Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1989 Oct;210(4):513–525. doi: 10.1097/00000658-198910000-00012

Low-dose growth hormone and hypocaloric nutrition attenuate the protein-catabolic response after major operation.

Z M Jiang 1, G Z He 1, S Y Zhang 1, X R Wang 1, N F Yang 1, Y Zhu 1, D W Wilmore 1
PMCID: PMC1357936  PMID: 2802836

Abstract

To determine the effects of low-dose recombinant human growth hormone (GH) and hypocaloric nutrition on postoperative convalescence, we performed a placebo-controlled randomized double-blind trial in 18 patients after elective gastrectomy or colectomy. The subjects received parenteral nutrition containing 20 calories/kg per day and 1 g protein/kg per day. Daily injections of drug or placebo were given during the first postoperative week. The nine control subjects lost 3.3 kg (5.9% of preoperative weight) and had a cumulative nitrogen loss of 32.6 +/- 4.2 g nitrogen at eight days. The patients receiving GH lost significantly less weight (1.3 kg) and nitrogen loss was 7.1 +/- 3.1 g at eight days (p less than 0.001). Kinetic studies demonstrated that the anabolic effects of GH were associated with increased protein synthesis, and amino acid flux studies across the forearm revealed increased uptake of amino acid nitrogen in the GH-treated patients. Body compositional analysis revealed that the patients receiving GH maintained their lean body mass despite the major surgical procedure. Analysis of hand grip force showed a 10% loss of strength in the control subjects; with GH the patients maintained their grip force throughout the postoperative period. We conclude that the postoperative catabolic response can be modified with GH and hypocaloric nutrition. These metabolic and physiologic effects should now be studied in a larger number of patients to determine if this approach can reduce morbidity, mortality, and length of hospital stay for surgical patients.

Full text

PDF
515

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abumrad N. N., Rabin D., Diamond M. P., Lacy W. W. Use of a heated superficial hand vein as an alternative site for the measurement of amino acid concentrations and for the study of glucose and alanine kinetics in man. Metabolism. 1981 Sep;30(9):936–940. doi: 10.1016/0026-0495(81)90074-3. [DOI] [PubMed] [Google Scholar]
  2. Clowes G. H., Jr, Heideman M., Lindberg B., Randall H. T., Hirsch E. F., Cha C. J., Martin H. Effects of parenteral alimentation on amino acid metabolism in septic patients. Surgery. 1980 Oct;88(4):531–543. [PubMed] [Google Scholar]
  3. Fong Y., Rosenbaum M., Hesse D. G., Tracey K. J., Gertner J., Lowry S. F. Influence of substrate background on peripheral tissue responses to growth hormone. J Surg Res. 1988 Jun;44(6):702–708. doi: 10.1016/0022-4804(88)90104-7. [DOI] [PubMed] [Google Scholar]
  4. HOLDEN W. D., KRIEGER H., LEVEY S., ABBOTT W. E. The effect of nutrition on nitrogen metabolism in the surgical patient. Ann Surg. 1957 Oct;146(4):563–579. doi: 10.1097/00000658-195710000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Holter A. R., Fischer J. E. The effects of perioperative hyperalimentation on complications in patients with carcinoma and weight loss. J Surg Res. 1977 Jul;23(1):31–34. doi: 10.1016/0022-4804(77)90186-x. [DOI] [PubMed] [Google Scholar]
  6. Hunt D. R., Rowlands B. J., Johnston D. Hand grip strength--a simple prognostic indicator in surgical patients. JPEN J Parenter Enteral Nutr. 1985 Nov-Dec;9(6):701–704. doi: 10.1177/0148607185009006701. [DOI] [PubMed] [Google Scholar]
  7. Jaing Z. M., Zhang F. S., Zhu Y., He G. Z., Fei L. M., Tseng H. C., Sugarbaker S., Wilmore D. W. Evaluation of parenteral nutrition in the postoperative patient. Surg Gynecol Obstet. 1988 Feb;166(2):115–120. [PubMed] [Google Scholar]
  8. Johnson D. J., Brooks D. C., Pressler V. M., Hulton N. R., Colpoys M. F., Smith R. J., Wilmore D. W. Hypothermic anesthesia attenuates postoperative proteolysis. Ann Surg. 1986 Oct;204(4):419–429. doi: 10.1097/00000658-198610000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Kehlet H., Brandt M. R., Hansen A. P., Alberti K. G. Effect of epidural analgesia on metabolic profiles during and after surgery. Br J Surg. 1979 Aug;66(8):543–546. doi: 10.1002/bjs.1800660807. [DOI] [PubMed] [Google Scholar]
  10. Kinney J. M., Long C. L., Gump F. E., Duke J. H., Jr Tissue composition of weight loss in surgical patients. I. Elective operation. Ann Surg. 1968 Sep;168(3):459–474. doi: 10.1097/00000658-196809000-00013. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Manson J. M., Smith R. J., Wilmore D. W. Growth hormone stimulates protein synthesis during hypocaloric parenteral nutrition. Role of hormonal-substrate environment. Ann Surg. 1988 Aug;208(2):136–142. doi: 10.1097/00000658-198808000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Manson J. M., Wilmore D. W. Positive nitrogen balance with human growth hormone and hypocaloric intravenous feeding. Surgery. 1986 Aug;100(2):188–197. [PubMed] [Google Scholar]
  13. Mulholland J. H., Tui C., Wright A. M., Vinci V. J. NITROGEN METABOLISM, CALORIC INTAKE AND WEIGHT LOSS IN POSTOPERATIVE CONVALESCENCE : A STUDY OF EIGHT PATIENTS UNDERGOING PARTIAL GASTRECTOMY FOR DUODENAL ULCERS. Ann Surg. 1943 Apr;117(4):512–534. doi: 10.1097/00000658-194304000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Picou D., Taylor-Roberts T. The measurement of total protein synthesis and catabolism and nitrogen turnover in infants in different nutritional states and receiving different amounts of dietary protein. Clin Sci. 1969 Apr;36(2):283–296. [PubMed] [Google Scholar]
  15. Ponting G. A., Halliday D., Teale J. D., Sim A. J. Postoperative positive nitrogen balance with intravenous hyponutrition and growth hormone. Lancet. 1988 Feb 27;1(8583):438–440. doi: 10.1016/s0140-6736(88)91232-9. [DOI] [PubMed] [Google Scholar]
  16. SCHLOERB P. R., FRIIS-HANSEN B. J., EDELMAN I. S., SHELDON D. B., MOORE F. D. The measurement of deuterium oxide in body fluids by the falling drop method. J Lab Clin Med. 1951 Apr;37(4):653–662. [PubMed] [Google Scholar]
  17. Ziegler T. R., Young L. S., Manson J. M., Wilmore D. W. Metabolic effects of recombinant human growth hormone in patients receiving parenteral nutrition. Ann Surg. 1988 Jul;208(1):6–16. doi: 10.1097/00000658-198807000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES