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Plasma Ghrelin Concentrations, Food Intake, and Anorexia in Liver Failure

Unit of Metabolic Diseases (G.M., N.V.), Department of Internal Medicine and Gastroenterology, and Unit of Internal Medicine (G.B., M.Z), Department of Internal Medicine, Cardioangiology, Hepatology, "Alma Mater Studiorum" University of Bologna, I-40138 Bologna, Italy; and Department of Internal Medicine (P.L., P.D.F.), Section of Internal Medicine, Endocrine and Metabolic Sciences, University of Perugia, I-06126 Perugia, Italy

Address all correspondence and requests for reprints to: Professor Giulio Marchesini, M.D., Unit of Metabolic Diseases, "Alma Mater Studiorum" University of Bologna, Via Massarenti 9, I-40138 Bologna, Italy. E-mail: giulio.marchesini{at}unibo.it.

Ghrelin is related to feeding behavior and nutrition in several physiological and pathological conditions. We tested the hypothesis that the anorexia and the decreased food intake of advanced liver failure might be associated with hyperghrelinemia. Fasting ghrelin was measured in 43 cirrhotic patients, food intake was self-assessed using the Corli score and a 3-d dietary record (n = 25), and anorexia/hunger was tested by a Likert scale. Fifty healthy subjects, matched for age and body mass index, served as controls. Ghrelin levels were not systematically increased in cirrhosis (414 ± 164 vs. 398 ± 142 pmol/liter in controls) but increased with decreasing Corli score (P = 0.014) and along the scale of anorexia/hunger (P = 0.0001), which were both related to the 3-d dietary record (P = 0.009 and P < 0.0001, respectively). Logistical regression confirmed that high ghrelin (>500 pmol/liter) was significantly associated with a low calorie intake [odds ratio (OR), 3.03 for any 100-calorie reduced intake; P = 0.015], a reduced Corli score (OR, 3.09; P = 0.031), and the anorexia score (OR, 3.37; P = 0.009), after adjustment for body mass index. The study confirms the previously observed relationship of fasting ghrelin with food intake in disease-associated malnutrition. In the presence of anorexia, hyperghrelinemia might indicate a compensatory mechanism trying to stimulate food intake, which is nonetheless ineffective in the physiological range.

This work was supported by a grant from the University of Bologna, Fondi Ricerca Istituzionale, 2002.

Abbreviations: BMI, Body mass index; OR, odds ratio.

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