Nutricion Cirrosis

Alcohol & Alcoholism Vol. 38, No. 1, pp. 60–66, 2003 doi:10.1093/alcalc/agg015, available online at www.alcalc.oupjournals.org

LOW SERUM LEPTIN LEVELS AND MALNUTRITION IN CHRONIC ALCOHOL MISUSERS HOSPITALIZED BY SOMATIC COMPLICATIONS
FRANCISCO SANTOLARIA*, ANTONIA PÉREZ-CEJAS1, MARÍA-REMEDIOS ALEMÁN, EMILIO GONZÁLEZ-REIMERS, ANTONIO MILENA1, MARÍA-JOSÉ DE LA VEGA1, ANTONIO MARTÍNEZ-RIERA andMARÍA-ANGELES GÓMEZ-RODRÍGUEZ2
Servicio de Medicina Interna, 1Servicio de Laboratorio and 2Servicio de Medicina Nuclear, Hospital Universitario de Canarias, Spain (Received 1 May 2002; first review notified 20 May 2002; in revised form 12 July 2002; accepted 2 August 2002) Abstract — Aims: Leptin is a peptide produced by fat cells which regulates fat mass by decreasing food intake and increasingresting energy expenditure, so an increase of serum leptin could be an indicator of malnutrition. Our objective was to determine serum leptin levels (at admission and on the 15th day) in 79 male alcohol misusers, hospitalized by somatic complications, who drink more than 80 g ethanol/day, and to analyse its relationships with nutritional status assessed by anthropometry and dual-energy X-rayabsortiometry (DEXA), insulin-like growth factor (IGF-1) and its binding protein (IGF1BP-3); acute phase reaction assessed by C-reactive protein (CRP), interleukin-6 (IL-6) and type II soluble receptor of tumour necrosis factor (TNF) (sTNFRII); serum oestradiol and testosterone; and the amount and duration of ethanol intake, the smoking habit and the presence of liver cirrhosis. Methods: Patients wereadmitted through the emergency room, and blood for the above-mentioned determinations was taken at 08.00 on the following day, so none of the patients was acutely intoxicated at this time. The control group was composed of 32 healthy male (agematched) subjects. Results: Malnutrition was frequent among alcoholics. Serum leptin levels were closely related to total fat both in controls and inalcoholics. Serum leptin levels were decreased in alcoholics, even after adjusting for the amount of fat. Those alcoholics who reported anorexia and weight loss showed decreased leptin levels. After 15 days of hospitalization, serum leptin did not increase, in contrast with LDL cholesterol, serum albumin, prealbumin, IGF-1, IGF1BP-3 and testosterone which increased, whereas oestradiol and acute phasereactants, such as CRP, IL-6 and sTNFRII, were decreased. Serum leptin was not related to gonadal hormones at admission, but on day 15 we found a negative correlation between leptin and testosterone, and a positive one with oestradiol. Conclusions: Serum leptin levels are related to many factors, e.g. fat mass, age, smoking, serum testosterone and oestradiol levels, growth factors such as IGF-1 andCRP, and cytokines, such as IL-6 and sTNFRII. The most important of these is fat mass, as shown by multivariate analysis. Since serum leptin levels are decreased in alcohol misusers, we consider this decrease to be a consequence of a low fat mass.

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INTRODUCTION Leptin is a cytokine-type peptide which is mainlyproduced by fat tissue. It regulates fat mass by decreasing food intake [it decreases the content of neuropeptide Y (NPY) in the hypothalamus] and increasing resting energy expenditure (Zhang et al., 1994). Leptin is also related to gonadotropin secretion, so that mice and rats deficient in leptin fail to undergo puberal development (Ahima et al., 1996). In addition, leptin is produced by fat under theeffect of proinflammatory cytokines. However, its increase in situations characterized by acute phase reaction, such as sepsis, remains controversial (Arnalich et al., 1999; Carlson et al., 1999; Moses et al., 2001; Papathanassoglou et al., 2001). Chronic ethanol intake may alter serum leptin levels by different mechanisms. Chronic alcoholics, frequently undernourished, show a reduced fat mass...