title: Ghrelin, leptin and insulin in cirrhotic children and adolescents: relationship with cirrhosis severity and nutritional status.
abstract: OBJECTIVE
  Ghrelin, leptin, and insulin concentrations are involved in the control of food intake and they seem to be associated with anorexia-cachexia in cirrhotic patients. The present study aimed to investigate the relationship between the nutritional status and fasting ghrelin, leptin and insulin concentrations in pediatric cirrhotic patients.
  
  
  METHODS
  Thirty-nine patients with cirrhosis and 39 healthy controls aged 0-15 years matched by sex and age were enrolled. Severity of liver disease was assessed by Child-Pugh classification, and Pediatric for End Stage Liver Disease (PELD) or Model for End-stage Liver Disease (MELD) scores. Blood samples were collected from patients and controls to assay total ghrelin, acyl ghrelin, leptin and insulin by using a commercial ELISA kit. Anthropometry parameters used were standard deviation score of height-for-age and triceps skinfold thickness-for-age ratio. A multiple linear regression analysis was used to determine the correlation between dependent and independent variables.
  
  
  RESULTS
  Acyl ghrelin was significantly lower in cirrhotic patients than in controls [142 (93-278) pg/mL vs 275 (208-481) pg/mL, P=0.001]. After multiple linear regression analysis, total ghrelin and acyl ghrelin showed an inverse correlation with age; acyl ghrelin was associated with the severity of cirrhosis and des-acyl ghrelin with PELD or MELD scores ≥15. Leptin was positively correlated with gender and anthropometric parameters. Insulin was not associated with any variable.
  
  
  CONCLUSIONS
  Low acyl ghrelin and high des-acyl ghrelin concentrations were associated with cirrhosis severity, whereas low leptin concentration was associated with undernourishment in children and adolescents with cirrhosis.
authors.affiliation: Experimental Laboratory of Gastroenterology and Hepatology, Centro de Pesquisas do Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. cleal@hcpa.ufrgs.br
authors.forename: Cristina T L
authors.initials: CT
authors.lastname: Dornelles
authors.forename: Helena A S
authors.initials: HA
authors.lastname: Goldani
authors.forename: Maria Inês A
authors.initials: MI
authors.lastname: Wilasco
authors.forename: Rafael L
authors.initials: RL
authors.lastname: Maurer
authors.forename: Carlos O
authors.initials: CO
authors.lastname: Kieling
authors.forename: Marilene
authors.initials: M
authors.lastname: Porowski
authors.forename: Cristina T
authors.initials: CT
authors.lastname: Ferreira
authors.forename: Jorge L
authors.initials: JL
authors.lastname: Santos
authors.forename: Sandra M G
authors.initials: SM
authors.lastname: Vieira
authors.forename: Themis R
authors.initials: TR
authors.lastname: Silveira
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005215:Fasting; D005260:Female; D054439:Ghrelin / Q000097:blood*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007328:Insulin / Q000097:blood*; D020738:Leptin / Q000097:blood*; D008103:Liver Cirrhosis / Q000097:blood* / Q000503:physiopathology; D008297:Male; D009752:Nutritional Status; D012720:Severity of Illness Index
chemical_list: D054439:Ghrelin; D007328:Insulin; D020738:Leptin