No long-term cardiometabolic consequences of childhood rhGH therapy in adults born SGA

medwireNews: Cardiometabolic 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 118.6/71.5 mmHg).

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 Health.

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

Lancet Child Adolesc Health 2022; doi:10.1016/S2352-4642(22)00240-1
Martin Savage
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