title: Increased suppression of serum ghrelin concentration by hyperinsulinemia in women with anorexia nervosa.
abstract: BACKGROUND
  Ghrelin is a peptide secreted mainly by the stomach, which has the ability to stimulate appetite and food intake. Serum ghrelin concentration decreases rapidly after a meal, probably because of the concurrent increase in serum insulin. Anorexia nervosa (AN) is an eating disorder, which is characterized by high serum ghrelin concentration; however, the regulation of circulating ghrelin by insulin in this disorder remains unclear.
  
  
  OBJECTIVE
  To estimate serum ghrelin concentration in the fasting state and after hyperinsulinemia in women with AN.
  
  
  METHODS
  We examined 19 women with AN, 26 lean healthy women, and 25 women who were overweight or obese. Serum ghrelin concentration was measured in the fasting state and after euglycemic hyperinsulinemic clamp.
  
  
  RESULTS
  Insulin sensitivity was similar in AN and normal-weight women, and was markedly decreased in the obese subjects. In the fasting state, serum ghrelin was higher in AN group than in other groups (normal-weight, P=0.017; obese, P=0.0001) and in normal-weight women than in obese women (P=0.044). Hyperinsulinemia resulted in a marked decrease in serum ghrelin in AN (P<0.0001) and normal-weight women (P=0.002). The fall in serum ghrelin was higher in AN group than in other groups (normal-weight, P=0.0008; obese, P=0.0001), and was related to insulin sensitivity (r=0.24, P<0.05). In multiple regression analysis, only fasting serum ghrelin and the presence of AN were independent predictors of this fall.
  
  
  CONCLUSIONS
  Women with AN have an increased suppression of serum ghrelin by hyperinsulinemia. This phenomenon might lead to an increased and more rapid feeling of satiety in AN.
authors.affiliation: Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, M Curie-Sklodowskiej 24A, 15-276 Bialystok, Poland.
authors.forename: Monika
authors.initials: M
authors.lastname: Karczewska-Kupczewska
authors.forename: Marek
authors.initials: M
authors.lastname: Straczkowski
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Adamska
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Nikolajuk
authors.forename: Elzbieta
authors.initials: E
authors.lastname: Otziomek
authors.forename: Maria
authors.initials: M
authors.lastname: Górska
authors.forename: Irina
authors.initials: I
authors.lastname: Kowalska
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000378:metabolism*; D005215:Fasting / Q000502:physiology; D005260:Female; D054439:Ghrelin / Q000097:blood*; D015309:Glucose Clamp Technique; D006801:Humans; D006946:Hyperinsulinism / Q000378:metabolism*; D007328:Insulin / Q000097:blood*; D009765:Obesity / Q000378:metabolism; D012528:Satiety Response / Q000502:physiology*; D055815:Young Adult
chemical_list: D054439:Ghrelin; D007328:Insulin