Skip to main content

Advertisement

SpringerLink
Log in

Morbidly Obese are Ghrelin and Leptin Hyporesponders with Lesser Intragastric Balloon Treatment Efficiency

Ghrelin and Leptin Changes in Relation to Obesity Treatment

  • Clinical Research
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Ghrelin and leptin recently emerged as the most influential neuroendocrine factors in the pathophysiology of obesity. The said peptides act in reciprocity and are responsible for regulation of appetite and energy metabolism. Intragastric balloons acquired worldwide popularity for obesity treatment. However, the roles of ghrelin and leptin in intragastric balloon treatment were still not systematically studied.

Methods

A prospective single-center study included 43 Caucasians treated with BioEnterics intragastric balloon, with age range of 18–60, and divided to non-morbid (body mass index cutoff 40 kg/m2) or morbid type of obesity, with 12 months follow-up. Serum hormonal samples were taken from fasting patients and kept frozen until analyses.

Results

Significant differences were observed in anthropometrics and there were no differences between genders or comorbidities. The baseline weight for non-morbid vs. morbid was 104 kg (90–135) vs. 128.5 kg (104–197). Weight loss was statistically different between the studied groups during the study course with a median control weight at 6 months of 92 kg (72–121) vs. 107 kg (84–163), p < 0.001. Treatment was successful for 18 (94.7%) vs. 16 (66.7%) patients, p = 0.026. Ghrelin varied from 333.3 to 3,416.8 pg/ml and leptin from 1.7 to 61.2 ng/ml, with a statistically significant time-dependent relationship. A significant difference (p = 0.04) with emphasized ghrelin peak was found in the 3rd month of treatment for non-morbidly obese subjects.

Conclusions

The importance of ghrelin and leptin in treatment-induced changes was reaffirmed. Ghrelin hyper-response in non-morbidly obese subjects characterized greater short-term treatment efficiency and landmarked an inclination to weight regain. The results suggest a potential pattern of individualization between obese patients according to body mass index towards intragastric balloon or bariatric surgery. Further studies are needed in order to get better insights in the pathophysiologic mechanisms of obesity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

BIB:

BioEnterics intragastric balloon

BMI:

Body mass index

NASH:

Non-alcoholic steatohepatitis

PCO:

Polycystic ovary syndrome

S:

Silbutramine

O:

Orlistat

A:

Alternative treatment

LTW:

Loss of total weight

%LTW:

Percentage of loss of total weight

EBW:

Excess body weight over the “ideal” BMI of 25 kg/m2

%EWL:

Percentage of excess weight loss

References

  1. Mathus-Vliegen EM. Obesity: intragastric balloons—a bubble to combat the obesity bubble? Nat Rev Gastroenterol Hepatol. 2010;7:7–8.

    Article  PubMed  Google Scholar 

  2. Dumonceau JM, Francois E, Hittelet A, et al. Single vs repeated treatment with the intragastric balloon: a 5-year weight loss study. Obes Surg. 2010;20:692–7.

    Article  PubMed  Google Scholar 

  3. Dastis NS, Francois E, Deviere J, et al. Intragastric balloon for weight loss: results in 100 individuals followed for at least 2.5 years. Endoscopy. 2009;41:575–80.

    Article  PubMed  Google Scholar 

  4. Herve J, Wahlen CH, Schaeken A, et al. What becomes of patients one year after the intragastric balloon has been removed? Obes Surg. 2005;15:864–70.

    Article  PubMed  CAS  Google Scholar 

  5. Dumonceau JM. Evidence-based review of the BioEnterics intragastric balloon for weight loss. Obes Surg. 2008;18:1611–7.

    Article  PubMed  Google Scholar 

  6. Tschop M, Weyer C, Tataranni PA, et al. Circulating ghrelin levels are decreased in human obesity. Diabetes. 2001;50:707–9.

    Article  PubMed  CAS  Google Scholar 

  7. Havel PJ. Peripheral signals conveying metabolic information to the brain: short-term and long-term regulation of food intake and energy homeostasis. Exp Biol Med (Maywood). 2001;226:963–77.

    CAS  Google Scholar 

  8. Davis JF, Choi DL, Schurdak JD, et al. Leptin regulates energy balance and motivation through action at distinct neural circuits. Biol Psychiatry. 2010;69:668–74.

    Article  PubMed  Google Scholar 

  9. Mion F, Napoleon B, Roman S, et al. Effects of intragastric balloon on gastric emptying and plasma ghrelin levels in non-morbid obese patients. Obes Surg. 2005;15:510–6.

    Article  PubMed  Google Scholar 

  10. Konopko-Zubrzycka M, Baniukiewicz A, Wroblewski E, et al. The effect of intragastric balloon on plasma ghrelin, leptin, and adiponectin levels in patients with morbid obesity. J Clin Endocrinol Metab. 2009;94:1644–9.

    Article  PubMed  CAS  Google Scholar 

  11. Martinez-Brocca MA, Belda O, Parejo J, et al. Intragastric balloon-induced satiety is not mediated by modification in fasting or postprandial plasma ghrelin levels in morbid obesity. Obes Surg. 2007;17:649–57.

    Article  PubMed  Google Scholar 

  12. Tymitz K, Engel A, McDonough S, et al. Changes in ghrelin levels following bariatric surgery: review of the literature. Obes Surg. 2011;21:125–30.

    Article  PubMed  Google Scholar 

  13. Tschop M, Wawarta R, Riepl RL, et al. Post-prandial decrease of circulating human ghrelin levels. J Endocrinol Investig. 2001;24:RC19–21.

    CAS  Google Scholar 

  14. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894:i–xii, 1–253.

  15. Favretti F, Mazrizio DL, Segato G, et al. The BioEnterics intragastric balloon for the nonsurgical treatment of obesity and morbid obesity. In: Schauer PR, Schirmer BD, Brethauer SA, et al., editors. Minimally invasive bariatric surgery. New York: Springer; 2007.

    Google Scholar 

  16. Deitel M, Gawdat K, Melissas J. Reporting weight loss 2007. Obes Surg. 2007;17:565–8.

    Article  PubMed  Google Scholar 

  17. Kojima M, Hosoda H, Date Y, et al. Ghrelin is a growth-hormone-releasing acylated peptide from stomach. Nature. 1999;402:656–60.

    Article  PubMed  CAS  Google Scholar 

  18. Date Y, Kojima M, Hosoda H, et al. Ghrelin, a novel growth hormone-releasing acylated peptide, is synthesized in a distinct endocrine cell type in the gastrointestinal tracts of rats and humans. Endocrinology. 2000;141:4255–61.

    Article  PubMed  CAS  Google Scholar 

  19. Ariyasu H, Takaya K, Tagami T, et al. Stomach is a major source of circulating ghrelin, and feeding state determines plasma ghrelin-like immunoreactivity levels in humans. J Clin Endocrinol Metab. 2001;86:4753–8.

    Article  PubMed  CAS  Google Scholar 

  20. Sakata I, Nakamura K, Yamazaki M, et al. Ghrelin-producing cells exist as two types of cells, closed- and opened-type cells, in the rat gastrointestinal tract. Peptides. 2002;23:531–6.

    Article  PubMed  CAS  Google Scholar 

  21. Murray CD, Kamm MA, Bloom SR, et al. Ghrelin for the gastroenterologist: history and potential. Gastroenterology. 2003;125:1492–502.

    Article  PubMed  CAS  Google Scholar 

  22. Gualillo O, Caminos J, Blanco M, et al. Ghrelin, a novel placental-derived hormone. Endocrinology. 2001;142:788–94.

    Article  PubMed  CAS  Google Scholar 

  23. Drazen DL, Vahl TP, D’Alessio DA, et al. Effects of a fixed meal pattern on ghrelin secretion: evidence for a learned response independent of nutrient status. Endocrinology. 2006;147:23–30.

    Article  PubMed  CAS  Google Scholar 

  24. Faraj M, Havel PJ, Phelis S, et al. Plasma acylation-stimulating protein, adiponectin, leptin, and ghrelin before and after weight loss induced by gastric bypass surgery in morbidly obese subjects. J Clin Endocrinol Metab. 2003;88:1594–602.

    Article  PubMed  CAS  Google Scholar 

  25. Lopez-Nava G, Rubio MA, Prados S, et al. BioEnterics(R) intragastric balloon (BIB(R)). Single ambulatory center Spanish experience with 714 consecutive patients treated with one or two consecutive balloons. Obes Surg. 2011;21:5–9.

    Article  PubMed  Google Scholar 

  26. Genco A, Cipriano M, Bacci V, et al. Intragastric balloon followed by diet vs intragastric balloon followed by another balloon: a prospective study on 100 patients. Obes Surg. 2010;20:1496–500.

    Article  PubMed  Google Scholar 

  27. Suzuki H, Hibi T. Does Helicobacter pylori attack ghrelin-producing cells? J Gastroenterol. 2005;40:437–9.

    Article  PubMed  Google Scholar 

  28. Fruhbeck G, Diez Caballero A, Gil MJ. Fundus functionality and ghrelin concentrations after bariatric surgery. N Engl J Med. 2004;350:308–9.

    Article  PubMed  Google Scholar 

  29. Zhang Y, Proenca R, Maffei M, et al. Positional cloning of the mouse obese gene and its human homologue. Nature. 1994;372:425–32.

    Article  PubMed  CAS  Google Scholar 

  30. Considine RV, Sinha MK, Heiman ML, et al. Serum immunoreactive-leptin concentrations in normal-weight and obese humans. N Engl J Med. 1996;334:292–5.

    Article  PubMed  CAS  Google Scholar 

  31. Ahren B, Baldwin RM, Havel PJ. Pharmacokinetics of human leptin in mice and rhesus monkeys. Int J Obes Relat Metab Disord. 2000;24:1579–85.

    Article  PubMed  CAS  Google Scholar 

  32. Soderberg S, Ahren B, Jansson JH, et al. Leptin is associated with increased risk of myocardial infarction. J Intern Med. 1999;246:409–18.

    Article  PubMed  CAS  Google Scholar 

  33. Soderberg S, Ahren B, Stegmayr B, et al. Leptin is a risk marker for first-ever hemorrhagic stroke in a population-based cohort. Stroke. 1999;30:328–37.

    Article  PubMed  CAS  Google Scholar 

  34. Havel PJ. Role of adipose tissue in body-weight regulation: mechanisms regulating leptin production and energy balance. Proc Nutr Soc. 2000;59:359–71.

    Article  PubMed  CAS  Google Scholar 

  35. Levin N, Nelson C, Gurney A, et al. Decreased food intake does not completely account for adiposity reduction after ob protein infusion. Proc Natl Acad Sci USA. 1996;93:1726–30.

    Article  PubMed  CAS  Google Scholar 

  36. Licinio J, Caglayan S, Ozata M, et al. Phenotypic effects of leptin replacement on morbid obesity, diabetes mellitus, hypogonadism, and behavior in leptin-deficient adults. Proc Natl Acad Sci USA. 2004;101:4531–6.

    Article  PubMed  CAS  Google Scholar 

  37. Rosenbaum M, Goldsmith R, Bloomfield D, et al. Low-dose leptin reverses skeletal muscle, autonomic, and neuroendocrine adaptations to maintenance of reduced weight. J Clin Invest. 2005;115:3579–86.

    Article  PubMed  CAS  Google Scholar 

  38. Nikolic M, Mirosevic G, Ljubicic N, et al. Obesity treatment using a BioEnterics intragastric balloon (BIB)—preliminary Croatian results. Obes Surg. 2010. doi:10.1007/s11695-010-0101-7.

    Google Scholar 

  39. Sallet JA, Marchesini JB, Paiva DS, et al. Brazilian multicenter study of the intragastric balloon. Obes Surg. 2004;14:991–8.

    Article  PubMed  Google Scholar 

  40. Mathus-Vliegen EM. Intragastric balloon treatment for obesity: what does it really offer? Dig Dis. 2008;26:40–4.

    Article  PubMed  Google Scholar 

  41. Genco A, Cipriano M, Materia A, et al. Laparoscopic sleeve gastrectomy versus intragastric balloon: a case–control study. Surg Endosc. 2009;23:1849–53.

    Article  PubMed  Google Scholar 

  42. Melissas J, Mouzas J, Filis D, et al. The intragastric balloon—smoothing the path to bariatric surgery. Obes Surg. 2006;16:897–902.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank all professional contributors for English language review and statistical analyses and personnel involved in the medical care of subjects.

Conflicts of interest

None declared

Author information

Authors and Affiliations

  1. Interventional Gastroenterology Unit, Department of Internal Medicine, University Hospital Centre “Sestre Milosrdnice”, Vinogradska 29, Zagreb, 10000, Croatia

    Marko Nikolic, Marko Boban, Neven Ljubicic, Vladimir Supanc, Gorana Mirosevic, Vanja Zjacic-Rotkvic & Petar Gacina

  2. Department of Cardiovascular Diseases, University Hospital Centre “Rebro”, Zagreb, Croatia

    Borka Pezo Nikolic

  3. Department of Clinical Biochemistry, University Hospital Centre “Sestre Milosrdnice”, Zagreb, Croatia

    Ruzica Krpan & Ljubica Posavec

  4. Department of Bariatric Surgery, University Hospital Centre “Sestre Milosrdnice”, Zagreb, Croatia

    Miroslav Bekavac-Beslin

Authors
  1. Marko Nikolic
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marko Boban
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Neven Ljubicic
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vladimir Supanc
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gorana Mirosevic
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Borka Pezo Nikolic
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ruzica Krpan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ljubica Posavec
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Vanja Zjacic-Rotkvic
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Miroslav Bekavac-Beslin
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Petar Gacina
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marko Nikolic.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nikolic, M., Boban, M., Ljubicic, N. et al. Morbidly Obese are Ghrelin and Leptin Hyporesponders with Lesser Intragastric Balloon Treatment Efficiency. OBES SURG 21, 1597–1604 (2011). https://doi.org/10.1007/s11695-011-0414-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-011-0414-1

Keywords

Search

Navigation