Magdalena Gibas-Dorna

Fasting and postprandial levels of ghrelin, leptin and insulin in lean, obese and anorexic subjects

Introduction Ghrelin, leptin and insulin are involved in neurohormonal regulation of energetic homeostasis. Aim We investigated the correlation between nutritional status and plasma levels of leptin, ghrelin and insulin in lean, obese and anorexic subjects. Material and methods Nineteen obese and 18 anorexic adults were enrolled in the study. Seventeen adults with normal body mass index (BMI) served as controls. Blood samples were taken twice: before breakfast and 2 h after breakfast. Fasting and postprandial ghrelin, leptin and insulin were examined. The following correlations were estimated: between BMI and basal level of tested hormones, between insulin and ghrelin, and between insulin and leptin. The threshold level of significance was p ≤ 0.05 for all calculations. Results Basal insulin level was lowest in anorexic patients and greatest in obese subjects. Fasting plasma ghrelin was lower in obesity and higher in anorexia as compared with the controls. Comparing with controls, fasting leptin levels were higher in obese and lower in anorexic subjects. There was positive correlation between BMI and basal leptin level in obesity. A significant postprandial increase was noted for insulin in all studied groups. Increased leptin and decreased ghrelin levels were detected 2 h after a meal in the control group. In obese patients, postprandial leptin was lower than before food intake, and fasting leptin showed positive correlation with basal insulin level. Conclusions Basal plasma ghrelin, leptin and insulin levels differ according to nutritional status. Impaired ghrelin and leptin secretion and insulin sensitivity may be involved in the pathogenesis of eating disorders.

Urinary tract infection during pregnancy affects the level of leptin, ghrelin and insulin in maternal and placental blood.

Abstract Aim. We examined ghrelin, leptin and insulin in maternal blood during normal pregnancy and pregnancy complicated by urinary tract infection (UTI), as well as in cord blood at labor. Methods. A total of 36 delivering women with history of UTI during the third trimester of pregnancy were enrolled in the study; 12 healthy pregnant women served as a control. Infection markers (CRP and procalcitonin) were determined in maternal blood during the course of UTI and at labor. Ghrelin, leptin and insulin were determined during labor in venous maternal and in umbilical cord blood. Results. We found negative correlation between infection markers in maternal blood during UTI, and level of tested hormones in cord blood, indicating potential risk of placental impairment due to energetic imbalance. We noted lower level of leptin in mothers with UTI and no change in leptin from umbilical blood comparing subjects with and without UTI. Low level of ghrelin was observed in maternal and cord blood when pregnancy was complicated by UTI. Insulin concentrations were high in mothers with UTI and low in their newborns cord blood. Increased maternal insulin level could indicate peripheral insulin resistance caused by the infection. Conclusion. UTI during pregnancy affects the concentration of hormones responsible for regulating energetic homeostasis within the placenta.

Functional constipation in children – evaluation and management

Almost 1/3 of gastrointestinal consultations are related to constipation, and over 90% of them are of functional origin. Proper diagnosis and adequate treatment (both nonpharmacological and pharmacological) may limit the number of specialist visits and can be beneficial for therapeutic effects. The treatment is long lasting and requires unique discipline of parents/guardians and coordination supervised by the referring doctor. This paper presents the most important aspects of diagnostic and therapeutic processes regarding functional constipation in neonates and toddlers.

Huntington Disease - principles and practice of nutritional management.

Huntington disease (HD) is a degenerative brain disease clinically manifested by the characteristic triad: physical symptoms including involuntary movements and poor coordination, cognitive changes with less ability to organize routine tasks, and some emotional and behavioral disturbances. For patients with HD, feeding is one of the problems they have to face. People with HD often have lower than average body weight and struggle with malnutrition. As a part of therapy, good nutrition is an intervention maintaining health and functional ability for maximally prolonged time. In the early stages of HD, small amounts of blenderized foods given orally are recommended. In more advanced stages, enteral nutrition is essential using gastric, or jejunal tubes for short term. Most severe cases require gastrostomy or gastrojejunostomy. Although enteral feeding is well tolerated by most of the patients, a number of complications may occur, including damage to the nose, pharynx, or esophagus, aspiration pneumonia, sinusitis, metabolic imbalances due to improper nutrient and fluid supply, adverse effects affecting gastrointestinal system, and refeeding syndrome.

Relationship between adipokines and lipid profile in postmenopausal women with different apolipoprotein E genotypes.

ABSTRACT The aim of the authors of this study was to clarify the relationships among apolipoprotein E (ApoE) genotype, blood pressure, lipid profile, serum leptin, and adiponectin in healthy postmenopausal women. The study was conducted between March 2011 and December 2012 on 266 participants aged 50–65 years from the Institute of Rural Health in Lublin, Poland. Results showed that women had four combinations of genotypes: ɛ2/ɛ3, ɛ3/ɛ3, ɛ3/ɛ4, and ɛ4/ɛ4. Carriers of different genotypes did not differ in terms of age, body mass index (BMI), blood pressure, total cholesterol, high-density lipoprotein (HDL) cholesterol, and adiponectin levels. Mean low-density lipoprotein (LDL) cholesterol levels were higher in ε4 carriers compared to non-carriers. Fasting serum leptin concentrations were higher in homozygotes ɛ4/ɛ4. Leptin correlated positively with BMI in all study groups and with LDL in ɛ2/ɛ3, ɛ3/ɛ3, and ɛ3/ɛ4. Adiponectin correlated negatively with triglycerides in ɛ2/ɛ3, ɛ3/ɛ3, and ɛ3/ɛ4 and positively with HDL in ɛ2/ɛ3 carriers. Adipokines were not associated with blood pressure. Multiple regression analyses demonstrated associations among leptin, ApoE ɛ4/ɛ4, BMI, and LDL, and among adiponectin, BMI, and triglycerides. In healthy postmenopausal women ɛ4/ɛ4 genotype was associated with lower leptin levels. Homozygosity ɛ4/ɛ4 was associated with a more atherogenic lipid profile and possibly dysregulation of leptin and adiponectin signaling in lipid metabolism.

The Effect of VASER Abdominal Liposuction on Metabolic Profile in Overweight Males

The aim of the current study was to examine the liposuction-induced metabolic changes with regard to release of major adipokines and insulin sensitivity in overweight male patients. Seventeen overweight male patients aged 37.15 ± 9.60 years (6 with diabetes type 2, 11 without comorbidities) and 10 age-matched healthy lean controls were enrolled in the study. Using Vibration Amplification of Sound Energy at Resonance System, ultrasound assisted liposuction was applied onto the deep layers of abdominal subcutaneous adipose tissue. The mean volume supranatant fat was 2208 ± 562 ml. To eliminate the confounding effects of postsurgical inflammation and to evaluate delayed metabolic effects, fasting blood was collected on the day of liposuction, within 1 to 2 months and more than 6 months after surgery. Serum leptin, soluble receptor for leptin, adiponectin, insulin, and glucose concentrations were tested and insulin sensitivity was calculated using updated model Homeostasis Model Assessment 2. Both treatment groups (diabetic and nondiabetic patients) experienced similar postsurgical weight reduction with concomitant lowering of body mass index value at 1 to 2 months follow-up, which was sustained after 6 months from surgery. Improvement in insulin sensitivity at 1 to 2 months follow-up was observed (p = .017 and p = .002, for diabetics and nondiabetics, respectively) and this change persisted over the next 4 months. At the same time, no significant changes in adipokines and soluble leptin receptor were found. These data demonstrate that in terms of metabolic consequences, Vibration Amplification of Sound Energy at Resonance abdominal liposuction might have beneficial effects in overweight diabetic and nondiabetic males by improving their insulin sensitivity.

Variations in leptin and insulin levels within one swimming season in non-obese female cold water swimmers.

Abstract Aim: We examined whether cold water swimming for seven consecutive months changes basal leptin and insulin concentrations and insulin sensitivity in healthy non-obese women. Materials and methods: Fourteen recreational female swimmers aged 45 ± 8.7 years, regularly swimming outdoors during winter months were exposed to cold water at least twice a week. Fasting blood samples were collected in October, January and April. Serum leptin, insulin and glucose concentrations were tested and insulin sensitivity was calculated using updated model HOMA2. Results: Repeated cold water baths significantly increased insulin sensitivity and decreased insulin and leptin concentrations (p = 0.006, p = 0.032, p = 0.042, respectively). Leptin concentration positively correlated with body-mass index (BMI) and insulin level (r = 0.412, r = 0.868, respectively). Insulin level inversely correlated with insulin sensitivity and positively with glucose (r = −0.893, r = 0.166, respectively). No associations between leptin and insulin sensitivity were found. Conclusion: Regular cold water swimming may stimulate metabolic changes suggesting that leptin and insulin participate in adaptive metabolic mechanisms triggered by repeated cold exposure accompanied by mild exercise in healthy non-obese women.

The role of clinical guidelines for the management of severe acute pancreatitis

Objective: To present the case of severe acute pancreatitis and identify some of the deviations from practice guidelines, that could negatively affect treatment-related outcomes. Clinical presentation: A 66-year-old male presented at the city hospital with jaundice, fever and abdominal pain. Acute pancreatitis was diagnosed, but not properly classified, and open cholecystectomy with choledochotomy was performed. The patient developed multiple systemic and local complications and his condition worsened. The clinical condition was stabilized after long-term hospitalization (over 40 days) in Emergency Department and Clinic of Gastroenterology, but the recovery was not complete. Conclusions: Patients with acute pancreatitis caused by gallstones require careful preoperative assessment according to the current established recommendations.