Nephrology Dialysis Transplantation, Vol 12, Issue 11 2318-2323, Copyright © 1997 by Oxford University Press
G Young, G Woodrow, S Kendall, B Oldroyd, J Turney, A Brownjohn and M Smith
Background: Protein-energy malnutrition occurs in
patients with chronic renal failure primarily due to loss of appetite. The
ob gene protein, leptin, which is secreted by
adipocytes, regulates body composition by lowering food intake. We have
measured plasma leptin in undialysed and dialysed patients and in controls
and the concentrations have been related to body composition, dietary
intake, and biochemistry. Methods: Plasma leptin was
measured by radioimmunoassay in 93 individuals in groups of undialysed,
peritoneal dialysed, and haemodialysed patients and controls. Body
composition was determined by DEXA. Results:
Protein-energy malnutrition was evident in non-dialysed and dialysed
patients from low lean or fat tissues, plasma albumin and transferrin. A
third of the dialysis patients were eating less than prescribed intakes.
Leptin relative to total fat mass (ng/ml/kg) was significantly greater for
patients than for controls, particularly the dialysed patients. Leptin was
highly correlated with total, arm, leg, and all other fat measurements,
e.g. r for leptin vs% total fat was: undialysed 0.88, PD 0.81, HD 0.93, and
controls 0.83 (P <0.0001 for all). Dialysis patients with the
highest leptin/fat mass ratio had low protein intakes and significantly
lower lean tissue mass. Leptin/fat ratio correlated inversely with dietary
intake e.g. with protein intake in g/day an marginally in g/kg of ideal
weight/day. Leptin concentration was unrelated to plasma creatinine or
residual renal function or to the protein 'nutritional indices', albumin
and transferrin. Conclusion: Our data suggests that
leptin is markedly increased in some patients with chronic renal failure.
The association of increased leptin with low protein intake and loss of
lean tissue is consistent with leptin contributing to malnutrition but a
definitive role cannot be substantiated by this study. Key
words: body composition; chronic renal failure; dialysis;
dietary intake; fat; leptin
ORIGINAL ARTICLES
Increased plasma leptin/fat ratio in patients with chronic renal failure: a cause of malnutrition?
Renal Research Unit, Renal Unit and Department of Medical Physics, General Infirmary, Leeds, UK; Corresponding author at: Renal Research Unit, D Floor, Clarendon Wing, Leeds General Infirmary, Leeds LS2 9NS, UK
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