Biological Trace Element Research

, Volume 127, Issue 3, pp 191–199 | Cite as

Serum Zinc, Plasma Ghrelin, Leptin Levels, Selected Biochemical Parameters and Nutritional Status in Malnourished Hemodialysis Patients

Article

Abstract

This study was performed to investigate the serum zinc (Zn), plasma ghrelin, leptin levels and nutritional status, and to evaluate the potential association between malnutrition and these investigated parameters in malnourished hemodialysis (HD) patients. Fifteen malnourished HD patients, aged 42.9 ± 2.11 years, who underwent the HD for 46.44 ± 7.1 months and 15 healthy volunteers, aged 41.0 ± 2.17 years, were included in this study. The nutritional status of the subjects was determined by the subjective global assessment (SGA). Anthropometric measurements were taken by bioelectrical impedance after HD. Blood samples were collected for the analysis of zinc (Zn), ghrelin, leptin, and selected blood parameters. The HD patients consumed less energy and nutrients than controls. In HD patients, body weight, body mass index (BMI) (p < 0.001), basal metabolic rate (BMR), body fat, lean body mass (LBM), serum Zn, copper (Cu) (p < 0.05), sodium (Na) (p < 0.01), glucose (p < 0.05), albumin (p < 0.01), total cholesterol (p < 0.001), and ghrelin (p < 0.05) were lower whereas body water ratio (p < 0.001), serum potassium (K) (p < 0.01), inorganic phosphorous (Pi), blood urea nitrogen, creatinine (p < 0.001), and plasma insulin (p < 0.05) levels were higher than the controls. No difference existed between HD patients and controls regarding plasma leptin levels. There were positive correlations for body weight–fasting glucose and body weight–leptin (p < 0.05), body weight–BMI and body weight–LBM (p < 0.01); body fat–leptin (p < 0.05); BMI–fasting glucose, BMI–leptin, and BMI–body fat (p < 0.05); albumin–hemoglobin and albumin–insulin (p < 0.05). Negative correlation was found for SGA score–ghrelin (p < 0.05). Malnutrition in HD patients may result from inadequate energy and nutrient intake and low Zn and ghrelin levels. Zinc supplementation to the diets of HD patients may be of value to prevent the malnutrition.

Keywords

Hemodialysis Ghrelin Leptin Malnutrition Zinc 

References

  1. 1.
    Rodriguez Ayala E, Pecoits-Filho R, Heimbürger O, Lindholm B, Nordfors L, Stenvinkel P (2004) Associations between plasma ghrelin levels and body composition in end-stage renal disease: a longitudinal study. Nephrol Dial Transplant 19:421–426PubMedCrossRefGoogle Scholar
  2. 2.
    Aguilera A, Cirugeda A, Amair R, Sansone G, Alegre L, Codoceo R, Bajo MA, del Peso G, Diez JJ, Sanchez-Tomero JA, Selgas R (2004) Ghrelin plasma levels and appetite in peritoneal dialysis patients. Adv Perit Dial 20:194–199PubMedGoogle Scholar
  3. 3.
    Stojanovic M, Stojanovic D, Stefanovic V (2008) The impact of malnutrition on mortality in patients on maintenance hemodialysisi in Serbia. Organs 32:398–405CrossRefGoogle Scholar
  4. 4.
    Uyanik F (2004) Bazı iz elementlerin organizmadaki başlıca fonksiyonları ve bağışıklık üzerine etkileri (The main function os some trace element in organism and their effects on immunity). Erciyes Üniversitesi Sağlık Bilimleri Dergisi (Erciyes University Journal of Health Science) 9(2):49–58Google Scholar
  5. 5.
    Mafra D, Cuppari L, Cozzolino SMF (2002) Iron and zinc status of patinets with chronic renal failure who are not on dialysis. J Renal Nutr 12(1):38–41CrossRefGoogle Scholar
  6. 6.
    Mak RH, Cheung W (2006) Energy homeostasis and cachexia in chronic kidney disease. Pediatr Nephrol 21:1807–1814PubMedCrossRefGoogle Scholar
  7. 7.
    Stenvinkel P, Heimburger O, Lönnqvist F (1997) Serum leptin concentrations correlate to plasma insulin concentrations independent of body fat content in chronic renal failure. Nephrol Dial Transplant 12:1321–1325PubMedCrossRefGoogle Scholar
  8. 8.
    Dötsch J, Nüsken K, Schroth M, Rascher W, Meissner U (2005) Alterations of leptin and ghrelin serum concentrations in renal disease: simple epiphenomena. Pediatr Nephrol 20:701–706PubMedCrossRefGoogle Scholar
  9. 9.
    Merabet E, Dagogo-Jack S, Coyne DW, Klein S, Santiago JV, Hmiel SP, Landt M (1997) Increased plasma leptin concentration in end stage renal disease. J Clin Endocrinol Metab 82:847–850PubMedCrossRefGoogle Scholar
  10. 10.
    Landt M, Parvin CA, Dagogo-Jack S, Bryant B, Coyne DW (1999) Leptin elimination in hyperleptinaemic peritoneal dialysis patients. Nephrol Dial Transplant 14:732–739PubMedCrossRefGoogle Scholar
  11. 11.
    Akamizu T, Takaya K, Irako T, Hosoda H, Teramukai S, Matsuyama A, Tada H, Miura K, Shimizu A, Fukushima M, Yokode M, Tanaka K, Kangawa K (2004) Pharmacokinetics, safety, and endocrine and appetite effects of ghrelin administration in young healthy subjects. Eur J Endocriology 150:447–455CrossRefGoogle Scholar
  12. 12.
    Wren AM, Seal LJ, Cohen MA, Brynes AE, Frost GS, Murphy KG, Dhillo WS, Ghatei MA, Bloom SR (2001) Ghrelin enhances appetite and increases food intake in humans. J Clin Endocrinol Metab 86:5992–5995PubMedCrossRefGoogle Scholar
  13. 13.
    Malik IA, English PJ, Ghatei MA, Bloom SR, MacFarlane IA, Wilding JP (2004) The relationship of ghrelin to biochemical and anthropometric markers of adult growth hormone deficiency. Clin Endocrinol (Oxf) 60:137–141CrossRefGoogle Scholar
  14. 14.
    Fagerberg B, Hulten LM, Hulthe J (2003) Plasma ghrelin, body fat, insulin resistance and smoking in clinically healthy men: The atherosclerosis and insulin resistance study. Metabolism 52:1460–1463PubMedCrossRefGoogle Scholar
  15. 15.
    Flanagan DE, Evans ML, Monsod TP, Rife F, Heptulla RA, Tamborlane WV, Sherwin RS (2001) The influence of insulin on circulating ghrelin. Am J Physiol Endocrinol Metab 284(2):313–316Google Scholar
  16. 16.
    Morpurgo PS, Resnik M, Agosti F, Cappiello V, Sartorio A, Spada A (2003) Ghrelin secretion in severely obese subjects before and after a 3-week integrated body mass reduction program. J Endocrinol Invest 26:723–730PubMedGoogle Scholar
  17. 17.
    Tschöp M, Weyer C, Tataranni PA, Devanarayan V, Ravussin E, Heiman ML (2001) Circulating ghrelin levels are decreased in human obesity. Diabetes 50:707–709PubMedCrossRefGoogle Scholar
  18. 18.
    Ukkola O, Poykko SM, Antero Kesaniemi Y (2006) Low plasma ghrelin concentration is an indicator of the metabolic syndrome. Ann Med 38:274–279PubMedCrossRefGoogle Scholar
  19. 19.
    Muccioli G, Pons N, Ghe C, Catapano F, Granata R, Ghigo E (2004) Ghrelin and des-acyl ghrelin both inhibit isoproterenol-induced lipolysis in rat adipocytes via a non-type 1 a growth hormone secretagogue receptor. Eur J Pharmacol 498:27–35PubMedCrossRefGoogle Scholar
  20. 20.
    Perez-Fontan M, Cordido F, Rodriguez-Carmona A, Peteiro J, Garcia-Naveiro R, Garcia-Buela J (2004) Plasma ghrelin levels in patients undergoing hemodialysis and peritoneal dialysis. Nephrol Dial Transplant 19:2095–2100PubMedCrossRefGoogle Scholar
  21. 21.
    Chang CC, Hung CH, Chen HL, Hwang KL, Lin CY (2007) Peritoneal transport characteristics and dwelling time significantly impact ghrelin clearance in peritoneal dialysis patients. Nephrol Dial Transplant 22:224–228PubMedCrossRefGoogle Scholar
  22. 22.
    Jarkovska Z, Hodkova M, Sazamova M, Rosica M, Dusilova-Sulkova S, Marek J, Justova V, Lacinova Z, Haluzik M, Kresk M (2005) Plasma levels of active and total ghrelin in renal failure: A relationship with GH/IGF-I axis. Growth Horm IGF Res 15(6):369–76PubMedCrossRefGoogle Scholar
  23. 23.
    Sun JY, Jing MY, Wang JF, Zi TN, Fu LJ, Lu M, Pan L (2006) Effect of zinc on biochemical parameters and changes in related gene expression assessed by DNA microarrays in pituitary of growing rats. Nutrition 22:187–196PubMedCrossRefGoogle Scholar
  24. 24.
    Iglesias P, Diez JJ, Fernanadez-Reyez MJ, Codoceos R, Alvarez-Fidalgo P, Bajo MA, Aguilera A, Selgas R (2006) Serum ghrelin concentrations in patients with chronic renal failure undergoing dialysis. Clin Endocrinol (Oxf) 64:68–73CrossRefGoogle Scholar
  25. 25.
    Jarkovska Z, Rosicka M, Krsek M et al (2005) Plasma ghrelin levels in patients with end-stage renal disease. Physiol Res 54:403–408PubMedGoogle Scholar
  26. 26.
    Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, Jeejeebhoy KN (1987) What is subjective global assessment of nutritional status? JPEN 11:8–13Google Scholar
  27. 27.
    Nursal TZ, Noyan T, Tarım A, Karakayali H (2005) A new weighted scoring system for Subjective Global Assessment. Nutrition 21:666–671PubMedCrossRefGoogle Scholar
  28. 28.
    Jones CH, Akbani H, Croft DC, Worth DP (2002) The relationship between serum albumin and hydration status in hemodialysis patients. J Renal Nutr 12:209–212CrossRefGoogle Scholar
  29. 29.
    Faintuch J, Morais AA, Silva MA, Vidigal EJ, Costa RA, Lyrio DC, Trindade CR, Karoline KP (2006) Nutritional profile and inflammatory status of hemodialysis patients. Ren Fail 28:295–301PubMedCrossRefGoogle Scholar
  30. 30.
    Suliman ME, Stenvinkel P, Qureshi AR, Bárány P, Heimburger O, Anderstam B, Alvestrand A, Lindholm B (2004) Hyper homocysteinemia in relation to plasma free amino acids, biomarkers of inflammation and mortality in patients with chronic kidney disease starting dialysis therapy. Am J Kidney Dis 44:455–465PubMedCrossRefGoogle Scholar
  31. 31.
    Locatelli Fouque D, Heimburger O, Drüeke TB, Cannata-Andía JB, Hörl WH, Ritz E (2002) Nutritional status in dialysis patients: a European consensus. Nephrol Dial Transplant 17(4):563–72CrossRefGoogle Scholar
  32. 32.
    Mafra D, Cuppari L, Favaro L, Cozzolino SMF (2004) Zinc levels after iron supplementation in patients with chronic kidney disease. J Renal Nutr 14(3):164–169CrossRefGoogle Scholar
  33. 33.
    Bozalioğlu S, Ozkan Y, Turan M, Simşek B (2005) Prevalence of zinc deficiency and immune response in short-term hemodialysis. J Trace Elem Med Biol 18(3):243–252PubMedCrossRefGoogle Scholar
  34. 34.
    Kalaycıoğlu L, Serpek B, Nizamlıoğlu M, Başpınar N, Tiftik AM (2000) Biyokimya, Selçuk Üniv Vet Fak Yayınevi, Konya, ss 35–53Google Scholar
  35. 35.
    Dvornik S, Cuk M, Backi S, Zaputovic L (2006) Serum zinc concentrations in the maintenance hemodialysis patients. Coll Antropol 1:125–129Google Scholar
  36. 36.
    Üstdal M, Özgünen (1997) Hekimlikte biyokimya: Hangi test istenmeli? Barış Kitabevi, İstanbul, ss.101–109Google Scholar
  37. 37.
    Mc Dowell LR (1992) Minerals in animal and human nutrition, Academic Pres Inc California, pp 152–371Google Scholar
  38. 38.
    Underwood JE (1977) Trace elements in human and animal nutrition. Academic, San Francisco London, pp 196–233Google Scholar

Copyright information

© Humana Press Inc. 2008

Authors and Affiliations

  1. 1.Department of Nutrition and Dietetics, Atatürk Health SchoolUniversity of ErciyesKayseriTurkey
  2. 2.Department of Biochemistry, Faculty of Veterinary MedicineUniversity of ErciyesKayseriTurkey
  3. 3.Department of Quality ControlArmy Drug Factory, DışkapıAnkaraTurkey

Personalised recommendations