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Ghrelin, anthropometry and nutritional assessment in geriatric hospital patients

Ghrelin, Anthropometrie und Ernährungsassessment bei geriatrischen Krankenhauspatienten

Zeitschrift für Gerontologie und Geriatrie volume 40, pages 31–36 (2007)Cite this article

Abstract

Loss of appetite is an important causal factor for malnutrition in the elderly, and age-associated changes of hormone levels seem to be of great relevance in this regard. At present there has been no study exploring the role of the appetite stimulating hormone ghrelin in geriatric hospital patients.

Study population

121 (f 82, m 39) patients from two geriatric wards of our hospital. Mean age was 80.2±7.7 years.

Results

The basal ghrelin level (mean 158.43±144.02 pg/ml) showed no gender difference. No association with the age of the patients could be demonstrated. There was an inverse correlation of basal ghrelin with BMI, upper arm circumference, triceps skin fold, basal leptin and insulin. No correlation between established screening/assessment tools for malnutrition – Mini Nutritional Assessment (MNA), Subjective Global Assessment (SGA), Nutritional Risk Screening (NRS) – could be shown. Even after grouping the ghrelin levels into six different disease categories, no significant difference could be shown between them.

Conclusion

For our patients aged 67 to 94, no correlation with age could be shown. Nevertheless the basal level of ghrelin is substantially lower when compared to a younger population with similar BMI, while the anorectic hormone leptin shows no substantial difference. This causes a more anorectic hormonal constellation which may contribute to the loss of appetite in geriatric patients.

Zusammenfassung

Appetitmangel ist ein für die Entstehung der Mangelernährung bei älteren Menschen bedeutender Kausalfaktor, für dessen Entstehung altersassoziierte hormonelle Veränderungen als wesentlich erachtet werden. Bezogen auf geriatrische Patienten existieren bislang keine Untersuchungen zur Rolle des appetitregulierenden Hormons Ghrelin.

Patientengut

121 (w 82, m 39) Patienten zweier akutgeriatrischen Krankenhausstationen. Durchschnittsalter 80,2±7,7 Jahre.

Ergebnisse

Der basale Ghrelinspiegel (Mittelwert 158,43±144,02 pg/ml) wies keine signifikanten Geschlechtsunterschiede auf, noch war eine Assoziation mit dem Alter der Patienten nachweisbar. Es zeigte sich eine signifikante inverse Korrelation des Ghrelinspiegels zu BMI, Oberarmumfang, Trizepshautfaltendicke sowie zum Leptin- und Insulinspiegel. Zwischen den Ghrelinspiegeln und den Ergebnissen etablierter Screening-/Assessmentverfahren bezüglich des Vorliegens einer Mangelernährung – Mini Nutritional Assessment (MNA), Subjective Global Assessment (SGA), Nutritional Risk Screening (NRS) – ließ sich keine Korrelation nachweisen. Nach Zusammenfassung der Patienten zu größeren Erkrankungsgruppen (u. a. zerebrovaskuläre, infektiöse, tumoröse Erkrankungen) zeigte sich bei Vergleich der Ghrelinspiegel keine signifikante Differenz zwischen den Gruppen.

Schlussfolgerung

Obwohl für Patienten zwischen 67 und 94 Jahren keine Korrelation zum Alter nachweisbar war, ist die Höhe des basalen Ghrelinspiegels im Vergleich zu einem jüngeren Kollektiv mit ähnlichen BMI-Werte deutlich geringer. Das anorektische Hormon Leptin zeigt hingegen keine wesentlichen Unterschiede. Es resultiert eine mehr anorektische Hormonkonstellation, die zum Appetitmangel geriatrischer Patienten beitragen kann.

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Literatur

  1. Bauer JM, Vogl T, Wicklein S, Trögner J, Mühlberg W, Sieber CC (2005) Comparison of the mini nutritional assessment, subjective global assessment, and nutritional risk screening (NRS 2002) for nutritional screening and assessment in geriatric hospital patients. Z Gerontol Geriatr 38:322–327

    PubMed  Article  CAS  Google Scholar 

  2. Bertoli S, Magni P, Krogh V, Ruscica M, Dozio E, Testolin G, Battezzati A (2006) Is ghrelin a signal of decreased fat-free mass in elderly subjects? Eur J Endocrinol 155:321–330

    PubMed  Article  CAS  Google Scholar 

  3. Broglio F, Gottero C, Prodam F, Me E, Destefanis S, Riganti F, Ragazzoni F, Seardo MA, van der Lely AJ, Ghigo E (2006) Ghrelin as a new factor in the central network controlling appetite and food intake. In: Mantovani G (ed) Cachexia and wasting. Springer, Milan Berlin Heidelberg New York, pp 235–245

  4. Cummings DE, Purnell JQ, Frayo RS, Schmidova K, Wisse BE, Weigle DS (2001) A preprandial rise in plasma ghrelin levels suggests a role in meal initiation in humans. Diabetes 123:1120–1128

    Google Scholar 

  5. Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, Jeejeebhoy KN (1987) What is subjective global assessment of nutritional status. JPEN 11:8–14

    CAS  Google Scholar 

  6. Di Francesco V, Zamboni M, Dioli A, Zoico E, Mazzali G, Omizzolo F, Bissoli L, Solerte SB, Benini L, Bosello O (2005) Delayed postprandial gastric emptying and impaired gallbaldder contraction together with elevated cholezystokinin and peptide YY serum levels sustain satiety and inhibit hunger in healthy elderly persons. J Gerontol Biol Sci Med Sci 60(12):1581–1585

    Google Scholar 

  7. Erdmann J, Lippl F, Schusdziarra V (2003) Differential effect of protein and fat on ghrelin levels in man. Regul Pept 116:101–107

    PubMed  Article  CAS  Google Scholar 

  8. Erdmann J, Lippl F, Wagenpfeil S, Schusdziarra V (2005) Differential association of basal and postprandial ghrelin with leptin, insulin, and type 2 diabetes. Diabetes 54:1371–1378

    PubMed  CAS  Google Scholar 

  9. Flanagan DE, Evans ML, Monsod TP, Rife F, Heptulla RA, Tamborlane WV, Sherwin RS (2003) The influence of insulin on circulating ghrelin. Am J Physiol Endocrinol Metab 284:E313–E316

    PubMed  CAS  Google Scholar 

  10. Guigoz Y, Vellas B, Garry PJ (1996) Assessing the nutritional status of the elderly: The Mini Nutritional Assessment as part of the geriatric evaluation. Nutr Rev 54:S59–65

    PubMed  CAS  Article  Google Scholar 

  11. Koehler KM (1994) The New Mexico aging process study. Nutr Rev 52:S34–S37

    PubMed  CAS  Article  Google Scholar 

  12. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z, Ad Hoc ESPEN Working Group (2003) Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clinical Nutrition 22:321–336

    PubMed  Article  Google Scholar 

  13. Langenberg C, Bergstrom J, Laughlin AG, Barrett-Connor E (2005) Ghrelin and the metabolic syndrome in older adults. J Clin Endocrinol Metab 90:6448–6453

    PubMed  Article  CAS  Google Scholar 

  14. Langenberg C, Bergstrom J, Laughlin GA, Barrett-Connor E (2005) Ghrelin, adiponectin, and leptin do not predict long-term changes in weight and body mass index in older adults: longitudinal analysis of the Rancho Bernardo cohort. Am J Epidemiol 162:1189–1197

    PubMed  Article  Google Scholar 

  15. Marchesini G, Bianchi G, Lucidi P, Villanova N, Zoli M, De Feo P (2004) Plasma ghrelin concentrations, food intake, and anorexia in liver failure. J Clin Endocrinol Metab 89:2136–2141

    PubMed  Article  CAS  Google Scholar 

  16. Nagaya N, Moriya J, Yasumura Y, Uematsu M, Ono F, Shimizu W, Ueno K, Kitakaze M, Miyatake K, Kangawa K (2004) Effects of ghrelin administration on left ventricular function, exercise capacity, and muscle wasting in patients with chronic heart failure. Circulation 110:3674–3679

    PubMed  Article  CAS  Google Scholar 

  17. Nagaya N, Itoh T, Murakami S, Oya H, Uematsu M, Miyatake K, Kangawa K (2005) Treatment of cachexia with ghrelin in patients with COPD. CHEST 128:1187–1193

    PubMed  Article  CAS  Google Scholar 

  18. Neary NM, Small CJ, Wren AM, Lee JL, Druce MR, Palmierei C, Frost GS, Ghatei MA, Coombes RC, Bloom SR (2004) Ghrelin increases energy intake in cancer patients with impaired appetite: Acute, randomized, placebo-controlled trial. J Clin Endocrinol Metab 89:2832–2836

    PubMed  Article  CAS  Google Scholar 

  19. Otto B, Cuntz U, Fruehauf E, Wawarta R, Folwaczny C, Riepl RL, Heiman ML, Lehnert P, Fichter M, Tschop M (2001) Weight gain decreases elevated plasma ghrelin concentrations of patients with anorexia nervosa. Eur J Endocrinol 145:669–673

    PubMed  Article  CAS  Google Scholar 

  20. Rigamonti AE, Pincelli AI, Corra B, Viarengo R, Bonomo SM, Galimberti D, Scacchi M, Scarpine E, Cavagnini F, Muller EE (2002) Plasma ghrelin concentrations in elderly subjects: comparison with anorectic and obese patients. J Endocrinol 175:R1–R5

    PubMed  Article  CAS  Google Scholar 

  21. Roberts SB, Rosenberg I (2006) Nutrition and aging: changes in the regulation of energy metabolism with aging. Physiol Rev 86:651–667

    PubMed  Article  CAS  Google Scholar 

  22. Rothenberg EM (2002) Resting, activity and total energy expenditure at age 91–96 compared to age 73. J Nutr Health Aging 6:177–178

    PubMed  CAS  Google Scholar 

  23. Sjogren A, Osterberg T, Steen B (1994) Intake of energy, nutrients and food items in a ten-year cohort comparison and in a six-year longitudinal perspective: a population study of 70- and 76-year-old Swedish people. Age Aging 23:108–112

    Article  CAS  Google Scholar 

  24. Sturm K, MacIntosh CG, Parker BA, Wishart J, Horowitz M, Chapman IM (2003) Appetite, food intake, and plasma concentrations of cholezystokinin, ghrelin, and other gastrointestinal hormones in undernourished older women and well-nourished young and older women. J Clin Endocrinol Metab 88:3747–3755

    PubMed  Article  CAS  Google Scholar 

  25. Volkert D (2004) Ernährungszustand, Energie- und Substratstoffwechsel im Alter. Aktuel Ernaehr Med 29:190–197

    Article  Google Scholar 

  26. Yukawa M, Cummings DE, Matthys CC, Callahan HS, Frayo RS, Spiekerman CF, Weigle DS (2006) Effect of aging on the response of ghrelin to acute weight loss. J Am Geriatr Assoc 54:648–653

    Article  Google Scholar 

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Affiliations

  1. Lehrstuhl für Innere Medizin V – Geriatrie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Medizinische Klinik 2 Klinikum Nürnberg, Prof.-Ernst-Nathan-Straße 1, 90419, Nürnberg, Germany

    J. M. Bauer, R. Wirth, J. Troegner, T. Eberl, H. J. Heppner & C. C. Sieber

  2. Else-Kröner-Fresenius-Zentrum für Ernährungsmedizin, Technische Universität München, München, Germany

    J. Erdmann & V. Schusdziarra

Authors
  1. J. M. Bauer
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  2. R. Wirth
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  3. J. Troegner
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  4. J. Erdmann
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  5. T. Eberl
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  6. H. J. Heppner
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  7. V. Schusdziarra
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  8. C. C. Sieber
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Correspondence to J. M. Bauer.

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Bauer, J.M., Wirth, R., Troegner, J. et al. Ghrelin, anthropometry and nutritional assessment in geriatric hospital patients. Z Gerontol Geriatr 40, 31–36 (2007). https://doi.org/10.1007/s00391-007-0429-3

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  • DOI: https://doi.org/10.1007/s00391-007-0429-3

Key words

  • ghrelin
  • appetite regulation
  • geriatric patients
  • Mini Nutritional Assessment
  • Nutritional Risk Screening

Schlüsselwörter

  • Ghrelin
  • Appetitregulation
  • Geriatrische Patienten
  • Mini Nutritional Assessment
  • Nutritional Risk Screening