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Serum leptin correlates with fat mass but not dietary energy intake in continuous ambulatory peritoneal dialysis patients.

OBJECTIVES: In view of previous studies demonstrating hyperleptinemia in uremic and hemodialysis patients, the aims of the present study were to determine whether serum leptin levels are elevated in peritoneal dialysis (PD) patients, to establish whether leptin is significantly removed by PD, and to elucidate the relationship of plasma leptin to body composition, dietary intake, nutritional indices, and dialysis adequacy. DESIGN: Cross-sectional analysis of PD patients and matched healthy controls. SETTING: Tertiary-care institutional dialysis center. PARTICIPANTS: The study included 49 PD patients [35 women and 14 men; median age 63 years, interquartile range (IQR) 49.5-68.5 yr; body mass index (BMI) 25.5 +/- 0.8] and 27 controls (11 men and 16 women; median age 42 years, IQR 34.8-51; BMI 27.2 +/- 0.9). For evaluation of leptin clearance, 8 patients receiving nocturnal intermittent PD were also evaluated. MAIN OUTCOME MEASURES: The primary outcome measure was plasma leptin concentration. Dialysate leptin concentration was also measured in 7 patients. RESULTS: Serum leptin levels were significantly higher (p < 0.01) in patients (males: median 11 ng/mL, IQR 9-19 ng/mL; females: 53 ng/mL, 19.5-128 ng/mL) compared with controls (males: 5.5 ng/mL, 4-9.5 ng/mL; females: 12 ng/mL, 9.8-17.3 ng/mL). Leptin levels in both groups correlated positively with BMI (r = 0.64 and 0.60, respectively; p < 0.0001) and with percentage body fat determined by dual-energy x-ray absorptiometry (r = 0.86 and 0.82, respectively; p < 0.01). Dialysis patients exhibited a greater increase in serum leptin for any given increase in BMI. No significant correlation was observed between leptin concentration and residual renal function, dialysis adequacy (Kt/V), dietary protein or caloric intake, or serum levels of albumin, prealbumin, C-reactive protein, glucose, and insulin-like growth factor-I. Although leptin was detectable in peritoneal dialysate after a 6-hour dwell (median 4.2 ng/mL, IQR 1.1-8.5 ng/mL, n = 8), serum leptin levels were not appreciably lowered following intermittent PD via an automated cycler (63.9 +/- 19.3 ng/mL vs 57.6 +/- 20.5 ng/mL, p = NS, n = 8). CONCLUSIONS: Serum leptin levels are elevated in PD patients and are not appreciably cleared by PD. Although hyperleptinemia correlates poorly with dialysis adequacy and protein intake, a strong and significant relationship was maintained between serum leptin and fat mass. Serum leptin could therefore serve as a useful clinical marker of body fat content in PD patients.

Adipose Tissue↗
PubMed1977

Amino acid fortification of wheat diets fed at varying levels of energy intake to rats.

The effects on growth and nitrogen utilization of protein quality improvement of white bread fed under varying degrees of adequacy of food energy have been studied. Weanling rats were fed white bread bread plus lysine, and bread plus lysine plus threonine at energy levels ranging from 55% to 100% of ad libitum consumption. Weight gain, protein efficiency ratio (PER), net protein ratio (NPR), and net protein utilization (NPU) were measured and plotted against food consumption. The improvement in growth and nitrogen utilization resulting from amino acid fortification of bread, even when food intake was little more than half ad libitum consumption, was significant. For example, the NPR and NPU values obtained with lysine fortified bread fed at 70% of adlibitum consumption were 1.5 to 2 times those obtained with unfortified bread in spite of the fact that the latter rats consumed 25% more food energy. The implications of these findings for practical problems in human nutrition are discussed.

Animals↗
PubMed1993

Relationship of premorbid mass and energy intake to increase of body mass during the treatment of anorexia nervosa.

Dietary intakes were compared in two groups of patients with anorexia nervosa, those who had earlier been "heavy" (n = 27, peak body mass = 65.0 +/- 7.5 kg) and those who had always been "light" (n = 25, peak body mass = 51.5 +/- 7.3 kg). Both groups were initially given a food intake of 7.5 MJ per day, and this was increased as needed to yield a controlled 1-2 kg per week increase of body mass. Body mass was restored most rapidly in the patients who reached the lowest weights, whether the classification was based upon the lowest body mass observed during the illness (gain in weeks 0-7, p < .002) or the body mass on admission to hospital (gain in weeks 0-14, p < .02, weeks 7-14, p < .01). Classifying patients in terms of their peak premorbid mass, the light group consumed food energy at a faster rate than the heavy group over the first 7 weeks of hospital treatment (p < .008), but nevertheless they did not gain more weight. Food intake reached a plateau in both groups between weeks 7 and 14 of treatment, although the light group was still consuming more energy than the heavy subjects (p < .005). Prospective observations on two light and two heavy patients confirmed both the time course of weight gain and the greater energy needed for a given increase of body mass in light patients. It is suggested that during the early stages of recovery from anorexia nervosa, energy utilization is more efficient in the heavier patients. However, it seems more difficult to sustain a high food intake in such patients, possibly because they fear a return to obesity.

Adolescent↗