Importance of plasma ghrelin levels with special reference to nutritional metabolism and energy expenditure in pediatric patients with severe motor and intellectual disabilities
Importance of plasma ghrelin levels with special reference to nutritional metabolism and energy expenditure in pediatric patients with severe motor and intellectual disabilities
复制标题
血浆生长素释放肽水平的重要性，特别是对于患有严重运动和智力障碍的儿科患者的营养代谢和能量消耗
DOI：
10.1016/j.clnesp.2021.01.043
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发表时间：
2021
影响因子：
3
通讯作者：
Takaharu Oue
中科院分区：
文献类型：
--
作者：
Masahiro Zenitani;Hiroshi Hosoda;Satoko Nose;Kenji Kangawa;Hisayoshi Kawahara;Takaharu Oue
背景与目的严重运动和智能障碍(SMID)儿童患者的营养代谢是复杂的，因此，很难对能量需求进行适当的估计。为了探讨Ghrelin在能量代谢调节中的作用，我们调查了SMID患儿血浆Ghrelin水平，并分析了其作为能量储备调节指标的营养意义。方法对40例SMID患者，包括脑瘫(CP)和肌肉疾病(MD)患者(n=20)和健康对照组(n=13)进行空腹血浆总、酰基和去酰基ghrelin水平检测。分析血浆Ghrelin水平与人体测量、血营养指标、能量摄入量、静息能量消耗(REE)的相关性。结果SMID患者的体重指数(BMI)、体重z分数(BW)、身高、体重指数(BMI)、白蛋白(Alb)显著低于对照组。CP患者的总生长激素、酰基生长素、中上臂周长(MUAC)、视黄醇结合蛋白、转甲状腺素、肌酐和血糖均显著高于MD患者。CP患者的总Ghrelin、酰化Ghrelin和MD患者的Des-acyl Ghrelin与MUAC和上臂脂肪面积呈显著负相关。在CP患者中，总Ghrelin和酰基Ghrelin与REE/BW(千卡/千克)呈显著正相关，总Ghrelin对REE/BW有预测作用(R2=0.625，P<0.0001)。在CP患者中，总Ghrelin和酰基Ghrelin相反地反映了全身脂肪质量，导致与REE/BW呈显著正相关。血浆Ghrelin的测定可能有助于评估儿童SMID患者的营养代谢和能量储备，如CP和MD患者。
Background & aimsNutritional metabolism is complex in pediatric patients with severe motor and intellectual disability (SMID), and therefore, appropriate estimation of the energy requirements is difficult. Focusing on ghrelin's role in energy metabolism regulation, we investigated plasma ghrelin levels in pediatric SMID patients and analyzed its nutritional significance as a regulatory marker of energy reserve.MethodsFasting plasma total, acyl, and des-acyl ghrelin levels in 40 patients with SMID, including cerebral palsy (CP) (n = 20) and muscular disease (MD) (n = 8), and healthy controls (n = 13) were investigated. The correlations of plasma ghrelin levels with anthropometry, blood nutritional markers, energy intake, and resting energy expenditure (REE) measured with indirect calorimetry were analyzed. Apvalue < 0.05 was considered significant.ResultsSMID patients had significantly higher acyl ghrelin, and lower body mass index (BMI), z-scores of body weight (BW), body height and BMI, and albumin than controls. CP patients had significantly higher total and acyl ghrelin, z-score of the mid-upper arm circumference (MUAC), retinol-binding protein, transthyretin, creatinine, and glucose than MD patients. Total and acyl ghrelin in CP patients and des-acyl ghrelin in MD patients had significant negative correlations with MUAC and upper arm fat area. In CP patients, total and acyl ghrelin had significant positive correlations with REE/BW (kcal/kg), and total ghrelin was predictive of REE/BW (r2= 0.625,p< 0.0001).ConclusionsAn increase in acyl ghrelin observed in SMID patients possibly indicates energy reserve deficiency. In CP patients, total and acyl ghrelin inversely reflected total body fat mass, resulting in strongly positive correlations with REE/BW. The measurement of plasma ghrelin may be useful to assess nutritional metabolism and energy reserve in pediatric SMID patients, such as CP and MD patients.