Obesity
Conditions
Keywords
growth hormone, overfeeding, energy expenditure, protein metabolism, lipid metabolism
Brief summary
With the alarming increase in the prevalence of obesity, identifying factors that predispose individuals to weight-gain is of critical importance. Even when caloric intake and physical activity levels are well controlled, susceptibility for weight-gain is heterogeneous. Basal metabolic rate (BMR) represents the largest portion of daily energy expenditure in normal adults, and as such, variability in BMR among individuals can be a major factor in determining the susceptibility for gaining weight. However, factors responsible for this variability in BMR and resistance to weight-gain remain unclear. Our preliminary data indicate that high-normal growth hormone (GH) concentration is associated with resistance to weight-gain in rats when overfed and greater weight-loss in humans when underfed. In addition, the investigators have found that the pulsatility of GH secretion has profound effects on several metabolic processes. Therefore, together these findings suggest that endogenous GH secretion is associated with body weight regulation, and the pulsatility (peak amplitude) of GH secretion, rather than the absolute GH concentration, per se, may be responsible for this effect. Because GH influences many of the key metabolic processes that contribute to BMR (e.g.; protein synthesis, proteolysis, substrate cycling), the investigators anticipate that the resistance to weight-gain in persons with elevated GH concentrations will be associated with an increase in BMR due to acceleration of some or all of these processes. Our overall hypothesis is that increased GH secretion can protect against weight-gain due to an augmentation of major metabolic processes that contribute to BMR. Identifying factors responsible for predisposing individuals to weight-gain will lead to establishing improved methods for reducing the prevalence of obesity.
Detailed description
The susceptibility to gain weight is highly variable even when caloric intake and physical activity are well controlled. Because basal metabolic rate (BMR) represents \ 70% of total daily energy expenditure (TDEE), even a small difference in BMR can affect daily energy balance, thereby increasing the susceptibility for gaining weight. Our preliminary data indicate that high-normal growth hormone (GH) secretion is associated with resistance to weight-gain in rats when overfed and greater weight-loss in humans when underfed. Given that GH influences many of the key metabolic processes that contribute to BMR, the investigators hypothesize that persons with high-normal GH will be resistant to weight-gain because of a high BMR, resulting from accelerated rates of these processes. The investigators will measure basal 24h GH secretion and BMR in 106 non-obese men and women. The investigators will also measure protein synthesis, proteolysis, triglyceride/fatty acid cycling (all measured using stable isotope tracer methods) to determine the relationships among these processes, BMR, and GH \[Specific Aim 1\]. Subjects identified as having low-normal (\<1.5 ug/L) and high-normal (\>3 ug/L) 24h GH will then be admitted to the hospital for a 2 wk overfeeding protocol (\ 2000 kcal/d \>TDEE - with restricted physical activity), immediately followed by a 4 wk caloric restriction protocol (\ 750 kcal/d \<TDEE) to compare changes in weight, body composition and intra-abdominal adiposity between these groups that differ markedly in their GH secretion (GH measured before the diet) \[Specific Aim 2\]. A subset of subjects with low-normal GH will receive intravenous GH throughout the 2 wk overfeeding period at either: 1. a constant rate or 2. as a pulsatile infusion (to mimic endogenous secretion). BMR will be assessed daily and protein synthesis, proteolysis, and triglyceride/fatty acid cycling will be measured at the end of the 2 wks \[Specific Aim 3\]. The investigators anticipate that a higher GH pulsatility (peak amplitude), rather than elevated GH concentration, per se, will increase protein synthesis, proteolysis, and triglyceride/fatty acid cycling with a resultant increase in BMR and resistance to weight-gain. Identifying factors responsible for predisposing individuals to weight-gain will help combat the alarming rise in the prevalence of obesity.
Interventions
overfeeding 2000kcals/day above energy requirements for 14d
growth hormone administrated for 2 weeks (dose = 1.0 mg/m2/d)
Sponsors
Study design
Eligibility
Inclusion criteria
Age = 21-35 years Weight stable (\< ± 5 pound over past 6 months) Premenopausal (women only) Body mass index 18 - 26 kg/m2 Must be willing to be randomized to receive GH infusion during 2 week Michigan Clinical Research Unit (MCRU) visit
Exclusion criteria
* Evidence of metabolic or cardiovascular disease Pregnancy (women only) Hyperlipidemia (fasting plasma triglyceride concentration \> 150 mg/dl) Hematocrit \< 34% Liver Function test abnormalities participating in a regular exercise program (\> 2 h/week) taking any prescription medication (except birth control)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 2 Week Skeletal Muscle Protein Synthesis | 2 weeks | after an overnight fast |
| Changes in Fat Mass | 2 weeks | — |
| Changes in Fat-free Mass | 2 weeks | — |
| Baseline Whole Body Protein Turnover | baseline | Whole body proteolytic rate (Leucine Ra) |
| Baseline Skeletal Muscle Protein Synthesis | baseline | after an overnight fast |
| Lipolytic Rate | 2 weeks | — |
| Whole Body Protein Turnover After 2 Week Intervention | 2 weeks | whole body proteolytic rate (leucine Ra) |
| 24 Hour Average Plasma Growth Hormone Concentration | 2 weeks | — |
| Changes in Body Weight | 2 weeks | — |
Countries
United States
Participant flow
Recruitment details
All subjects were admitted to the Michigan Clinical Research Unit at the University of Michigan Hospital. Subjects were recruited from February 2006-February 2011.
Pre-assignment details
Before the overeating intervention all subjects were admitted to the hospital for a 2-day experiment to assess their plasma growth hormone and insulin profiles.
Participants by arm
| Arm | Count |
|---|---|
| Control 9 non-obese (initial body mass index 23.5 +/- 0.3 kg/m2), weight stable, relatively sedentary (physical activity \</- 2h/week), healthy adults not taking any medications were admitted to the hospital for 2 weeks during which time they ate \
4000 kcal/day and their plasma growth hormone concentration was allowed to decline naturally. | 9 |
| Growth Hormone Treatment 8 non-obese (initial body mass index 23.5 +/- 0.3 kg/m2), weight stable, relatively sedentary (physical activity \</- 2h/week), healthy adults not taking any medications were admitted to the hospital for 2 weeks during which time they ate \
4000 kcal/day and received exogenous growth hormone treatment administered in 4 daily injections to mimic physiological growth hormone secretion throughout the 2-week overeating period. | 8 |
| High Growth Hormone Treatment 5 non-obese (initial body mass index 23.5 +/- 0.3 kg/m2), weight stable, relatively sedentary (physical activity \</- 2h/week), healthy adults not taking any medications were admitted to the hospital for 2 weeks during which time they ate \
4000 kcal/day and received a relatively high daily dose of growth hormone. | 5 |
| Total | 22 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Overall Study | Withdrawal by Subject | 0 | 0 | 2 |
Baseline characteristics
| Characteristic | Growth Hormone Treatment | High Growth Hormone Treatment | Control | Total |
|---|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 8 Participants | 5 Participants | 9 Participants | 22 Participants |
| Age, Continuous | 23.1 years STANDARD_DEVIATION 1 | 24.9 years STANDARD_DEVIATION 1.9 | 24.5 years STANDARD_DEVIATION 1.2 | 24.4 years STANDARD_DEVIATION 0.8 |
| Region of Enrollment United States | 8 participants | 5 participants | 9 participants | 22 participants |
| Sex: Female, Male Female | 1 Participants | 1 Participants | 2 Participants | 4 Participants |
| Sex: Female, Male Male | 7 Participants | 4 Participants | 7 Participants | 18 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — |
| other Total, other adverse events | 1 / 9 | 0 / 8 | 0 / 5 |
| serious Total, serious adverse events | 0 / 9 | 0 / 8 | 0 / 5 |
Outcome results
24 Hour Average Plasma Growth Hormone Concentration
Time frame: 2 weeks
Population: per protocol
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Control (CON) | 24 Hour Average Plasma Growth Hormone Concentration | 0.4 ng/mL | Standard Error 0.1 |
| Growth Hormone Treatment (GHT) | 24 Hour Average Plasma Growth Hormone Concentration | 1.2 ng/mL | Standard Error 0.1 |
| High Growth Hormone Treatment (High-GHT) | 24 Hour Average Plasma Growth Hormone Concentration | 4.1 ng/mL | Standard Error 0.3 |
2 Week Skeletal Muscle Protein Synthesis
after an overnight fast
Time frame: 2 weeks
Population: per protocol
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Control (CON) | 2 Week Skeletal Muscle Protein Synthesis | 0.063 skeletal muscle protein%/hour | Standard Error 0.015 |
| Growth Hormone Treatment (GHT) | 2 Week Skeletal Muscle Protein Synthesis | 0.062 skeletal muscle protein%/hour | Standard Error 0.018 |
| High Growth Hormone Treatment (High-GHT) | 2 Week Skeletal Muscle Protein Synthesis | 0.082 skeletal muscle protein%/hour | Standard Error 0.011 |
Baseline Skeletal Muscle Protein Synthesis
after an overnight fast
Time frame: baseline
Population: per protocol
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Control (CON) | Baseline Skeletal Muscle Protein Synthesis | 0.043 skeletal muscle protein%/hour | Standard Error 0.009 |
| Growth Hormone Treatment (GHT) | Baseline Skeletal Muscle Protein Synthesis | 0.047 skeletal muscle protein%/hour | Standard Error 0.011 |
| High Growth Hormone Treatment (High-GHT) | Baseline Skeletal Muscle Protein Synthesis | 0.033 skeletal muscle protein%/hour | Standard Error 0.006 |
Baseline Whole Body Protein Turnover
Whole body proteolytic rate (Leucine Ra)
Time frame: baseline
Population: per protocol
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Control (CON) | Baseline Whole Body Protein Turnover | 2.1 μmol/kg fat free mass/min) | Standard Error 0.1 |
| Growth Hormone Treatment (GHT) | Baseline Whole Body Protein Turnover | 1.9 μmol/kg fat free mass/min) | Standard Error 0.1 |
| High Growth Hormone Treatment (High-GHT) | Baseline Whole Body Protein Turnover | 1.6 μmol/kg fat free mass/min) | Standard Error 0.1 |
Changes in Body Weight
Time frame: 2 weeks
Population: per protocol
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Control (CON) | Changes in Body Weight | 2.4 kg | Standard Error 0.6 |
| Growth Hormone Treatment (GHT) | Changes in Body Weight | 3.6 kg | Standard Error 0.6 |
| High Growth Hormone Treatment (High-GHT) | Changes in Body Weight | 3.1 kg | Standard Error 0.7 |
Changes in Fat-free Mass
Time frame: 2 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Control (CON) | Changes in Fat-free Mass | 0.7 kg | Standard Error 0.3 |
| Growth Hormone Treatment (GHT) | Changes in Fat-free Mass | 2.2 kg | Standard Error 0.3 |
| High Growth Hormone Treatment (High-GHT) | Changes in Fat-free Mass | 2.3 kg | Standard Error 0.6 |
Changes in Fat Mass
Time frame: 2 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Control (CON) | Changes in Fat Mass | 1.6 kg | Standard Error 0.3 |
| Growth Hormone Treatment (GHT) | Changes in Fat Mass | 1.7 kg | Standard Error 0.2 |
| High Growth Hormone Treatment (High-GHT) | Changes in Fat Mass | 1.1 kg | Standard Error 0.3 |
Lipolytic Rate
Time frame: 2 weeks
Population: per protocol
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Control (CON) | Lipolytic Rate | 180 µmol/min | Standard Error 19 |
| Growth Hormone Treatment (GHT) | Lipolytic Rate | 200 µmol/min | Standard Error 20 |
| High Growth Hormone Treatment (High-GHT) | Lipolytic Rate | 195 µmol/min | Standard Error 25 |
Whole Body Protein Turnover After 2 Week Intervention
whole body proteolytic rate (leucine Ra)
Time frame: 2 weeks
Population: per protocol
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Control (CON) | Whole Body Protein Turnover After 2 Week Intervention | 2.8 µmol/kg fat free mass/min | Standard Error 0.2 |
| Growth Hormone Treatment (GHT) | Whole Body Protein Turnover After 2 Week Intervention | 2.3 µmol/kg fat free mass/min | Standard Error 0.1 |
| High Growth Hormone Treatment (High-GHT) | Whole Body Protein Turnover After 2 Week Intervention | 1.9 µmol/kg fat free mass/min | Standard Error 0.1 |