Plasma ghrelin concentrations, food intake, and anorexia in liver failure

ABSTRACT Ghrelin is related to feeding behavior and nutrition in several physiological and pathological conditions. We tested the hypothesis that the anorexia and the decreased food intake of advanced liver failure might be associated with hyperghrelinemia. Fasting ghrelin was measured in 43 cirrhotic patients; food intake was self-assessed using the Corli score and by a 3-day dietary record (n=25); anorexia/hunger was tested by a Likert scale. Fifty healthy subjects, matched for age and BMI, served as controls. Ghrelin levels were not systematically increased in cirrhosis (414±164 pmol/L vs. 398±142 in controls), but increased with decreasing Corli score (P=0.014) and along the scale of anorexia/hunger (P=0.0001), which were both related to the 3-day dietary record (P=0.009 and P<0.0001, respectively). Logistic regression confirmed that high ghrelin (>500 pmol/L) was significantly associated with a low calorie intake (OR, 3.03 for any 100-calorie reduced intake; P=0.015), a reduced Corli score (OR, 3.09; P=0.031) and the anorexia score (OR, 3.37; P=0.009), after adjustment for BMI. The study confirms the previously-observed relationship of fasting ghrelin with food intake in disease-associated malnutrition. In the presence of anorexia, hyperghrelinemia might indicate a compensatory mechanism trying to stimulate food intake, which is nonetheless ineffective in the physiologic range.