The evaluation of serum leptin level and other hormonal parameters in children with severe malnutrition

doi:10.1016/j.clinbiochem.2003.12.010

Clinical Biochemistry

Volume 37, Issue 5, May 2004, Pages 382-387

https://doi.org/10.1016/j.clinbiochem.2003.12.010 Get rights and content

Abstract

Objectives: Protein–energy malnutrition (PEM) is a clinical problem caused by inadequate intake of one or more nutritional elements, and remains as one of the most important health problems in developing countries. The aim of this study is to determine the relationship among leptin concentrations, body weight and concentrations of some serum hormones, e.g., basal GH, IGF-1, basal cortisol and IGF-BP3, in severe malnourished children, and to determine the effects of leptin in malnourished children.

Design and methods: The study group consisted of 36 children diagnosed with PEM. Thirty healthy children were enrolled as the control group. After an overnight fast and before initiation of feedings, fasting venous blood samples were obtained from a forearm vein with needle technique for routine tests, and leptin, IGF-1, IGF-BP3, basal GH and cortisol levels were measured. Tests were carried out in the laboratories of the Department of Biochemistry by commercial kits.

Results: Serum leptin levels of infants with marasmus and kwashiorkor were significantly lower than that of the controls (2.09 ± 0.93 and 2.27 ± 1.01, 6.82 ± 2.28 ng/ml, respectively, P < 0.001). However, there was no significant difference between serum leptin levels in children with marasmus and those with kwashiorkor (P > 0.05). Serum IGF-1 and IGF-BP3 levels were significantly lower in malnourished children (P < 0.001, both). Also, basal GH and cortisol levels were significantly higher in malnourished children (P < 0.001, both). There was a positive correlation among serum leptin levels and IGF-1 and IGF-BP3 levels and also a negative correlation among serum leptin levels and basal GH and cortisol levels in children diagnosed with marasmus or kwashiorkor and the control group.

Conclusions: The decrease of energy intake and adipose tissue and serum IGF-1 levels in children with PEM may result in decrease of leptin secretion. Decrease in serum leptin levels may initiate food intake by increasing appetite and stimulating the secretion of cortisol and GH that might increase energy expenditure through an autocrine mechanism. Moreover, serum leptin level may be an important signal to reflect the metabolism of children with PEM.

Introduction

Protein–energy malnutrition (PEM) is a clinical problem caused by inadequate intake of one or more nutritional elements, and remains as one of the most important health problems in developing countries [1]. Severe form of PEM affects 2–3% of the pediatric population worldwide, and PEM prevalence is approximately 20% in our country [2], [3].

Leptin, a product of the ob gene, is expressed in adipocytes and secreted in pulses and in a nyctohemeral rhythm into circulation [4], [5]. Leptin level reaches the maximum values in the morning and the minimum values in the afternoon [6]. Factors controlling the nyctohemeral rhythm of leptin secretion include sleep and sleep-induced elevations in glucose, insulin and growth hormone (GH) concentrations [7], [8], [9]. Leptin has a suppressive effect on neuropeptide Y (NPY) expression and secretion by neurons in the arcuate nucleus. NPY is a strong stimulator of appetite and is known to be involved in the regulation of various pituitary hormones, e.g., stimulation of insulin like growth factor 1 (IGF-1) through suppression of GH [5], [10], [11]. Human studies have shown that serum leptin concentrations increase with food intake and decrease with fasting at a more rapid rate and greater magnitude than the change in adiposity. Long-term insufficient nutrition influences decrease of leptin concentration [12], [13], [14]. Insulin-like growth factor 1 secretion depends on GH and also on nutritional status, and is stimulated by increase of blood glucose after feeding. In studies on malnourished children, IGF-1 concentrations are found decreased. The biological effects of IGF-1 are regulated by insulin-like growth factor binding proteins (the most important of which is IGF-BP3), which are responsible for its transport in the blood [15], [16].

The aims of this study are to determine the relationship among leptin concentrations, body weight and some serum hormone concentrations, e.g., basal GH, IGF-1, basal cortisol and IGF-BP3 in severe malnourished children, and to evaluate the effects of leptin in malnourished children.

Section snippets

Methods

The study group consisted of 36 children diagnosed with PEM. The body weight and height percentiles of these children were until the third percentile and they did not have any other chronic disease or infection other than nutritional insufficiency. Marasmus and kwashiorkor were identified according to the Wellcome classification of PEM types. Kwashiorkor was identified on children whose body weight to age ratio (according to Gomez) was between 60% and 80%, whose body weight to height ratio

Results

In the study group, 21 cases (7 females and 14 males) were diagnosed as marasmus and 15 cases (6 females and 9 males) as kwashiorkor; in the control group, of the 30 cases, 14 were females and 16 were males. Anthropometric data for the study and control groups are presented in Table 1. Patients with PEM (marasmus and kwashiorkor) had significantly lower weights, heights, weights for age, weights for height, triceps skinfold thickness, BMI and Z score for weight compared with the control group (P

Discussion

Several anthropometric and biochemical parameters are utilized to establish the diagnosis and the identification of malnourished children as having marasmus or kwashiorkor. In this study, the serum leptin level of severely malnourished children was measured and its diagnostic significance was assessed. Leptin is a sensitive marker of nutritional status.

Serum leptin levels changes with nutritional status and energy intake. Thus, it may be an indicator of excess storage of energy or chronic

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The evaluation of serum leptin level and other hormonal parameters in children with severe malnutrition

Abstract

Introduction

Section snippets

Methods

Results

Discussion

Metabolism

Nutrition

Metabolism

Nutrition

Malnutrition

Ontogeny of serum leptin concentrations in the human

Clin. Endocrinol.

Plasma leptin in ınfants: relations to birth weight and weight loss

Am. Acad. Pediatr.

Gain in body fat is inversely related to the nocturnal rise in serum leptin level in young females

J. Clin. Endocrinol. Metab.

Diurnal and ultradian rhythmicity of plasma leptin. Effects of gender and adiposity

J. Clin. Endocrinol. Metab.

Acute and chronic effect of insulin on leptin production in humans

Diabetes

Circadian and ultradian variations of leptin in normal man under continuos enteral nutrition: Relationship to sleep and body temperature

J. Clin. Endocrinol. Metab.

Role of serum leptin in the regulation of weight gain early infancy

Biol. Neonate

Cord blood leptin concentrations in relation to intrauterine growth

Endocrinology