Departamento de Fisiologia, Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, São Paulo, São Paulo, Brazil.
Faculdade de Medicina Universidade Federal do Ceará, Departamento de Medicina Clínica e Departamento de Saúde Comunitária, Brazilian Group for the Study of Inherited and Acquired Lipodystrophies (BRAZLIPO) - Hospital Universitário Walter Cantídio, Fortaleza-Ceará, Brazil.
PLoS One. 2021 Jan 7;16(1):e0244667. doi: 10.1371/journal.pone.0244667. eCollection 2021.
Patients with congenital generalized lipodystrophy (CGL) have very low levels of leptin and are described as having a voracious appetite. However, a direct comparison between CGL and eutrophic individuals is lacking, regarding both appetite parameters and acylated ghrelin, the hormone form that is active in acute food intake stimulation. The objective of the present study was to address whether and in what extent the subjective appetite parameters and acylated ghrelin response to a meal are affected in CGL individuals, in comparison to eutrophic individuals. Additionally, an obese group was included in the study, to allow the comparison between a leptin-resistant and a leptin-deficient condition on these aspects.
Eutrophic controls (EUT, n = 10), obese subjects (OB, n = 10) and CGL (n = 11) were fasted overnight and then received an ad libitum meal. Blood was collected and the visual analogue scale was applied before and 90 minutes after the meal. An additional blood sample was collected at 60 minutes for ghrelin determination.
The CGL patients showed low fasting levels of leptin and adiponectin, dyslipidemia, and insulin resistance. The caloric intake was similar among the 3 groups. However, both CGL (p = 0.02) and OB (p = 0.04) had shorter satiation times than EUT. The CGL patients also had lower satiety time (p = 0.01) and their sensation of hunger was less attenuated by the meal (p = 0.03). Fasting acylated ghrelin levels were lower in CGL than in EUT (p = 0.003). After the meal, the levels tended to decrease in EUT but not in CGL and OB individuals.
The data indicate that, although not hyperphagic, the CGL patients present appetite disturbances in relation to eutrophic individuals. Their low fasting levels of acylated ghrelin and the absence of the physiological drop after meal intake suggest a role of these disturbances in hunger attenuation and satiety but not in acute satiation.
患有先天性全身性脂肪营养不良（CGL）的患者瘦素水平极低，被描述为食欲旺盛。然而，缺乏 CGL 与营养良好个体之间在食欲参数和酰化 ghrelin（一种在急性食物摄入刺激中起作用的激素形式）方面的直接比较。本研究的目的是确定 CGL 个体的主观食欲参数和酰化 ghrelin 对膳食的反应是否以及在何种程度上受到影响，与营养良好的个体进行比较。此外，还纳入了一个肥胖组，以便在这些方面比较瘦素抵抗和瘦素缺乏的情况。
禁食过夜的营养良好的对照组（EUT，n=10）、肥胖组（OB，n=10）和 CGL 组（n=11）接受随意进食餐。在餐前和餐后 90 分钟采集血液并应用视觉模拟评分法，在 60 分钟时采集额外的血液样本用于测定 ghrelin。
CGL 患者表现出瘦素和脂联素水平低、血脂异常和胰岛素抵抗。三组的热量摄入相似。然而，CGL（p=0.02）和 OB（p=0.04）的饱腹感时间都短于 EUT。CGL 患者的饱腹感时间也较短（p=0.01），他们的饥饿感在进餐时减弱较少（p=0.03）。CGL 患者的空腹酰化 ghrelin 水平低于 EUT（p=0.003）。进餐后，EUT 的水平趋于下降，但 CGL 和 OB 个体的水平没有下降。
数据表明，尽管 CGL 患者不贪吃，但他们的食欲与营养良好的个体存在紊乱。他们的空腹酰化 ghrelin 水平较低，以及餐后摄入后没有生理性下降，提示这些紊乱在饥饿感减弱和饱腹感方面发挥作用，但在急性饱食感方面不起作用。
