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Previous Volume 346:1623-1630 May 23, 2002 Number 21 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Flier, J. S. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

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.

Source Information

From the Departments of Medicine (D.E.C., D.S.W., R.S.F., P.A.B., M.K.M.) and Surgery (E.P.D.), University of Washington; the Veterans Affairs Puget Sound Health Care System (D.E.C., R.S.F., M.K.M.); the Harborview Medical Center (D.S.W., P.A.B.); and University Hospital (E.P.D.) — all in Seattle; and the Department of Medicine, Oregon Health and Science University, Portland (J.Q.P.).

Address reprint requests to Dr. Cummings at the Veterans Affairs Puget Sound Health Care System, Seattle Div., 1660 S. Columbian Way, S-111-Endo, Seattle, WA 98108, or at davidec{at}u.washington.edu.

Full Text of this Article

Related Letters:

Weight Loss and Plasma Ghrelin Levels
Rubino F., Gagner M., Camilleri M., Cremonini F., Geliebter A., Cummings D. E., Purnell J. Q., Weigle D. S.
Extract | Full Text | PDF  
N Engl J Med 2002; 347:1379-1381, Oct 24, 2002. Correspondence

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