Elevated Plasma Ghrelin Level in Underweight Patients with Chronic Obstructive Pulmonary Disease

Abstract

Ghrelin, a novel growth hormone-releasing peptide, has been shown to cause a positive energy balance by reducing fat use and stimulating food intake. This study investigated whether plasma ghrelin is associated with clinical parameters in patients with chronic obstructive pulmonary disease. Plasma ghrelin was measured in 50 patients and 13 control subjects, together with anabolic and catabolic factors. Patients were divided into two groups based on body mass index: underweight patients (n = 26) or normal weight patients (n = 24). Plasma ghrelin was significantly higher in underweight patients than in normal weight patients and healthy control subjects. Circulating tumor necrosis factor-alpha, interleukin-6, and norepinephrine were significantly higher in underweight patients than in normal weight patients. Plasma ghrelin correlated negatively with body mass index and correlated positively with catabolic factors such as tumor necrosis factor-alpha and norepinephrine. In addition, plasma ghrelin correlated positively with percent predicted residual volume and residual volume-to-total lung capacity ratio. In conclusion, plasma ghrelin was elevated in underweight patients with chronic obstructive pulmonary disease, and the level was associated with a cachectic state and abnormality of pulmonary function.

Systemic manifestations and comorbidities of COPD

“…By contrast, circulating concentrations of ghrelin, a growth hormone-releasing peptide that increases food intake, is elevated in cachectic patients with COPD [19].…”

Ghrelin Gene Products in Acute and Chronic Inflammation

“…Ghrelin circulating concentrations are increased in pathological conditions characterized by cachexia, including chronic heart failure, COPD, and different types of cancer (Garcia et al 2005;Itoh et al 2004;Kerem et al 2008;Nagaya et al 2001;Shimizu et al 2003). Regardless of the underlying disease, this cachexiaassociated hyperghrelinemia may represent either a compensatory mechanism to the negative energy balance and the inflammatory state or the development of a resistance to the ghrelin signaling.…”

“…Ghrelin is commonly altered in pathological conditions affecting body mass and/or body energy metabolism, negatively correlating with body mass index (BMI) (van der Lely et al 2004). Ghrelin circulating levels are indeed lower in overweight or obese subjects than in normal individuals (Tschöp et al 2000), with the exception of Prader Willi syndrome (Cummings et al 2002), and higher in conditions characterized by energy inadequacy such as anorexia/cachexia associated with cancer (Garcia et al 2005;Shimizu et al 2003) and several other pathologies including chronic heart and renal failure, chronic obstructive pulmonary disease (COPD), and cystic fibrosis (Cohen et al 2008;Itoh et al 2004;Nagaya et al 2001;Yoshimoto et al 2002). Insulin and glucose are among the major determinants of ghrelin secretion that, in turn, modulates insulin secretion and glucose metabolism (van der Lely et al 2004;Wiedmer et al 2007).…”

A study to assess nutritional profile in chronic obstructive pulmonary disease patients

“…Itoh T et al in 2004 showed decrease in prealbumin level in underweight individuals whose BMI <18 kg/m 2 which was significant with p value <0.01 and also significant with control group which is consistent to our finding of decrease pre-albumin level as most of patient with COPD has low BMI <18 kg/m 2 in our study group. 15 So pre-albumin can be used as an early indicator of malnutrition in COPD patients. But further study comparing serum carnitine level and serum pre-albumin is required to find which can be used as best indicator for malnutrition.…”