Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Research Group on Geriatrics, Working Group Nutrition and Body Composition, Berlin, Germany.
German Institute of Human Nutrition Potsdam - Rehbrücke, Department of Physiology and Energy Metabolism, Nuthetal, Germany.
Nutrition. 2019 Jul-Aug;63-64:81-86. doi: 10.1016/j.nut.2018.11.004. Epub 2018 Nov 22.
Fibroblast growth factor (FGF)21 is promptly induced by short fasting in animal models to regulate glucose and fat metabolism. Data on FGF21 in humans are inconsistent and FGF21 has not yet been investigated in old patients with cachexia, a complex syndrome characterized by inflammation and weight loss. The aim of this study was to explore the association of FGF21 with cachexia in old patients compared with their healthy counterparts.
Serum FGF21 and its inactivating enzyme fibroblast activation protein (FAP)-α were measured with enzyme-linked immunoassays. Cachexia was defined as ≥5% weight loss in the previous 3 mo and concurrent anorexia (Council on Nutrition appetite questionnaire).
We included 103 patients with and without cachexia (76.9 ± 5.2 y of age) and 56 healthy controls (72.9 ± 5.9 y of age). Cachexia was present in 16.5% of patients. These patients had significantly higher total FGF21 levels than controls (952.1 ± 821.3 versus 525.2 ± 560.3 pg/mL; P = 0.012) and the lowest FGF21 levels (293.3 ± 150.9 pg/mL) were found in the control group (global P < 0.001). Although FAP-α did not differ between the three groups (global P = 0.082), bioactive FGF21 was significantly higher in patients with cachexia (global P = 0.002). Risk factor-adjusted regression analyses revealed a significant association between cachexia and total (β = 649.745 pg/mL; P < 0.001) and bioactive FGF21 (β = 393.200 pg/mL; P <0.001), independent of sex, age, and body mass index.
Patients with cachexia exhibited the highest FGF21 levels. Clarification is needed to determine whether this is an adaptive response to nutrient deprivation in disease-related cachexia or whether the increased FGF21 values contribute to the catabolic state.
成纤维细胞生长因子 21（FGF21）在动物模型中可迅速被短期禁食诱导，以调节葡萄糖和脂肪代谢。人类中关于 FGF21 的数据并不一致，并且尚未在伴有炎症和体重减轻的复杂恶病质的老年患者中研究 FGF21。本研究的目的是比较 FGF21 与老年恶病质患者和健康对照者的相关性。
采用酶联免疫吸附法测定血清 FGF21 及其失活酶成纤维细胞激活蛋白（FAP）-α。定义恶病质为过去 3 个月体重下降≥5%，同时伴有厌食（营养学会食欲问卷）。
共纳入 103 例恶病质患者（76.9 ± 5.2 岁）和 56 例健康对照者（72.9 ± 5.9 岁）。16.5%的患者存在恶病质。与对照组相比，这些患者的总 FGF21 水平明显更高（952.1 ± 821.3 比 525.2 ± 560.3 pg/ml；P=0.012），而对照组的 FGF21 水平最低（293.3 ± 150.9 pg/ml；全局 P<0.001）。尽管三组间 FAP-α 无差异（全局 P=0.082），但恶病质患者的生物活性 FGF21 明显更高（全局 P=0.002）。调整危险因素的回归分析显示，恶病质与总 FGF21（β=649.745 pg/ml；P<0.001）和生物活性 FGF21（β=393.200 pg/ml；P<0.001）呈显著相关，与性别、年龄和体重指数无关。
恶病质患者表现出最高的 FGF21 水平。尚需进一步阐明，这是疾病相关恶病质中对营养缺乏的适应性反应，还是增加的 FGF21 值导致了分解代谢状态。
