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American Journal of Clinical Nutrition, Vol. 85, No. 3, 808-815, March 2007
© 2007 American Society for Nutrition

ORIGINAL RESEARCH COMMUNICATION

Altered postprandial glucose, insulin, leptin, and ghrelin in liver cirrhosis: correlations with energy intake and resting energy expenditure1,2,3

Evangelos Kalaitzakis, Ingvar Bosaeus, Lena Öhman and Einar Björnsson

1 From the Department of Internal Medicine, Faculty of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (EK, IB, and EB), and the Department of Clinical Immunology, Faculty of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (LÖ)

Background:Liver cirrhosis is associated with reduced energy intake and increased resting energy expenditure.

Objective:We aimed to investigate the possible role of glucose, insulin, leptin, and ghrelin in the pathogenesis of these alterations.

Design:Nutritional status, energy intake, resting energy expenditure, and fasting glucose, insulin, and leptin were assessed in 31 patients with cirrhosis. Postprandial glucose, insulin, C-peptide, leptin, and ghrelin responses were studied in a subgroup of patients after a standard meal. Ten healthy subjects served as controls.

Results:Patients with cirrhosis had a lower energy intake (P < 0.05), higher resting energy expenditure (P < 0.05), higher fasting leptin (P < 0.05), and higher insulin resistance (P < 0.001) than did the healthy control subjects. In the patients with cirrhosis, fasting leptin was negatively correlated with resting energy expenditure (r = –0.38, P < 0.05) but not with energy intake. In control subjects, leptin was negatively correlated with energy intake (r = –0.72, P < 0.05) but not with resting energy expenditure. The patients with cirrhosis had higher postprandial glucose (P < 0.001) and lower ghrelin (P < 0.05) concentrations at 4 h postprandially than did the control subjects. The increase in ghrelin from its minimal postmeal value to 4 h postmeal was negatively correlated (r = –0.66, P = 0.014) with weight loss in the patients with cirrhosis. Energy intake was negatively correlated (r = –0.42, P < 0.01) with the postprandial increase in glucose.

Conclusions:In cirrhosis, altered postprandial glucose and ghrelin are associated with reduced energy intake and weight loss, respectively, and the effects of leptin on energy intake and expenditure seem to be altered. Insulin resistance might be involved in these altered postprandial responses.

Key Words: Glucose • insulin • leptin • ghrelin • insulin resistance • energy intake • resting energy expenditure • liver cirrhosis • malnutrition






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