Normal IGFBP-1 levels in lean, short, SGA children may reflect a normal metabolic state, despite reported hyperinsulinemia. IGFBP-1 is modulated by polymorphic variability and seems to be an additional player in the complex interaction between the IGF-IGFBP axis, glucose homeostasis, and lipid metabolism.

Background: GnRH analogue (GnRHa) combined with GH treatment has been proposed to increase adult height. Effect on metabolic profile and GH, IGF1, and IGFBP3 levels in short small for gestational age (SGA) children is unknown. Objective: To assess fat mass and lean body mass SDS, percentage trunk fat, blood pressure (BP), insulin sensitivity (Si), b-cell function (disposition index, DI), lipid profile, and GH, IGF1, and IGFBP3 levels during 2 years of combined treatment. Subjects: Forty-one pubertal short SGA children with a mean (GS.D.) age of 12.1 (G1.0) years. Design: Children received 3.75 mg of leuprolide acetate depot subcutaneously every 4 weeks, and they were randomly assigned to receive 1 mg (group A) or 2 mg (group B) of GH/m 2 per day. Results: Percentage trunk fat increased in both groups, but to a lower extent in group B. Lean body mass SDS increased only in group B. Changes in BP, Si, DI, and lipids were similar in both groups. Si significantly decreased, but DI remained unchanged. Lipids remained normal. GH and IGF1 levels were significantly higher in group B. Conclusion: Our study is the first to report that 2 years of combined treatment with a GnRHa and either 1 or 2 mg GH/m 2 per day does not adversely affect body composition and metabolic profile of short SGA children who come under medical attention at the onset of puberty. There was a dose-dependent effect on fat mass SDS height , percentage trunk fat, lean body mass SDS height , and GH and IGF1 levels in favor of treatment with GnRHa and the higher GH dose of 2 mg/m 2 per day.

Aim: We determined whether subclassification of short small for gestational age (SGA) children according to birth anthropometrics could delineate different patterns in gestation, delivery, postnatal growth, response to growth hormone (GH) treatment and parental height. Methods: 201 short SGA children were divided into three groups, SGA_L, SGA_L+W and SGA_L+W+HC, according to birth length (L), weight (W) and head circumference (HC) ≤–2.00 standard deviation score (SDS). Results: SGA_L+W+HC children were born after the shortest gestational age and more often by caesarean section than SGA_L children (36.3 vs. 38.1 weeks, 68.4 vs. 24.4%). SGA_L+W children had an intermediate pattern and experienced most gestational hypertension (p = 0.01). At birth, SGA_L+W+HC children were shorter than SGA_L or SGA_L+W (–4.12 vs. –2.67 and –3.72 SDS, p ≤ 0.001). During the first 3 years of life, SGA_L+W+HC children exhibited an increased growth in height (0.98 SDS) and HC (1.28 SDS) than SGA_L (height, –0.06 SDS; HC, –0.30 SDS) and SGA_L+W (height, 0.62 SDS; HC, –0.31 SDS). However, HC SDS remained smaller for SGA_L+W+HC than the other groups at age 3. The groups did not differ in growth response during GH treatment. SGA_L children tended to have shorter parents and target height than SGA_L+W+HC children. Conclusions: Our study shows that subclassification of short SGA children might be a useful method for investigating SGA children as the subgroups revealed a different gestation, delivery and postnatal growth pattern. Response to GH treatment was not different between the groups.