Escobar L, Freire J M, Girón J A, Vázquez J M, Pajares M, Ortego J, Gavilán I, Chover A J, Carrasco M, Epinosa R, Marín F, Aguilar M
Servicio de Endocrinología y Nutricion, Hospital Universitario Puerta del Mar, Cádiz.
Rev Esp Med Nucl. 2000 Jun;19(3):199-206.
The present study was conducted in order to analyze the relationship existing between leptin and insulin levels in massive weight loss and weight recovery. Thirteen patients with severe obesity, 14 patients with anorexia nervosa and 13 healthy control subjects were studied. The patients with severe obesity underwent a vertical banded gastroplasty followed by an 800 kcal/day diet for 12 weeks. They were evaluated prior to (body mass index [BMI] 51.2 +/- 8.8 Kg/m2) and after drastic weight loss (BMI 40.6 +/- 6.7 Kg/m2). Patients with anorexia nervosa were treated exclusively with nutritional therapy during 12 weeks, and they were evaluated at their lowest weight status (BMI 16.2 +/- 2.2 Kg/m2) and after weight recovery (BMI 17.9 +/- 2.3 Kg/m2). The BMI of the normal subjects was in the normal range of 20 to 27 Kg/m2 (average 22.8 +/- 2.6 Kg/m2). BMI, percentage of body fat, waist circumference, and serum levels of leptin, insulin, and C-peptide were determined in each patient and normal subject. In severely obese patients, serum leptin and insulin decreased significantly after drastic weight reduction (leptin: from 51.8 +/- 22.3 to 23.7 +/- 10.2 ng/ml; insulin: from 27.1 +/- 13.3 to 17.2 +/- 7.2 mU/ml). In patients with anorexia nervosa, the mean serum leptin levels were significantly higher after weight recovery (5.5 +/- 3.2 vs 7.6 +/- 6 ng/ml). Serum leptin in the severe obesity group correlated positively with BMI, percentage body fat and waist circumference before and after weight loss. In those patients suffering from anorexia nervosa, serum leptin correlated positively with the BMI, percentage of body fat, and waist circumference in the low weight state and after weight recovery. In addition, their serum insulin correlated with BMI and waist circumference after weight recovery. These data reveal that serum leptin concentration correlates significantly with the BMI and body fat content 1) in subjects with a range of weight and caloric intake, 2) in obese patients after drastic weight loss; 3) in anorexic patients after weight gain; and that hyper- or normoinsulinemia do not seem to have any influence on the leptin changes caused by weight loss or gain.
本研究旨在分析大幅减重及体重恢复过程中瘦素与胰岛素水平之间的关系。研究对象包括13例重度肥胖患者、14例神经性厌食症患者和13名健康对照者。重度肥胖患者接受垂直捆绑胃成形术，随后进行为期12周、每日800千卡热量的饮食。在大幅减重前（体重指数[BMI]为51.2±8.8千克/平方米）和减重后（BMI为40.6±6.7千克/平方米）对他们进行评估。神经性厌食症患者在12周内仅接受营养治疗，并在其体重最低时（BMI为16.2±2.2千克/平方米）和体重恢复后（BMI为17.9±2.3千克/平方米）进行评估。正常受试者的BMI在20至27千克/平方米的正常范围内（平均为22.8±2.6千克/平方米）。测定了每位患者和正常受试者的BMI、体脂百分比、腰围以及血清瘦素、胰岛素和C肽水平。在重度肥胖患者中，大幅减重后血清瘦素和胰岛素显著下降（瘦素：从51.8±22.3降至23.7±10.2纳克/毫升；胰岛素：从27.1±13.3降至17.2±7.2毫单位/毫升）。在神经性厌食症患者中，体重恢复后血清瘦素平均水平显著升高（5.5±3.2对7.6±6纳克/毫升）。重度肥胖组血清瘦素在减重前后均与BMI、体脂百分比和腰围呈正相关。在那些患有神经性厌食症的患者中，血清瘦素在低体重状态和体重恢复后与BMI、体脂百分比和腰围呈正相关。此外，他们的血清胰岛素在体重恢复后与BMI和腰围相关。这些数据表明，血清瘦素浓度与BMI和体脂含量显著相关：1）在体重和热量摄入范围不同的受试者中；2）在大幅减重后的肥胖患者中；3）在体重增加后的厌食症患者中；并且高胰岛素血症或正常胰岛素血症似乎对体重减轻或增加引起的瘦素变化没有任何影响。
