The visceral and subcutaneous abdominal adipose tissue (AT) area and the subcutaneous hip AT area were assessed by magnetic resonance imaging (MRI) in 12 growth hormone-deficient adults before and after 6 mo of replacement with recombinant human growth hormone (rhGH) and in 12 healthy control subjects. The data obtained by MRI were compared with circumference measurements of waist and hip. Growth hormone-deficient patients compared with control subjects had a higher visceral AT area (P = 0.003) and subcutaneous AT area (P = 0.013); there was no significant difference in subcutaneous hip AT area. Six months of rhGH replacement reduced the subcutaneous hip AT area (19.8%), the subcutaneous abdominal AT area (15.6%), and particularly the visceral AT area (38.2%), resulting in fat areas that were not different from those of control subjects. Furthermore, this study shows that in contrast with control subjects, circumference measurements are not useful to predict AT areas in growth hormone-deficient patients and cannot be used to assess changes in AT areas during rhGH replacement.

The visceral and subcutaneous abdominal adipose tissue (AT) areas and the subcutaneous hip AT area were assessed by magnetic resonance imaging (MRI) in relation to serum lipid and plasma insulin levels in 12 growth hormone-deficient (GHD) adults before and after 6 months of replacement therapy with recombinant human growth hormone (rhGH) and in 12 healthy control subjects. Compared with control subjects, GHD patients had a significantly increased amount of visceral AT, which was inversely related with plasma HDL cholesterol and positively correlated with plasma triglyceride levels. Visceral AT was not associated with plasma total and LDL cholesterol or plasma insulin concentrations. GHD patients also had elevated serum total cholesterol, LDL cholesterol, and triglyceride levels compared with control subjects. After 6 months of rhGH replacement therapy the mean visceral, subcutaneous abdominal, and subcutaneous hip AT areas and serum concentration of total cholesterol decreased significantly, whereas serum HDL cholesterol concentration increased significantly. No significant correlations were found between changes in the amount of AT and changes in serum lipid and plasma insulin levels.

The resting metabolic rate (RMR), and body composition were assessed in 30 growth hormone-deficient (GHD) adults before and after 3 and 6 months of replacement therapy with recombinant human growth hormone (rhGH). In addition, insulin-like growth factor I (IGF-I), IGF binding proteins (IGFBPs) and plasma insulin were measured at baseline and at 6 months in relation to RMR. During 6 months of rhGH replacement therapy, body fat decreased from 18.2 +/- 1.5 (mean +/- SEM) to 14.3 +/- 1.6 kg (p < 0.0001), whereas fat-free mass (FFM) increased from 53.5 +/- 3.3 to 56.3 +/- 3.6 kg (p < 0.0001), RMR increased from 1246 +/- 92 to 1539 +/- 102 kcal/24 h (p < 0.0001) and RMR per kilogram of FFM increased from 23.2 +/- 0.6 to 27.4 +/- 0.5 (p < 0.0001). When RMR data were adjusted for the differences in FFM, it appeared that apart from the increase in FFM, other factors may play a role in the increase in RMR. During rhGH replacement therapy, IGF-I (p < 0.0001) and IGFBP-3 (p = 0.003) levels increased, whereas IGFBP-1 levels decreased significantly (p = 0.004). The FFM explained for about 80% of the variance in RMR. In addition, waist/hip ratio and plasma IGF-I contributed significantly to the explained variance of RMR. This study shows that in GHD adults FFM is the main determinant of RMR and that, next to the increase in FFM, changes in metabolic and hormonal parameters contribute to the increase in RMR during rhGH replacement therapy.

We demonstrated that ICU level was not associated with significant differences in the case-mix adjusted in-hospital and long-term mortality of ICU patients. This finding is in contrast with some earlier studies suggesting a volume-outcome relationship. Our results may be explained by the successful implementation of nationwide mandatory quality requirements and adequate staffing in all three levels of ICUs over the last years.

GH has a strong influence on body composition. However, the effects of GH deficiency in adults on water compartments are not well understood. Therefore, extracellular water (ECW) and total body water were independently determined by deuterium and bromide dilution and by bioimpedance spectrometry in GH-deficient (GHD) adults and compared to those in controls, matched for age, sex, body weight, and height.The results show that the percent body fat was significantly (P Ͻ 0.05) higher, and total body water and intracellular water (ICW) were significantly lower in GHD adults for males, females, and both sexes combined. ECW was not significantly different between the two groups. ECW/ICW in GHD adults (0.42 Ϯ 0.03) was significantly (P Ͻ 0.01) higher than that in controls (0.39 Ϯ 0.02). There was a significant positive relation between the ECW/ICW ratio and the percent body fat. These results were confirmed by the bioimpedance spectrometry measurements. (J Clin Endocrinol Metab 82: 907-911, 1997) G H HAS, APART from growth-stimulating effects, a strong influence on body composition (1). Recent studies have shown that adults with GH deficiency (GHD) have an increased body fat mass (BF) and a decreased fat-free mass (FFM) (2-5). Sustained high concentrations of GH, like those present in patients with acromegaly (6, 7), result in an relative increased amount of extracellular water (ECW). However, the effects of GHD in adults on water compartments are less well known. Because of the ability of GH to cause sodium retention (8, 9), a relative decrease in ECW is expected to occur when GH levels are reduced compared to that with normal GH levels. Indeed, it has been found that ECW is relatively low in GHD adults (10), and there is one study which indicates that in GHD adults ECW is reduced compared to total body water (TBW) (4). Other studies reveal no difference in relative ECW between GHD adults and controls (11,12). However, the results of the studies mentioned could have been confounded because the methods used did not independently determine TBW and ECW, and control subjects were not matched for age, sex, body weight, and height.The effect of GH administration on water compartments is also not unequivocal. GH treatment was shown to increase ECW in GHD adults (10, 12). However, as it is known that FFM increases with increased GH levels, it is essential to know whether the increase in ECW was relative to that in intracellular water (ICW). In another study in which ECW and ICW were determined independently, strong indications were found that GH treatment in elderly subjects results in an increase in ICW that was associated with a concomitant trend toward decreased ECW (13).To elucidate the controversies concerning the water compartments in GHD adults, we performed a comparative study between GHD adults and controls, matched for age, sex, body weight, and height, in which TBW and ECW were determined independently using deuterium and bromide dilution as well as bioimpedance spectrometry (BIS) for predicting ECW and ICW...