Low-dose growth hormone in adult home parenteral nutrition–dependent short bowel syndrome patients: A positive study

Abstract

Background & Aims: Controversy surrounds a 3-week treatment with a high-dose (0.14 mg · kg −1 · day −1) growth hormone (GH), glutamine, and high carbohydrate diet in home parenteral nutrition (HPN)-dependent patients with short-bowel syndrome (SBS). This study assessed treatment with low-dose GH in these patients. Methods: Twelve adult HPN-dependent (duration, 7 ± 1 years; mean ± SEM) patients with SBS (small-bowel remnant length, 48 ± 11 cm) who were on an unrestricted hyperphagic diet were randomized in a double-blind, placebo-controlled, crossover study. Patients received daily low-dose GH (0.05 mg · kg −1 · day −1) and placebo for two 3-week periods separated by a 1-week washout period. Net intestinal absorption of macronutrients was assessed using a duplicate diet; nutritional assessment and blood tests were performed. Data from each group were compared using Wilcoxon rank sum test. Results: Treatment with GH increased intestinal absorption of energy (15% ± 5%, P < 0.002), nitrogen (14% ± 6%, P < 0.04), carbohydrates (10% ± 4%, P < 0.04), and fat (12% ± 8%, NS). The increased food absorption represented 37% ± 16% of total parenteral energy delivery. Body weight ( P < 0.003), lean body mass ( P < 0.006), D-xylose absorption ( P < 0.02), insulin-like growth factor 1 ( P < 0.002), and insulin-like growth factor binding protein 3 ( P < 0.002) increased, whereas uptake of GH binding protein decreased ( P < 0.01), without any major adverse effect. Conclusions: Three weeks of low-dose GH significantly improved intestinal absorption in HPN-dependent SBS patients who were on a hyperphagic western diet.