GH Responsiveness Before and After a 3-Week Multidisciplinary Body Weight Reduction Program Associated with an Incremental Respiratory Muscle Endurance Training in Obese Adolescents

Abstract

Several studies have demonstrated that the obesity-related hyposomatropism is usually reversible after a consistent weight loss induced by diet and/or bariatric surgery. Recently, a single bout of respiratory muscle endurance training (RMET) by means of a specific commercially available device (Spiro Tiger^®) has been reported to induce a marked GH response in obese adults, its GH-releasing effect being significantly lower in obese adolescents. The GH response disappeared in both obese adults and adolescents when RMET was repeated at 2-h intervals in-between. The aim of the present study was to evaluate GH responses to repeated bouts of RMET administered before and after a 3-week in-hospital multidisciplinary body weight reduction program (entailing energy-restricted diet, 90 min/daily aerobic physical activity, psychological counseling, and nutritional education) combined with a progressively increasing RMET (15 daily sessions, 5 sessions per week) in 7 obese male adolescents [age: 12–17 years; body mass index (BMI): 38.5±3.1 kg/m²; percent fat mass (FM): 37.0±2.0%]. Blood samplings for GH determinations were collected during the 1^st and 15^th sessions, which were composed of 2 consecutive bouts of RMET (of identical intensity and duration) at 2-h interval in-between. At the beginning of the study, baseline GH levels significantly increased after the first bout of RMET in all subjects (p<0.05). The administration of the second bout of RMET resulted in a significantly lower (p<0.05) GH increase in comparison with the first one. Three weeks of the integrated intervention significantly reduced both body weight (from 115.3±9.2 kg to 111.5±8.7 kg, p<0.05) and FM (from 43.1±5.7 kg to 41.9±5.3 kg, p<0.05), these combined effects being, however, not sufficient to influence GH responsiveness to the 2 repeated bouts of RMET (GH peaks to the first bout: 4.8±1.6 ng/ml vs. 4.8±1.6 ng/ml; GH peaks to the second bout: 0.9±0.2 ng/ml vs. 1.1±0.1 ng/ml, before and after 3 weeks of the treatment, respectively, p=NS). In conclusion, a 3-week incremental RMET combined with a body weight reduction intervention does not seem useful to positively influence the reduced GH responsiveness to 2 repeated RMET bouts in obese adolescents. More intensive and/or long-term RMET protocols, associated with energy-restricted diets, determining more consistent changes in body composition, are likely needed to restore the impaired GH-IGF-1 function of obese adolescents.

Key words

GH - energy-restricted diet - obesity - repeated bouts - respiratory muscle ­endurance training - weight loss

• References

• 1 Scacchi M, Pincelli AI, Cavagnini F. Growth hormone in obesity. Int J Obes Relat Metab Disord 1999; 23: 260-271
• 2 Maccario M, Grottoli S, Procopio M, Oleandri SE, Rossetto R, Gauna C, Arvat E, Ghigo E. The GH/IGF-I axis in obesity: influence of neuro-endocrine and metabolic factors. Int J Obes Relat Metab Disord 2000; 24 (Suppl. 02) S96-S99
• 3 Veldhuis JD, Iranmanesh A, Ho KK, Waters MJ, Johnson ML, Lizarralde G. Dual defects in pulsatile growth hormone secretion and clearance subserve the hyposomatotropism of obesity in man. J Clin Endocrinol Metab 1991; 72: 51-59
• 4 De Marinis L, Bianchi A, Mancini A, Gentilella R, Perrelli M, Giampietro A, Porcelli T, Tilaro L, Fusco A, Valle D, Tacchino RM. Growth hormone secretion and leptin in morbid obesity before and after biliopancreatic diversion: relationships with insulin and body composition. J Clin Endocrinol Metab 2004; 89: 174-180
• 5 Makimura H, Stanley T, Mun D, You SM, Grinspoon S. The effects of central adiposity on growth hormone (GH) response to GH-releasing hormone-arginine stimulation testing in men. J Clin Endocrinol Metab 2008; 93: 4254-4260
• 6 Rasmussen MH, Hvidberg A, Juul A, Main KM, Gotfredsen A, Skakkebaek NE, Hilsted J, Skakkebae NE. Massive weight loss restores 24-hour growth hormone release profiles and serum insulin-like growth factor-I levels in obese subjects. J Clin Endocrinol Metab 1995; 80: 1407-1415
• 7 Sartorio A, Agosti F, Patrizi A, Compri E, Muller EE, Cella SG, Rigamonti AE. Growth hormone response induced by a respiratory muscle endurance training in healthy subjects. Horm Metab Res 2012; 44: 319-324
• 8 Sartorio A, Agosti F, Patrizi A, Gattico A, Tringali G, Giunta M, Muller EE, Rigamonti AE. GH and Cortisol Responses Following an acute session of respiratory muscle endurance training in severely obese patients. Horm Metab Res 2013; 45: 239-244
• 9 Sartorio A, Agosti F, Patrizi A, Tringali G, Cella SG, Rigamonti AE. GH responses to two consecutive bouts of respiratory muscle endurance training in obese adolescents and adults. Horm Metab Res 2013; 45: 688-693
• 10 Rigamonti AE, Agosti F, De Col A, Marazzi N, Lafortuna CL, Cella SG, Muller EE, Sartorio A. Changes in plasma levels of ghrelin, leptin, and other hormonal and metabolic parameters following standardized breakfast, lunch, and physical exercise before and after a multidisciplinary weight-reduction intervention in obese adolescents. J Endocrinol Invest 2010; 33: 633-639
• 11 Cacciari E, Milani S, Balsamo A, Spada E, Bona G, Cavallo L, Cerutti F, Gargantini L, Greggio M, Tomini G, Cicognani A. Italian cross-sectional growth charts for height, weight and BMI (2 to 20 yr). J Endocrinol Invest 2006; 29: 581-593
• 12 Società Italiana di Nutrizione Umana. Livelli di Assunzione Raccomandati di Energia e Nutrienti per la Popolazione Italiana. Società Italiana di Nutrizione Umana 1996
• 13 Schwarz F, ter Haar DJ, van Riet HG, Thijssen JH. Response of growth hormone (GH), FFA, blood sugar and insulin to exercise in obese patients and normal subjects. Metabolism 1969; 18: 1013-1020
• 14 Bensimhon DR, Kraus WE, Donahue MP. Obesity and physical activity: a review. Am Heart J 2006; 151: 598-603
• 15 August GP, Caprio S, Fennoy I, Freemark M, Kaufman FR, Lustig RH, Silverstein JH, Speiser PW, Styne DM, Montori VM. Endocrine Society . Prevention and treatment of pediatric obesity: an endocrine society clinical practice guideline based on expert opinion. J Clin Endocrinol Metab 2008; 93: 4576-4599
• 16 Henderson M, Daneman D, Hux J, Hanley A. Exercise interventions in obese youth: are they effective?. J Pediatr Endocrinol Metab 2008; 21: 823-826
• 17 Muller EE, Cella SG, Rigamonti AE, degli Uberti EC, Ambrosio MR, Cocchi D. Aspects of the central nervous drive to growth hormone secretion during aging. Aging (Milano) 1997; 9 (4 Suppl) 7-8
• 18 Sartorio A, Spada A, Morabito F, Faglia G. Different GH responsiveness to repeated GHRH administration in normal children and adults. J Endocrinol Invest 1988; 11: 727-729
• 19 Ghigo E, Goffi S, Mazza E, Arvat E, Procopio M, Bellone J, Müller EE, Camanni F. Repeated GH-releasing hormone administration unravels different GH secretory patterns in normal adults and children. Acta Endocrinol 1989; 120: 598-601
• 20 Muller EE, Locatelli V, Cocchi D. Neuroendocrine control of growth hormone secretion. Physiol Rev 1999; 79: 511-607
• 21 Hasani-Ranjbar S, Soleymani Far E, Heshmat R, Rajabi H, Kosari H. Time course responses of serum GH, insulin, IGF-1, IGFBP1, and IGFBP3 concentrations after heavy resistance exercise in trained and untrained men. Endocrine 2012; 41: 144-151
• 22 Ubertini G, Grossi A, Colabianchi D, Fiori R, Brufani C, Bizzarri C, Giannone G, Rigamonti AE, Sartorio A, Muller EE, Cappa M. Young elite athletes of different sport disciplines present with an increase in pulsatile secretion of growth hormone compared with non-elite athletes and sedentary subjects. J Endocrinol Invest 2008; 31: 138-145
• 23 Maccario M, Tassone F, Grottoli S, Rossetto R, Gauna C, Ghigo E. Neuroendocrine and metabolic determinants of the adaptation of GH/IGF-I axis to obesity. Ann Endocrinol (Paris) 2002; 63: 140-144
• 24 Hochberg Z, Hertz P, Colin V, Ish-Shalom S, Yeshurun D, Youdim MB, Amit T. The distal axis of growth hormone (GH) in nutritional disorders: GH-binding protein, insulin-like growth factor-I (IGF-I), and IGF-I receptors in obesity and anorexia nervosa. Metabolism 1992; 41: 106-112
• 25 Wauters M, Considine RV, Van Gaal LF. Human leptin: from an adipocyte hormone to an endocrine mediator. Eur J Endocrinol 2000; 143: 293-311
• 26 Widdowson WM, Healy ML, Sönksen PH, Gibney J. The physiology of growth hormone and sport. Growth Horm IGF Res 2009; 19: 308-319