Eating pattern and the effect of oral glucose on ghrelin and insulin secretion in patients with anorexia nervosa

Tanaka, Muneki; Tatebe, Yoshiki; Nakahara, Toshihiro; Yasuhara, Daisuke; Sagiyama, Ken-ichiro; Muranaga, Tetsuro; Ueno, Hiroaki; Nakazato, Masamitsu; Nozoe, Shigeo; Naruo, Tetsuro

doi:10.1046/j.1365-2265.2003.01886.x

Cited by 50 publications

(30 citation statements)

References 55 publications

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“…Although differences in the speed of meal consumption across groups likely affected our data, the fact that the AUC analysis also yielded significant group differences argues that these differences cannot be attributed solely to differential rates of food consumption between groups. Interestingly, studies using an OGTT have also found a delay in the insulin response curve in both ill (39) and weight-restored AN subjects (10). Gastric and gut dysmotility associated with AN (26,34) may be an additional factor contributing to the right shift in glucose and insulin response curves observed in AN compared with control subjects, and the lower AUC for glucose and insulin in starved AN may reflect malabsorption.…”

Section: Discussionmentioning

confidence: 99%

“…In the case of glucose levels and insulin secretion in AN, for example, mixed results may be attributed to the use of oral glucose tolerance tests (OGTT) or liquid meals (10,39,47) rather than a mixed macronutrient solid meal representative of what patients are fed in a standard behavioral treatment program for AN. Furthermore, most studies have administered a test meal or OGTT only at the start of treatment in the starved state (39,47) or have failed to specify at what point in refeeding subjects were tested (42). When studies have examined responses to a solid meal they have often been limited to sample sizes of less than 10 subjects per group (see Ref.…”

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Insulin, glucose, and pancreatic polypeptide responses to a test meal in restricting type anorexia nervosa before and after weight restoration

Kinzig¹,

Coughlin²,

Redgrave³

et al. 2007

American Journal of Physiology-Endocrinology and Metabolism

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Prolonged malnutrition in individuals with anorexia nervosa (AN) has been associated with alterations in endocrine function that may play a sustaining role in the disorder. We hypothesized that abnormalities in endocrine responses to ingestion of a meal in AN are reversible and depend on weight restoration. We measured meal-induced endocrine responses in AN subjects at three time points during hospitalization: before refeeding (n ϭ 13, mean BMI 16.7 kg/m 2 ), after 2 wk of refeeding (mean BMI 18.0 kg/m 2 ), and in the weight-restored state (mean BMI 20.3 kg/m 2 ). Control subjects (n ϭ 13, BMI 19 -24.9 kg/m 2 ) were tested once. Tests were 2.5-h sessions in which blood was drawn every 15 min before, during, and after a ϳ650-kcal test breakfast. Relative to controls, peak levels of glucose were depressed and peak levels of insulin in response to ingestion of the test meal were delayed, with response patterns in the third trial most similar to controls. Pancreatic polypeptide (PP) levels were increased in AN relative to controls regardless of weight status. The delay in insulin release and elevated PP levels did not correct with short-term refeeding and may contribute to the high relapse rates and maintenance of AN.eating disorders; pancreatic function; refeeding ANOREXIA NERVOSA (AN) is a highly morbid pathological condition with the highest mortality rate among psychiatric disorders (35,46). This disorder is characterized by multiple metabolic and endocrine abnormalities, including failure of the homeostatic responses to malnutrition and semistarvation. Although most of these alterations are believed to be state related and to reverse with weight restoration, some may be traitrelated vulnerability factors that differentiate at-risk individuals. Whether trait or state related, some of these alterations may play a role in sustaining the rewarding nature of restricting behavior, thereby acting as mediators for AN.Unlike starvation, AN is characterized by an excess of both orexigenic and anorexigenic signaling, indicating dysregulation of hunger and satiety (25). Reduced hunger and desire to eat, coupled with increased fullness and satiety after a test meal, have been reported in AN (21, 31), although the capacity to respond to physiological hunger and satiety cues may not be entirely absent (11,32). Delayed gastric emptying and intestinal transit times are likely contributors to the reports of increased fullness and satiety after meals (8,13,22,24,26). Some investigators argue that these findings reflect tight cognitive control of normal appetite. However, relative to healthy comparison women, those with AN show reduced salivation, a heightened autonomic response to food, and fear and disgust in response to images of food (27,43), suggesting conditioned responses similar to those seen in simple phobias.Knowledge regarding signals and systems involved in mealto-meal regulation of food intake is rapidly expanding. Although newly found systems are studied exhaustively as they relate to obesity, their roles and respons...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Insulin, glucose, and pancreatic polypeptide responses to a test meal in restricting type anorexia nervosa before and after weight restoration

Kinzig¹,

Coughlin²,

Redgrave³

et al. 2007

American Journal of Physiology-Endocrinology and Metabolism

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“…It remains to be clarified whether salivary ghrelin might be a useful tool in clinical chemistry for diagnosis of metabolic or gastrointestinal disorders as has been postulated for serum ghrelin (49,50 ).…”

Section: Discussionmentioning

confidence: 99%

Identification of Ghrelin in Human Saliva: Production by the Salivary Glands and Potential Role in Proliferation of Oral Keratinocytes

Gröschl¹,

Topf²,

et al. 2005

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Background:We investigated whether ghrelin is present in human saliva, is produced by salivary glands, and physiologic consequences of these findings. Methods: Expression of ghrelin and specific receptor mRNA was determined by PCR. Proteins were identified by immunoblotting and size-exclusion fast protein liquid chromatography (FPLC) with consecutive RIA. Specific RIAs were used for quantification of salivary total and bioactive ghrelin. Distribution of ghrelin was investigated by immunohistochemistry in cryosections of the salivary glands. The effect of ghrelin on incorporation of 5-bromo-2-deoxyuridine as a measure of cell proliferation was investigated in primary oral keratinocytes. Results: Ghrelin is produced by the salivary glands. The hormone was identified in saliva and glands by immunoblotting and by FPLC fractionation of saliva. Immunohistochemistry demonstrated ghrelin distribution in the salivary glands. The receptor was also produced by the glands and by oral keratinocytes and was shown to be functional. Comparison of total ghrelin values for healthy individuals (body mass index, 18 -27 kg/m 2 ) showed significantly lower concentrations in saliva than in serum (P <0.01). The correlation between both matrices was r 2 ‫؍‬ 0.56 (P <0.001) with a negative correlation to body mass index (r 2 ‫؍‬ 0.314; P <0.01). Bioactive acylated ghrelin was also present in saliva. Incubation of keratinocytes with ghrelin led to signifi-

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“…Tanaka et al in 2003 found higher plasma levels of ghrelin in patients with AN Purging (AN-P) than in AN-R [59][60][61] . In 2004, the group of Tanaka replicated their findings in a later study which included a third subgroup of AN, a subgroup that required emergency hospitalization; in this group the patients were unable to eat and had an extreme loss of weight.…”

Section: Ghrelin and The Regulation Of Appetitementioning

confidence: 99%

“…However, the Troisi group compared data between patients with AN-P and BN, which probably had a higher BMI, which may explain the difference between the results of the two studies. There seems to be a relationship between ghrelin concentrations and patients with the compulsive/purging subtype for both AN (AN-P) and for BN [59][60][61] . However, this finding has still not reached a consensus, Monteleone et al 2008 47 found no significant difference in the concentration of plasma ghrelin when fasting in groups with AN-R and AN-P. One explanation for these conflicting results is the method used to measure ghrelin and how it was performed, the preference for using plasma or serum can affect the levels obtained in different studies.…”

Section: Ghrelin and The Regulation Of Appetitementioning

confidence: 99%

Ghrelin and eating disorders

Fabbri¹,

Deram²,

Kerr³

et al. 2015

Arch. Clin. Psychiatry (São Saulo)

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Background: Ghrelin is a potent hormone with central and peripheral action. This hormone plays an important role in the regulation of appetite, food intake, and energy balance. Studies have suggested that ghrelin is involved with eating disorders (ED), particularly bingeing and purging. Genetic variants have also been studied to explain changes in eating behavior. Methods: We conducted a literature review; we searched PubMed, Scientific Electronic Library Online (SciELO), and LILACS databases using the keywords "eating disorder", "ghrelin", "polymorphism", "anorexia nervosa", "bulimia nervosa", "binge eating disorder", and their combinations. We found 319 articles. Thirty-nine articles met the inclusion criteria. Results: High levels of ghrelin were found in patients with anorexia nervosa (AN), especially in the purging subtype (AN-P). There was also a positive correlation between fasting ghrelin level and frequency of episodes of bingeing/purging in bulimia nervosa (BN) and the frequency of bingeing in periodic binge eating disorder (BED). Some polymorphisms were associated with AN and BN. Conclusion: Changes in ghrelin levels and its polymorphism may be involved in the pathogenesis of EDs; however, further studies should be conducted to clarify the associations.

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Eating pattern and the effect of oral glucose on ghrelin and insulin secretion in patients with anorexia nervosa

Cited by 50 publications

References 55 publications

Insulin, glucose, and pancreatic polypeptide responses to a test meal in restricting type anorexia nervosa before and after weight restoration

Insulin, glucose, and pancreatic polypeptide responses to a test meal in restricting type anorexia nervosa before and after weight restoration

Identification of Ghrelin in Human Saliva: Production by the Salivary Glands and Potential Role in Proliferation of Oral Keratinocytes

Ghrelin and eating disorders

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