Ghrelin, the growth hormone secretagogue receptor ligand, is a key regulator of adiposity and food intake. However, the regulation of ghrelin in response to dietary fat intake remains largely unclear. Furthermore, cephalic elevation of ghrelin may influence fat absorption and postprandial lipaemia. Therefore, the aim of this study was to examine the effect of fat ingestion and vagal stimulation on the regulation of plasma ghrelin.Vagal stimulation was achieved by modified sham feeding (MSF). Eight healthy subjects (four male/four female) consumed a 50 g fat load on two separate occasions. On one occasion, the fat load was preceded by the MSF of a meal for 1 h. Blood, appetite and breath were analysed for 5 h postprandially.A 25% (S.E.M. 3·4) suppression in ghrelin concentration was observed after fat ingestion (P,0·001), without an increase in glucose or insulin. MSF in addition to oral fat enhanced ghrelin suppression further, as well as elevating plasma triacylglycerol (P,0·001) and reducing appetite (P,0·001). The fasting ghrelin concentration was inversely correlated with gastric half-emptying time (P=0·036).We conclude that ghrelin release may be influenced directly by both vagal stimulation and oral fat ingestion.

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Summary:We report two cases of acquired immune deficiency syndrome (AIDS), apparently without the usual exposure factors, in whom a temporal association was detected after detailed epidemiological investigation.The index case, a 45 year old housewife, had provided terminal home-nursing care for a 33 year old African man, who died from an undiagnosed encephalitis. At that time she had fissures of the skin of both her hands. Review of post-mortem pathology specimens of the African man allowed a retrospective diagnosis of AIDS with cerebral toxoplasmosis to be made.