Correspondence

Human Growth Hormone and Aging

N Engl J Med 2003; 348:2256-2257May 29, 2003

Article

To the Editor:

Vance's discussion of growth hormone (Feb. 27 issue)1 omits important reports in the literature. The combination of growth hormone and exercise (unlike exercise alone) has been shown to increase type II muscle fibers in the elderly2 — an important finding, since frailty and sarcopenia are predominantly related to the loss of type II fibers. There is no mention of the fact that decreased levels of insulin-like growth factor I have been reported to be associated with angina pectoris,3 myocardial infarction,4 and atherosclerosis,5 which are the leading causes of death in this country. The discussion also excludes a recent report that aging men with low levels of insulin-like growth factor I die earlier than those with high levels.6

Long-term prospective studies on the potential of growth hormone will take decades. In the meantime, the use of growth hormone should be based on a patient's clinical status and on a candid patient–physician discussion of current information on the pros and cons of such therapy.

Khalid Mahmud, M.D.
North Memorial Medical Center, Minneapolis, MN 55422
kmahmud@idinhealth.com

6 References

1. 1

   Vance ML. Can growth hormone prevent aging? N Engl J Med 2003;348:779-780
   Full Text | Web of Science | Medline

2. 2

   Hennessey JV, Chromiak JA, DellaVentura S, et al. Growth hormone administration and exercise effects on muscle fiber type and diameter in moderately frail older people. J Am Geriatr Soc 2001;49:852-858
   CrossRef | Web of Science | Medline

3. 3

   Conti E, Andreotti F, Sestito A, et al. Reduced levels of insulin-like growth factor-1 in patients with angina pectoris, positive exercise stress test, and angiographically normal epicardial coronary arteries. Am J Cardiol 2002;89:973-975
   CrossRef | Web of Science | Medline

4. 4

   Conti E, Andreotti F, Sciahbasi A, et al. Markedly reduced insulin-like growth factor-1 in the acute phase of myocardial infarction. J Am Coll Cardiol 2001;38:26-32
   CrossRef | Web of Science | Medline

5. 5

   van den Beld AW, Bots ML, Janssen JA, Pols HA, Lamberts SW, Grobbee DE. Endogenous hormones and carotid atherosclerosis in elderly men. Am J Epidemiol 2003;157:25-31
   CrossRef | Web of Science | Medline

6. 6

   Ruiz-Torres A, Soares de Melo Kirzner M. Ageing and longevity are related to growth hormone/insulin like growth factor-1 secretion. Gerontology 2002;48:401-407
   CrossRef | Web of Science | Medline

Author/Editor Response

Dr. Mahmud correctly notes that the combination of growth hormone and exercise increases type II muscle fibers in the elderly. As stated in my Retrospective article, changes in body composition with growth hormone administration do not improve function in the elderly. Reduced levels of insulin-like growth factor I may be associated with other diseases, although such an association is not proof of cause and effect and may echo the effect of disease; for example, insulin-like growth factor I may be low in young women with anorexia nervosa.1 That older men with low levels of insulin-like growth factor I may die earlier than those with high levels may reflect underlying diseases. Rudman et al. reported that elderly men living independently had higher levels of insulin-like growth factor I than those living in a nursing home and had fewer medical problems.2 Again, these associations are valid but do not demonstrate cause and effect.

“Long-term prospective studies on the potential of growth hormone will take decades”: I agree. Without such studies, anyone can easily fall prey to unproven claims. Recall laetrile for cancer: How many people “believed” that it was efficacious? How many did not receive appropriate therapies, in the quest for a “magic bullet”? Appropriate studies, not opinions, are the only way to determine whether a treatment is beneficial.

Mary Lee Vance, M.D.
University of Virginia Medical Center, Charlottesville, VA 22908
mlv@virginia.edu

2 References

1. 1

   Caregaro L, Favaro A, Santonastaso P, et al. Insulin-like growth factor 1 (IGF-1), a nutritional marker in patients with eating disorders. Clin Nutr 2001;20:251-257
   CrossRef | Web of Science | Medline

2. 2

   Rudman D, Nagraj HS, Mattson DE, et al. Hyposomatomedinemia in the men of a Veterans Administration nursing home: prevalence and correlates. Gerontology 1987;33:307-314
   CrossRef | Web of Science | Medline

Citing Articles (2)

Citing Articles

1. 1

   Filippo Mulinacci, Martinus A.H. Capelle, Robert Gurny, Alex F. Drake, Tudor Arvinte. (2011) Stability of human growth hormone: Influence of methionine oxidation on thermal folding. Journal of Pharmaceutical Sciences 100:2, 451-463
   CrossRef

2. 2

   (2003) Anti-Aging Medicine LiteratureWatch. Journal of Anti-Aging Medicine 6:3, 243-268
   CrossRef