ESPE Abstracts

Background: Small for gestational age (SGA) children are at increased risk of metabolic syndrome in adulthood and have below-average bone mineral density (BMD). Growth hormone treatment reduces fat mass and insulin sensitivity, increases lean body mass and improves height and BMD in short SGA children. We aimed to evaluate changes in body composition in SGA patients treated with growth hormone (GH), after its cessation, compared with young adults born appropriate for gestational age (AGA).

Methods: We performed a longitudinal study of twenty-one SGA patients without catch-up growth and previously treated with growth hormone. Individuals were followed up from the start for when growth hormone treatment was discontinued. Children’s body composition variables (BMD in femoral neck, in lumbar vertebrae, fat and lean body mass proportion) were evaluated annually with dual-energy X-ray absorptiometry and after treatment completion and was compared with data from untreated age and sex matched controls.

Findings: Twenty-one SGA and matched controls were included in the analysis. 70 percent of the patients SGA are females. At GH-stop, mean age 16.4 years and the mean final height of the group SGA was −1.57 SD. Fat mass and lean mass were similar for SGA patients and for controls [21.85% (8.75) and 77.95% (8.88) vs 23.22% (6.30) and 76.77% (6.30)] (P=0.155 and P=0.128, respectively). On the contrary, BMD in lumbar vertebrae was higher in SGA patients than in controls [−0.6 (0.85) vs. −0.83 (1.63)] (P=0.020). However, BMD in femoral neck did not differ between these two groups [−1.13 (0.97) SGA vs −0.47 (1.44) AGA], (P=0.731).

Interpretation: Significant changes in body composition are observed in SGA patients after completion of GH treatment, reflecting a loss of pharmacological effects of growth hormone. Once treatment is discontinued, fat mass, lean mass and bone mineral density in femoral neck show no significant differences compared to those of matched controls. BMD in lumbar vertebrae was higher in SGA patients compare to controls, indicating that long-term growth hormone treatment in SGA children has no unfavourable effects on metabolic health after cessation treatment.