Obesity Surgery

, Volume 24, Issue 1, pp 85–94 | Cite as

Fasting and Meal-Suppressed Ghrelin Levels Before and After Intragastric Balloons and Balloon-Induced Weight Loss

Original Contributions



Intragastric balloons may be an option for obese patients with weight loss failure. Its mode of action remains enigmatic. We hypothesised depressed fasting ghrelin concentrations and enhanced meal suppression of ghrelin secretion by the gastric fundus through balloon contact and balloon-induced delayed gastric emptying.


Patients were randomised to a 13-week period of sham or balloon treatment, followed by a 13-week period of balloon treatment in everyone. Blood samples for ghrelin measurement were taken in the fasting state and every 15 min for 1 h after a breakfast meal at the start, after 13 weeks and after 26 weeks. Patients filled out scales to assess satiety and kept a food diary.


Forty obese patients (BMI 43.1 kg/m2) participated. At the start, fasting ghrelin values were low with a blunted ghrelin response to a test meal. The presence of a balloon had no influence on fasting or meal-suppressed ghrelin concentrations. Despite a weight loss of 10 % after 13 weeks and 15 % after 26 weeks, fasting ghrelin concentrations did not change; neither did the ghrelin response to a meal. No relation was found between ghrelin and insulin, satiety, intermeal interval, the number of meals or subsequent energy intake. Ghrelin concentrations were more suppressed with greater weight loss or with balloons located in the fundus.


Ghrelin concentrations did not change by balloon treatment after 13 and 26 weeks and, unexpectedly, did not rise despite substantial weight loss and negative energy balance. This suppression might be of benefit in the maintenance of weight loss but could not be ascribed to the balloon treatment.


Obesity Ghrelin Intragastric balloon Gastric bubble Weight loss therapy Weight loss 


Conflict of Interest

There was no conflict of interest for both authors.


  1. 1.
    Mathus-Vliegen EM. Intragastric balloon treatment for obesity: what does it really offer? Dig Dis. 2008;26:40–4.PubMedCrossRefGoogle Scholar
  2. 2.
    Imaz I, Martinez-Cervell C, Garcia-Alvarez EE, et al. Safety and effectiveness of the intragastric balloon for obesity. A meta-analysis. Obes Surg. 2008;18:841–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Rolls BJ, Roe LS. Effect of the volume of liquid food infused intragastrically on satiety in women. Physiol Behav. 2002;76:623–31.PubMedCrossRefGoogle Scholar
  4. 4.
    Geliebter A, Westreich S, Gage D. Gastric distention by balloon and test-meal intake in obese and lean subjects. Am J Clin Nutr. 1998;48:592–4.Google Scholar
  5. 5.
    Melton PM, Kissileff HR, Pi-Sunyer FX. Cholecystokinin (CCK-8) affects gastric pressure and ratings of hunger and fullness in women. Am J Physiol. 1992;263(2 Pt 2):R452–6.PubMedGoogle Scholar
  6. 6.
    Cecil JE, Francis J, Read NW. Comparison of the effects of a high-fat and high-carbohydrate soup delivered orally and intragastrically on gastric emptying, appetite, and eating behaviour. Physiol Behav. 1999;67:299–306.PubMedCrossRefGoogle Scholar
  7. 7.
    Wren AM, Bloom SR. Gut hormones and appetite control. Gastroenterology. 2007;132:2116–30.PubMedCrossRefGoogle Scholar
  8. 8.
    Delzenne N, Blundell J, Brouns F, et al. Gastrointestinal targets of appetite regulation. Obes Rev. 2010;11:234–50.PubMedCrossRefGoogle Scholar
  9. 9.
    Kojima M, Hosoda H, Date Y, et al. Ghrelin is a growth-hormone-releasing acylated peptide from stomach. Nature. 1999;402:656–60.PubMedCrossRefGoogle Scholar
  10. 10.
    Gnanapavan S, Kola B, Bustin SA, et al. The tissue distribution of the mRNA of ghrelin and subtypes of its receptor, GHS-R, in humans. J Clin Endocrinol Metab. 2002;87:2988.PubMedCrossRefGoogle Scholar
  11. 11.
    Kojima M, Kangawa K. Ghrelin: structure and function. Physiol Rev. 2005;85:495–522.PubMedCrossRefGoogle Scholar
  12. 12.
    Williams DL, Cummings DE, Grill HJ, et al. Meal-related ghrelin suppression requires postgastric feedback. Endocrinology. 2003;144:2765–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Cummings DE, Weigle DS, Frayo RS, et al. Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N Engl J Med. 2002;346(21):1623–30.PubMedCrossRefGoogle Scholar
  14. 14.
    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.PubMedCrossRefGoogle Scholar
  15. 15.
    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.PubMedCrossRefGoogle Scholar
  16. 16.
    Konopko-Zubrzycka M, Nabiukiewicz A, Wroblewski E, et al. The effect of intragastric balloon on ghrelin, leptin and adiponectin levels in patients with morbid obesity. J Clin Endocrinol Metab. 2009;94:1644–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Mathus-Vliegen EM, Tytgat GN. Intragastric balloon for treatment-resistant obesity: safety, tolerance, and efficacy of 1-year balloon treatment followed by a 1-year balloon-free follow-up. Gastrointest Endosc. 2005;61:19–27.PubMedCrossRefGoogle Scholar
  18. 18.
    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.PubMedCrossRefGoogle Scholar
  19. 19.
    English PJ, Ghatei MA, Malik IA, et al. Food fails to suppress ghrelin levels in obese humans. J Clin Endocrinol Metab. 2002;87:2984.PubMedCrossRefGoogle Scholar
  20. 20.
    le Roux CW, Patterson M, Vincent RP, et al. Postprandial plasma ghrelin is suppressed proportional to meal calorie content in normal-weight but not obese subjects. J Clin Endocrinol Metab. 2005;90:1068–71.PubMedCrossRefGoogle Scholar
  21. 21.
    Tschop M, Weyer C, Tataranni PA, et al. Circulating ghrelin levels are decreased in human obesity. Diabetes. 2001;50:707–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Tentolouris N, Kokkinos A, Tsigos C, et al. Differential effects of high-fat and high-carbohydrate content isoenergetic meals on plasma active ghrelin concentrations in lean and obese women. Horm Metab Res. 2004;36:559–63.PubMedCrossRefGoogle Scholar
  23. 23.
    Callahan HS, Cummings DE, Pepe MS, et al. Postprandial suppression of plasma ghrelin level is proportional to ingested caloric load but does not predict intermeal interval in humans. J Clin Endocrinol Metab. 2004;89:1319–24.PubMedCrossRefGoogle Scholar
  24. 24.
    Shiiya T, Nakazato M, Mizuta M, et al. Plasma ghrelin levels in lean and obese humans and the effect of glucose on ghrelin secretion. J Clin Endocrinol Metab. 2002;87:240–4.PubMedCrossRefGoogle Scholar
  25. 25.
    Blom WA, Stafleu A, de Graaf C, et al. Ghrelin response to carbohydrate-enriched breakfast is related to insulin. Am J Clin Nutr. 2005;81:367–75.PubMedGoogle Scholar
  26. 26.
    Monteleone P, Bencivenga R, Longobardi N, et al. Differential responses of circulating ghrelin to high-fat or high-carbohydrate meal in healthy women. J Clin Endocrinol Metab. 2003;88:5510–4.PubMedCrossRefGoogle Scholar
  27. 27.
    Overduin J, Frayo RS, Grill HJ, et al. Role of the duodenum and macronutrient type in ghrelin regulation. Endocrinology. 2005;146:845–50.PubMedCrossRefGoogle Scholar
  28. 28.
    Blom WA, Lluch A, Stafleu A, et al. Effect of a high-protein breakfast on the postprandial ghrelin response. Am J Clin Nutr. 2006;83:211–20.PubMedGoogle Scholar
  29. 29.
    Little TJ, Doran S, Meyer JH, et al. The release of GLP-1 and ghrelin, but not GIP and CCK, by glucose is dependent upon the length of small intestine exposed. Am J Physiol Endocrinol Metab. 2006;291:E647–55.PubMedCrossRefGoogle Scholar
  30. 30.
    Blom WA, Lluch A, Vinoy S, et al. Effects of gastric emptying on the postprandial ghrelin response. Am J Physiol Endocrinol Metab. 2006;290:E389–95.PubMedCrossRefGoogle Scholar
  31. 31.
    Mathus-Vliegen EM, Van Ierland-Van Leeuwen ML, Roolker W. Gastric emptying, CCK release, and satiety in weight-stable obese subjects. Dig Dis Sci. 2005;50:7–14.PubMedCrossRefGoogle Scholar
  32. 32.
    Lucidi P, Murdolo G, Di Loreto C, et al. Ghrelin is not necessary for adequate hormonal counterregulation of insulin-induced hypoglycemia. Diabetes. 2002;51:2911–4.PubMedCrossRefGoogle Scholar
  33. 33.
    McLaughlin T, Abbasi F, Lamendola C, et al. Plasma ghrelin concentrations are decreased in insulin-resistant obese adults relative to equally obese insulin-sensitive controls. J Clin Endocrinol Metab. 2004;89:1630–5.PubMedCrossRefGoogle Scholar
  34. 34.
    Nikolic M, Boban M, Ljubicic N, et al. Morbidly obese are ghrelin and leptin hyporesponders with lesser intragastric balloon treatment efficiency. Obes Surg. 2011;21:1597–604.PubMedCrossRefGoogle Scholar
  35. 35.
    Purnell JQ, Cummings D, Weigle DS. Changes in 24-h area-under-the-curve ghrelin values following diet-induced weight loss are associated with loss of fat-free mass, but not with changes in fat mass, insulin levels or insulin sensitivity. Int J Obes (Lond). 2007;31:385–9.CrossRefGoogle Scholar
  36. 36.
    Hansen TK, Dall R, Hosoda H, et al. Weight loss increases circulating levels of ghrelin in human obesity. Clin Endocrinol (Oxf). 2002;56:203–6.CrossRefGoogle Scholar
  37. 37.
    Weigle DS, Cummings DE, Newby PD, et al. Roles of leptin and ghrelin in the loss of body weight caused by a low fat, high carbohydrate diet. J Clin Endocrinol Metab. 2003;88:1577–86.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • E. M. H. Mathus-Vliegen
    • 1
  • R. I. Eichenberger
    • 1
  1. 1.Department of Gastroenterology and Hepatology, Academic Medical CentreUniversity of AmsterdamAmsterdamThe Netherlands

Personalised recommendations