Ghrelin, leptin and insulin in cirrhotic children and adolescents: Relationship with cirrhosis severity and nutritional status ☆

Abstract Objective Ghrelin, leptin, and insulin concentrations are involved in the control of food intake and they seem to be associated with anorexia–cachexia in cirrhotic patients. The present study aimed to investigate the relationship between the nutritional status and fasting ghrelin, leptin and insulin concentrations in pediatric cirrhotic patients. Methods Thirty-nine patients with cirrhosis and 39 healthy controls aged 0–15 years matched by sex and age were enrolled. Severity of liver disease was assessed by Child–Pugh classification, and Pediatric for End Stage Liver Disease (PELD) or Model for End-stage Liver Disease (MELD) scores. Blood samples were collected from patients and controls to assay total ghrelin, acyl ghrelin, leptin and insulin by using a commercial ELISA kit. Anthropometry parameters used were standard deviation score of height-for-age and triceps skinfold thickness-for-age ratio. A multiple linear regression analysis was used to determine the correlation between dependent and independent variables. Results Acyl ghrelin was significantly lower in cirrhotic patients than in controls [142 (93–278) pg/mL vs 275 (208–481) pg/mL, P  = 0.001]. After multiple linear regression analysis, total ghrelin and acyl ghrelin showed an inverse correlation with age; acyl ghrelin was associated with the severity of cirrhosis and des-acyl ghrelin with PELD or MELD scores ≥ 15. Leptin was positively correlated with gender and anthropometric parameters. Insulin was not associated with any variable. Conclusion Low acyl ghrelin and high des-acyl ghrelin concentrations were associated with cirrhosis severity, whereas low leptin concentration was associated with undernourishment in children and adolescents with cirrhosis.