Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery.
BACKGROUND
Weight loss causes changes in appetite and energy expenditure that promote weight regain. Ghrelin is a hormone that increases food intake in rodents and humans. If circulating ghrelin participates in the adaptive response to weight loss, its levels should rise with dieting. Because ghrelin is produced primarily by the stomach, weight loss after gastric bypass surgery may be accompanied by impaired ghrelin secretion.


METHODS
We determined the 24-hour plasma ghrelin profiles, body composition, insulin levels, leptin levels, and insulin sensitivity in 13 obese subjects before and after a six-month dietary program for weight loss. The 24-hour ghrelin profiles were also determined in 5 subjects who had lost weight after gastric bypass and 10 normal-weight controls; 5 of the 13 obese subjects who participated in the dietary program were matched to the subjects in the gastric-bypass group and served as obese controls.


RESULTS
Plasma ghrelin levels rose sharply shortly before and fell shortly after every meal. A diet-induced weight loss of 17 percent of initial body weight was associated with a 24 percent increase in the area under the curve for the 24-hour ghrelin profile (P=0.006). In contrast, despite a 36 percent weight loss after gastric bypass, the area under the curve for the ghrelin profile in the gastric-bypass group was 77 percent lower than in normal-weight controls (P<0.001) and 72 percent lower than in matched obese controls (P=0.01). The normal, meal-related fluctuations and diurnal rhythm of the ghrelin level were absent after gastric bypass.


CONCLUSIONS
The increase in the plasma ghrelin level with diet-induced weight loss is consistent with the hypothesis that ghrelin has a role in the long-term regulation of body weight. Gastric bypass is associated with markedly suppressed ghrelin levels, possibly contributing to the weight-reducing effect of the procedure.
Cummings
David E
DE
Department of Medicine, University of Washington; the Veterans Affairs Puget Sound Health Care System, Seattle 98108, USA. davidec@u.washington.edu
Weigle
David S
DS
Frayo
R Scott
RS
Breen
Patricia A
PA
Ma
Marina K
MK
Dellinger
E Patchen
EP
Purnell
Jonathan Q
JQ
D000328:Adult; D001069:Appetite Regulation / Q000502:physiology; D001823:Body Composition; D002940:Circadian Rhythm; D004038:Diet, Reducing; D005260:Female; D015390:Gastric Bypass; D054439:Ghrelin; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D020738:Leptin / Q000097:blood; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood* / Q000628:therapy; D036361:Peptide Hormones; D010455:Peptides / Q000097:blood*; D011184:Postoperative Period; D015431:Weight Loss / Q000502:physiology*
D054439:Ghrelin; D007328:Insulin; D020738:Leptin; D036361:Peptide Hormones; D010455:Peptides