Impact of nutrition on somatotroph axis: a potential role in acromegaly and its cardiovascular risk?

Diet composition and energy intake directly modulate the growth hormone (GH) and insulin-like growth factor 1 (IGF-1) axis, and indirectly through endogenous regulators such as insulin, ghrelin, and adipokines. Moreover, diet has a well-established role in the prevention and management of various metabolic and cardiovascular comorbidities in the general population. Acromegaly caused by an endogenous overproduction of GH, is an endocrine disorder associated with increased risk of metabolic and cardiovascular comorbidities and excess mortality. The treatment of acromegaly aims to normalize GH and IGF-1 levels, manage complications and reduce mortality. There is a significant gap in research regarding the specific influence of diet on biochemical control and complications in acromegaly; therefore, consensus guidelines for managing metabolic and cardiovascular complications in acromegaly generally recommend the same nutritional interventions as those for the general population, even though the underlying pathogenic mechanisms often differ. This narrative review aims to provide an overview of how nutrition modulates the GH/IGF-1 axis and to summarize current evidence on the impact of various macronutrients and dietary patterns on biochemical control and comorbidity management in patients with acromegaly. Evidence in healthy subjects suggests that diets low in animal-derived proteins, combined with moderate fat and carbohydrate intake, may lower GH/IGF-1 activity. Nevertheless, further research is needed in patients with acromegaly to determine whether dietary interventions, such as those found effective in the general population, can help achieving biochemical control and effectively manage metabolic and cardiovascular comorbidities in this specific group.