ESPE Yearbook of Paediatric Endocrinology

Brief Summary: This longitudinal study explored the impact of metabolic surgery on the growth hormone (GH)/IGF-1 axis and its subsequent effects on adipose tissue function. The results suggest that bariatric surgery enhances GH-IGF-1 levels, which are linked to improved adipose tissue function and a reduction in inflammation markers.

This study explored how metabolic surgery influences the GH system, and how these changes are related to improvements in adipose tissue function. Markers of glucose metabolism, adipose tissue function, leptin levels, IGF-I, GH, and inflammatory status were assessed in 79 obese male adults before and after bariatric surgery, compared to 24 matched non-obese controls. As predicted, at baseline, obese patients had higher levels of serum insulin, leptin, and IGFBP3, similar levels of IGF-1, and lower levels of GH and IGFBP1 compared to controls. By 2 weeks post-surgery, there was an increase in serum GH and IGFBP1 levels and this effect improved throughout the follow-up period of 52 weeks, reaching levels that were higher than or equal to those of the controls. IGF-I levels began to increase later, with significant rises observed at 24- and 52-weeks post-surgery. No significant differences were found between participants who underwent sleeve gastrectomy and those who had gastric bypass surgery. The restoration of the GH/IGF-I system was linked to improvements in insulin sensitivity in adipose tissue, and to a reduction in insulin levels, free fatty acids levels and inflammation markers (IL1-ra, reactive C protein, TGFβ1).

These findings suggest that normalization of GH and IGF-I secretion in adipose tissue is a key mechanism by which surgery improves metabolic health (1,2).

References: 1. Sandhu MS, Heald AH, Gibson JM, Cruickshank JK, Dunger DB, Wareham NJ. Circulating concentrations of insulin-like growth factor-I and development of glucose intolerance: a prospective observational study. Lancet. 2002 May 18;359(9319):1740-5. doi: 10.1016/S0140-6736(02)08655-5. PMID: 12049864.2. Faramia J, Hao Z, Mumphrey MB, Townsend RL, Miard S, Carreau AM, Nadeau M, Frisch F, Baraboi ED, Grenier-Larouche T, Noll C, Li M, Biertho L, Marceau S, Hould FS, Lebel S, Morrison CD, Münzberg H, Richard D, Carpentier AC, Tchernof A, Berthoud HR, Picard F. IGFBP-2 partly mediates the early metabolic improvements caused by bariatric surgery. Cell Rep Med. 2021 Apr 20;2(4):100248. doi: 10.1016/j.xcrm.2021.100248. PMID: 33948578; PMCID: PMC8080239.