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Influence of Nutritional Recovery on the Leptin Axis in Severely Malnourished Children

Institute of Human Nutrition (K.S., E.V.-G., E.R.-V.), University of Guadalajara and Research Ward for Infant Nutrition, Hospital Civil of Guadalajara Dr. Juan I. Menchaca, 44340 S.L. Guadalajara, Jalisco, Mexico; Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnosis (J.K.), University Hospital, D-04103 Leipzig, Germany; and Institute of Nutrition, Department of Nutritional Physiology (K.S., G.J.), Friedrich Schiller University, D-07743 Jena, Germany

Address all correspondence and requests for reprints to: Dr. Gerhard Jahreis, Institute of Nutrition, Friedrich Schiller University, Dornburger Strasse 24, D-07743 Jena, Germany. E-mail: b6jage{at}uni-jena.de.

Context: Leptin might be more important as a starvation hormone than as a satiety signal. The role of the soluble leptin receptor (sOB-R) and its regulation in children with protein energy malnutrition (PEM) is poorly understood.

Design: We elucidated the effect of intensive nutritional support on the leptin axis in 26 severely malnourished toddlers who received infant milk-based formula for 2 wk via continuous enteral tube feeding followed by 2 wk ad libitum feeding. Serum levels of leptin, sOB-R, IGF-I, and IGF-binding protein-3 as well as anthropometric measurements were determined at the beginning of the study and at 2-wk intervals. The control group consisted of 13 well-nourished children.

Results: The following were changes in the PEM toddlers after the nutritional support. Leptin increased significantly (P < 0.001), reaching 166% of levels observed in control group. sOB-R decreased significantly (P < 0.001), and a 142-fold molar excess of sOB-R over leptin was found. There were significant correlations between leptin and IGF-I after 2 wk and IGF-binding protein-3 during the whole study. sOB-R was not correlated with any anthropometric data, whereas IGF-I was a predictor of sOB-R variance in the PEM toddlers (19.9%, P = 0.022).

Conclusion: It can be concluded that sOB-R has a modulatory effect on leptin in PEM children during nutritional recovery and participates in their adaptive survival mechanisms. Leptin and the molar excess of sOB-R over leptin are better biomarkers of nutritional status than IGF-I in PEM children during nutritional recovery.

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