metabolic variables, blood glucose remained within normal levels, and there was a reduction in the number of participants with altered cholesterol (p=0.023).

Conclusions:

The effect of rGH treatment was higher on LM than in FM, with increased LM adjusted for length and standardized for age and sex. Glycemia remained within the normal limits, and there was a decreased number of children with total cholesterol above the recommended levels.

Keywords:
Infant, small for gestational age; Body composition; Recombinant growth hormone

Variable	$\bar{X} (SD)$
GA (weeks)	38.9 (0.9)
Weight at birth (g)	2619 (525)
Weight at birth (z-score)	-1.4 (0.9)
Length at birth (cm)	44.1 (2.1)
Length at birth (z-score)	-2.6 (0.6)

	Initial (n=9) $\bar{X} (SD)$	18 months (n=9) $\bar{X} (SD)$	p-value
Weight (z-score)	-1,6 (1,7)	-1,1 (1,0)	0,301
Stature (z-score)	-2.8 (0.4)	-1.8 (0.5)	<0.001
BMI (z-score)	-0.2 (1.2)	-0.1 (1.2)	0.537
Waist circumference (cm)	53.7 (6.9)	54.7 (14.7)	0.758

	Initial (n=9) $\bar{X} (SD)$	18 months (n=9) $\bar{X} (SD)$	p-value	Variation	d ^* * Adjusted effect size (Cohen’s D)
LM (kg)	17.1 (5.9)	22.8 (7.6)	<0.001	5.62	0.81
LM (SDS)	-1.4 (1.4)	-0.6 (1.3)	0.162	–	–
LMI (Kg/m²)	12.3 (1.5)	13.1 (1.8)	0.008	0.78	0.46
LMI (SDS)	-0.4 (0.9)	0.2 (1.0)	0.007	0.56	0.58
BF%	17.6 (5.7)	19.5 (8.2)	0.382	–	–
BF% (SDS)	-0.6 (0.8)	-0.5 (0.9)	0.901	–	–
FM (kg)	3.8 (2.1)	6.1 (3.9)	0.033	2.34	0.69
FM (SDS)	-0.7 (0.7)	-0.6 (0.6)	0.426	–	–
FMI (kg/m²)	2.7 (1.2)	3.4 (1.9)	0.130^† † Teste de Wilcoxon	–	–
FMI (SDS)	-0.4 (0.6)	-0.1 (0.9)	0.145	–	–
AF (kg)	0.3 (0.3)	0.4 (0.2)	0.960	–	–
AF%	17.0 (6.9)	19.8 (8.3)	0.181	–	–

	Initial (n=9) $\bar{X} (SD)$	18 months (n=9) $\bar{X} (SD)$	p-value
Insulin (mUI/dL)	5.7 (4.3)	10.3 (7.7)	0.139^* * Teste de Wilcoxon
HOMA-IR (units)	0.7 (0.5)	1.3 (0.9)	0.139^* * Teste de Wilcoxon
Glucose (mg/dL)	77.2 (6.5)	85.0 (6.9)	0.017
Total cholesterol (mg/dL)	165.0 (21.3)	158.3 (17.2)	0.324
LDL – cholesterol (mg/dL)	98.3 (18.0)	93.1 (16.4)	0.409
HDL – cholesterol (mg/dL)	50.9 (11.1)	47.2 (8.8)	0.336
Triglycerides (mg/dL)	72.4 (34.9)	99.8 (88.3)	0.508
IGF-1 (mg/ml)	188.8 (48.2)	403.1 (116.4)	0.001

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[1] Corresponding author: E-mail: amasiero@unicentro.br (A. M. Kühl)