Fasting plasma ghrelin levels reflect malnutrition state in patients with liver cirrhosis

Ghrelin plays an important role in controlling the feeding and nutritional states by signaling hypothalamic centers. However, the role of ghrelin in cirrhotic patients in the malnutrition state remains unclear.

Thirty-four patients with liver cirrhosis (LC) and 10 healthy controls (normal controls, NC) were enrolled in this study. Fasting plasma ghrelin levels (desacyl form) were measured using a newly developed ELISA and the relationship among biochemical parameters including plasma leptin, body composition and energy metabolism were evaluated using an indirect calorimeter.

Plasma ghrelin levels were slightly but not significantly elevated in patients with LC when compared with NC. Plasma ghrelin levels showed a negative correlation (r=-0.432, p<0.01) with plasma leptin levels and positive correlations with blood urea nitrogen (BUN), creatinine, white blood cell count and C-reactive protein. No correlation with the severity of liver damage based on the classification of Child-Pugh was noted. Plasma ghrelin levels were significantly correlated with body mass index (BMI), arm muscular circumference (AMC), triceps skinfold thickness (TSF) (BMI, r=-0.389, p<0.05; AMC, r=-0.416, p<0.05; TSF, r=-0.459, p<0.01, respectively) and the substrate oxidation rates of glucose (%CHO), fat (%FAT) and non-protein respiratory quotients (npRQ) (%CHO, r=-0.391, p<0.05; %FAT, r=0.438, p<0.01; npRQ, r=-0.411, p<0.05, respectively). Four factors (npRQ, TSF, total bilirubin, BUN) associated with plasma ghrelin levels were identified by multiple regression analysis.

These data suggest that fasting plasma ghrelin levels may be a useful indicator reflecting malnutrition in patients with LC, although renal failure and inflammatory status are also closely associated with plasma ghrelin levels.