risk in people born small for gestational age (SGA) more than a decade after finishing
therapy with recombinant human growth hormone (rhGH) is no higher than in those
never given the treatment, a study shows.
This contradicts “the previously reported increased
metabolic and cardiovascular morbidity risk after childhood growth hormone treatment
in individuals born SGA”, say Wesley Goedegebuure (Erasmus University Medical
Centre, Rotterdam, the Netherlands) and study co-authors.
Their study included 167 patients, approximately
30 years of age, who during childhood had received an average of 8.9 years
of treatment with rhGH as part of a randomised trial. They were assessed for
cardiometabolic risk 5 and 12 years after stopping treatment, with 105
completing both assessments.
Twelve years after rhGH cessation, the study participants
experienced significant increases of fat mass, from an average of 10.32 to
19.42 kg, and also of trunk fat and limb fat, whereas lean body mass
decreased from an average of 43.37 to 42.23 kg.
They also had significant increases in total cholesterol (average
3.95 to 4.56 mmol/L) and in low-density lipoprotein (LDL) cholesterol and
triglycerides, as well as a decrease in high-density lipoprotein (HDL)
cholesterol and an increase in blood pressure (110.7/61.9 to
By contrast, insulin sensitivity improved during the
12 years after rhGH cessation, while the acute insulin response decreased
and beta-cell function remained stable.
But despite the changes over time, the absolute levels of
these risk factors at age 30 were not significantly different to those in
50 people of similar age who were also born SGA but did not receive rhGH,
so their final adult height standard deviation score remained lower than –2.0.
Cardiometabolic risk was also similar in 77 people who were born SGA but
had spontaneous catch-up to a typical adult height.
The researchers note that the reductions in lean body mass
in people formerly treated with rhGH occurred “only during the first 5 years,
probably due to loss of growth hormone properties.”
The team also looked at 92 adults of a similar age to
the SGA groups but who were appropriate for gestational age (AGA) at birth. The
SGA groups had similar cardiometabolic risk to the AGA participants, with
the exception of total and LDL cholesterol and triglycerides, which were higher
in the SGA groups than AGA controls (significant for all but one comparison),
and HDL cholesterol, which was significantly lower.
“Further investigation of the cause of this unfavourable
lipid profile in individuals born SGA is warranted”, write Goedegebuure and
team in The Lancet Child & Adolescent
However, with the exception of the lipid measures, the SGA
participants were no more likely than those who were AGA to have individual
components of the metabolic syndrome. They were also not significantly more
likely to have the syndrome itself (≥three components), with rates ranging
from 6% to 10% in the SGA groups and 4% in the AGA participants.
“This finding is reassuring, as these criteria comprise an
important clustering of risk factors for cardiovascular and metabolic disease”,
say the researchers.
By Eleanor McDermid
medwireNews is an
independent medical news service provided by Springer Healthcare Ltd. © 2022
Springer Healthcare Ltd, part of the Springer Nature Group