Background: Poor appetite is common in children with idiopathic short stature (ISS), and is usually improved with GH therapy.
Objective and hypotheses: To investigate the effect of GH therapy on appetite regulating hormones following a standard meal test (SMT) and to examine the association between these changes and growth response, body composition and resting energy expenditure (REE).
Method: Nine ISS pre-pubertal children underwent a SMT before and 4 months following initiation of GH. Leptin, ghrelin, GLP1 and insulin levels were measured; area under the curve (AUC) was calculated. Height, weight, body composition and REE were recorded at baseline and after 4 and 12 months.
Results: Following 4 months of GH therapy, an improvement in appetite was reported and a significant increase in height-SDS (P=0.011), weight-S.D.s (P=0.021) and REE (P=0.025) were observed. At 4 months, an increase in fasting insulin levels (P=0.043), a decrease in fasting GLP1 levels (P=0.038) and a decrease in fasting and meals AUC ghrelin levels (P=0.051) were observed, while leptin levels remained unchanged. The incremental response of ghrelin and GLP1 to SMT (ghrelin-continuous decrease, GLP-1 initial rise and subsequent fall), were similar before and during GH treatment. Ghrelin levels before GH treatment were positively correlated with the changes in weight-S.D.s and REE (fasting: r=0.667, P=0.05 and r=0.866, P=0.005 respectively; AUC: r=0.788, P=0.012, r=0.847, P=0.008 respectively). Ghrelin AUC levels at 4 months, were positively correlated with the changes in Ht-S.D.s (r=0.741, P=0.022) and free-fat-mass (r=0.890, P=0.001) at 12 months of GH treatment.
Conclusion: The significant reduction in ghrelin and GLP1 following GH treatment suggests a possible role for GH in appetite regulation. Fasting and meal-AUC levels of ghrelin may serve as biomarkers for predicting growth response to GH treatment. The mechanism linking GH with changes in appetite regulating hormones remain to be elucidated.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology