Total ghrelin plasma level in patients with the restrictive type of anorexia nervosa

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Abstract

Ghrelin is produced mainly in the stomach and is an essential link of the brain–gut axis. Ghrelin stimulates hunger centers in hypothalamus controlling food intake and body mass gain. The aim of the study is to analyze the total ghrelin plasma level in patients suffering from restrictive type of anorexia nervosa (AN-R). According to DSM-IV classification a group of 30 AN-R patients was investigated before and after 3 and 6 months of therapy. Therapy included normocaloric diet and cognitive–behavioral psychotherapy (CBT). The control group consisted of 20 girls without any eating disorders. Before the therapy the total ghrelin plasma level in AN-R patients was significantly higher than in the control group. After 3 and 6 months of treatment the total ghrelin plasma level in AN-R patients was significantly lower than in the control group. In AN-R patients, the total ghrelin plasma level is connected with the pathological feeding behavior.

Introduction

Ghrelin is a 28-amino acid peptide discovered by Kojima et al. in 1999 [1]. Its biological activity depends on the posttranslational acylation of serine 3 with octanoic acid. Ghrelin is mainly secreted by A-like cells in the fundus of stomach, but it is also produced in small quantities in the hippocampus, pancreas, intestines, male gonads, placenta and pituitary gland [2]. It is known that ghrelin influences the motility in the gastrointestinal system, secretion of hydrochloric acid and endo- and exogenous pancreas functions [3], [4]. It stimulates the secretion of such hormones as growth hormone, cortisol, prolactin, aldosterone, and adrenocorticotropic hormone [2], [3], [4], [5], [6], [7]. It also influences the cardiovascular system by reducing blood pressure and increasing cardiac output [2]. Ghrelin affects the proliferation of cancer cells, and it is known that resistance to ghrelin can be responsible for cancer cachexia [8]. The highest increase of the plasma ghrelin concentration is observed before food intake. After feeding the ghrelin plasma level decreases within 2 h [9]. Starvation and/or malnutrition results in an increase of ghrelin level [8]. Anorexia nervosa (AN) belongs to the group of eating disorders and may be connected with ghrelin dysfunction. The diagnostic criteria distinguish two subtypes of AN: the restrictive type and the binge-eating/purging type. Now in the medical area of interest is future therapy considering such orexigenic peptides like: ghrelin, neuropeptide Y, aquoti-related peptide, orexin A and orexin B and galanin. Our study investigates ghrelin role in the restrictive type of AN.

Section snippets

Subjects and protocol study

30 girls suffering from AN-R were hospitalized in the Child and Adolescent Psychiatry and Psychotherapy Ward at the John Paul II Pediatric Center in Sosnowiec in Poland. According to DSM-IV classification AN-R patients were examined [10]. They had a 15% body weight loss and their body mass index (BMI) was below 17.5 kg/m2. The mean duration of the disease before admission to the hospital was 11.5 ± 7 months, according to interviews with patients and their families. AN-R patients underwent therapy

BMI

The BMI before the therapy calculated for all 30 AN-R patients was 15.1 kg/m2 ± 1.4. After 3 months of treatment BMI increased to 17.2 kg/m2 ± 1.1 and a further increase was noted after 6 months of therapy to 17.7 kg/m2 ± 1.8. A statistically significant difference between BMI of AN-R patients and BMI of the control group was noted, as presented in Fig. 1.

Ghrelin

The comparison of the total ghrelin plasma level in AN-R patients and the control group is presented in Fig. 2.

Correlation between BMI and ghrelin

There was no correlation between BMI

Discussion

Ghrelin is the most sensitive determinant of the nutrition state. Secretion of ghrelin is strongly related to food intake. The hypothalamic–pituitary–suprarenal axis is activated when access to food is limited and during stress. The secretion of ghrelin mobilizes mechanisms counteracting states of energy deficits, stimulates searching for food and influences memory of information connected with eating [8], [11], [12]. The secretion of ghrelin increases during starvation and during expecting a

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