Perioperative growth hormone treatment increases nitrogen and fluid balance and results in short-term and long-term conservation of lean tissue mass.

Abstract

The surgical procedure for forming an ileoanal anastomosis with a J pouch (IAA) usually involves a temporary ileostomy; patients undergoing IAA surgery thus need to recover quickly because they return for ileostomy closure 3 mo later. We evaluated the effects of perioperative biosynthetic growth hormone (GH) treatment on short- and long-term changes in body composition and on nutritional intake. Patients with ulcerative colitis undergoing IAA surgery were randomly assigned to double-blind treatment with placebo (n = 12) or 6 IU GH twice daily (n = 12) from 2 d before to 7 d after the operation. Examinations were from 2 d before to 9 d after the operation and on days 30 and 90. Body composition was assessed with a dualenergy X-ray absorptiometry scanner. The 2 groups had similar nutritional intakes. On postoperative day 7, placebo-treated patients had lost 4.2 kg (95% CI: 3.0, 5.4) total tissue mass, 3.6 kg (2.1, 5.1) lean tissue mass, and 0.5 kg (20.1, 1.2) fat mass. These reductions persisted 3 mo later. Compared with placebo, GH improved nitrogen balance, changes in lean tissue mass [gain of 4.0 kg (1.9, 6.0), P = 0.001], and changes in total tissue mass [gain of 3.2 kg (1.6, 4.9), P = 0.001], but increased the loss of fat mass [loss of 0.7 kg (0.0, 1.5), P = 0.049] on postoperative day 7. Three months later, the placebo-treated patients had lost 2.4 kg (0.7, 4.2) more lean tissue mass than GH-treated patients (P = 0.009), whereas changes in total tissue and fat mass were not significantly different. Hence, GH treatment enhanced the long-term regain of lean tissue mass.