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Plasma Obestatin, Ghrelin, and Ghrelin/Obestatin Ratio Are Increased in Underweight Patients with Anorexia Nervosa But Not in Symptomatic Patients with Bulimia Nervosa

Department of Psychiatry, University of Naples, Largo Madonna delle Grazie, 80138 Naples, Italy

Address all correspondence and requests for reprints to: Palmiero Monteleone, M.D., Department of Psychiatry, University of Naples, Largo Madonna delle Grazie, 80138 Naples, Italy. E-mail: monteri{at}tin.it.

Introduction: Peptides of the gut-brain axis have a pivotal role in the regulation of energy homeostasis. Obestatin, a sibling of ghrelin derived from preproghrelin, is thought to oppose ghrelin effects on food intake. Because changes in ghrelin levels have been associated with anorexia nervosa (AN) and bulimia nervosa (BN), the investigation of obestatin production may further contribute to understanding the role of peripheral peptides in patients with eating disorders.

Methods: In the present study, we measured circulating blood levels of obestatin and ghrelin and assessed their relationships with anthropometric and clinical measures in 20 AN patients, 21 BN patients, and 20 appropriate healthy controls.

Results: Compared with healthy women, patients with BN showed no significant differences in plasma obestatin and ghrelin concentrations and in the ghrelin/obestatin ratio, whereas underweight AN patients displayed significantly increased circulating levels of both obestatin (P < 0.009) and ghrelin (P < 0.002) and an increased ghrelin/obestatin ratio (P < 0.04). Moreover, in AN women, positive correlations emerged between the ghrelin/obestatin ratio and current body weight and body mass index.

Conclusions: Underweight AN patients are characterized by increased concentrations of ghrelin and obestatin and a higher ghrelin to obestatin ratio. No changes in circulating ghrelin or obestatin as well as in ghrelin to obestatin ratio seem to occur in acutely ill patients with BN. Although those changes likely reflect the physiological state of symptomatic AN individuals, they may also contribute to the pathophysiology of the disorder.