Leptin and insulin response to long-term total parenteral nutrition depends on body fat mass

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• 作者：Kinan Rifai ; Stephan C. Bischoff ; Adji Widjaja ; Georg Brabant ; Michael P. Manns ; Johann Ockenga
• 关键词：Clinical trial ; Total parenteral nutrition ; Leptin ; Insulin ; Body composition
• 刊名：Clinical Nutrition
• 出版年：2006
• 出版时间：October 2006
• 年：2006
• 卷：25
• 期：5
• 页码：773-779
• 全文大小：169 K

文摘

Circulating leptin and insulin concentrations are physiologically representing energy homeostasis. However, the artificial situation of long-term total parenteral nutrition (TPN) and its effects on serum leptin and insulin is not fully understood.

Methods

We studied 42 gastroenterological patients who received TPN for 19±11 days. Serum leptin and insulin levels as well as body composition assessed by bioelectrical impedance analysis were evaluated on days 0, 7 and 14. Insulin sensitivity was estimated by calculating the QUICKI.

Results

Before the start of TPN, leptin correlated positively with female gender (P<0.03), BMI (P<0.02), fat mass (P<0.02), insulin levels (P<0.001) and QUICKI (P<0.001). Within the first week of TPN, an increase of leptin levels was found only in patients with a body fat mass of >30 % (P<0.02). As these were predominantly women, their leptin levels increased likewise (P<0.003). In regression analysis, fat mass (P<0.001), female gender (P<0.04), insulin levels (P<0.03), and i.v. glucose supply rates (P<0.05) were independently associated to leptin levels.

Conclusions

TPN—especially glucose—induces a neurohumoral response as shown here for leptin and insulin that is mainly depending on the fat mass. Better understanding of this regulatory mechanism during artificial nutrition could offer a new approach to improve its therapeutic effects.