The Levels of Ghrelin in Children with Cyanotic and Acyanotic Congenital Heart Disease

Hassan Mohammed Al-Asy, Amr A Donia, Doaa M El-Amrosy, Enaam Rabee, Amal Al Bendary
4.803 3.739

Abstract


The cause of growth retardation in congenital heart disease is multifactorial. The relationship between congenital heart disease (CHD), malnutrition, and growth retardation is well documented. Ghrelin has effects on nutrient intake and growth. Ghrelin exerts potent GH-releasing activity and stimulates food intake. Circulating ghrelin levels are increased in anorexia and cachexia, reduced in obesity and restored by weight recovery. The relation between ghrelin and congenital heart disease is evident in adults but it is not studied well in pediatric age. The aim of the present study is to evaluate the serum ghrelin in congenital heart disease. We measured serum ghrelin,  using ELISA technique in 60 patients with congenital heart disease (20 with acyanotic congenital heart disease with no heart failure (HF), 15 with  cyanotic congenital heart disease with no HF) and 25 patients with congenital heart disease (cyanotic or acyanotic) with HF, in addition to 30 age and sex matched children as a control group. All children were subjected to measurement of height, weight, body mass index (BMI). In comparison to controls, serum ghrelin levels were significantly higher in patients with congenital heart disease (acyanotic patients and cyanotic with or without HF than in the control group (p=0.01). Also ghrelin level was significantly increased in children with cyanotic congenital heart disease than in those with acyanotic congenital heart disease. Patient with congenital heart disease with evidence of HF had significant higher levels of serum ghrelin than those with congenital heart disease without HF. Weight, height and BMI were significantly lower in cyanotic and acyanotic patients compared to the control group (p=0.001), also these measures were significantly reduced in patients with congenital heart disease with HF than in those without heart failure. There was a significant negative correlation between serum ghrelin and BMI in patients with heart failure, cyanotic patients and acyanotic patients; (r = -0.608, -0.831 and -0.458)  and  (p = 0.007,  0.02  and 0.017) respectively. In onclusion, serum ghrelin levels is elevated in children with  acyanotic and cyanotic congenital heart disease with or without HF. Increased ghrelin levels represents malnutrition and growth retardation in these patients. This may suggest that ghrelin may have an important role as a compensatory mechanism in the regulation of the metabolic balance in these patients.  


Keywords


Ghrelin , congenital heart disease , cyanotic , a cyanotic , heart failure

Full Text:

E209


DOI: http://dx.doi.org/10.17334/jps.46761

References


Abad-Sinden, A.; Sutphen, JL. Growth and nutrition. In: Allan DH, Gutgesell HP, Clark EB, Driscoll DJ. , editors. Moss and Adams' Heart Disease in Infants, Children, and Adolescents. Philadelphia, Pa, USA: Lippincott Williams & Wilkins; 2001. pp. 325–332.

Arvat E, Di Vito L, Broglio F, et al. Preliminary evidence that Ghrelin, the natural GH secretagogue (GHS)-receptor ligand, strongly stimulates GH secretion in humans. Journal of Endocrinological Investigation. 2000;23:493– 4

Wren AM, Small CJ, Abbott CR, et al.: Ghrelin causes hyperphagia and obesity in rats. Diabetes. 2001;50:2540–2547

Tschöp M, Weyer C, Tataranni PA, Devanarayan V, Ravussin E, Heiman ML. :Circulating ghrelin levels are decreased in human obesity. Diabetes. 2001;50:707–709.

Tschöp M, Smiley DL, Heiman ML. Ghrelin induces adiposity in rodents. Nature. 2000;407(6806):908–913.

Kojima M, Hosoda H, Kangawa K.: Ghrelin, a novel growth-hormone-releasing and appetitestimulating peptide from stomach. Best Practice and Research in Clinical Endocrinology and Metabolism. 2004;18:517–530.

Nakazato M, Murakami N, Date Y, et al.: A role for ghrelin in the central regulation of feeding. Nature. 2001;409(6817):194–198.

Park HS, Lee K-U, Kim YS, Park CY: Relationships between fasting plasma ghrelin levels and metabolic parameters in children and adolescents. Metabolism Clinical and Experimental. 2005;54:925–929.

Whatmore AJ, Hall CM, Jones J, Westwood M, Clayton PE. Ghrelin concentrations in healthy children and adolescents. Clinical Endocrinology. 2003;59:649–654.

Unger R, DeKleermaeker M, Gidding SS, Christoffel KK.: Calories count. Improved weight gain with dietary intervention in congenital heart disease. American Journal of Diseases of Children. 1992;146:1078–1084.

Varan B, Tokel K, Yilmaz G. : Malnutrition and growth failure in cyanotic and acyanotic congenital heart disease with and without pulmonary hypertension. Archives of Disease in Childhood. 1999;81:49–52.

Gingell, RL.; Hornung, MG.: Growth problems associated with congenital heart disease in infancy. In: Lebenthal E. , editor. Textbook of Gastroenterology and Nutrition in Infancy. New York, NY, USA: Raven Press; 1989. pp. 639– 6

Abad-Sinden A, Sutphen JL. Growth and nutrition. In: Allan DH, Gutgesell HP, Clark EB, Driscoll DJ, editors. Moss and Adams' Heart Disease in Infants, Children, and Adolescents. Philadelphia, Pa, USA: Lippincott Williams & Wilkins; 2001. pp. 325–332.

Soriano-Guillén L, Barrios V, Argente J.: Physiopathological features and diagnostic utility of ghrelin protein in pediatrics. Anales de Pediatria. 2004;61:5–7.

Haqq AM, Farooqi IS, O'Rahilly S, et al. Serum ghrelin levels are inversely correlated with body mass index, age, and insulin concentrations in normal children and are markedly increased in Prader-Willi syndrome. The Journal of Clinical Endocrinology and Metabolism. 2003;88:174– 1

Baum D, Beck RQ, Haskell WL. Growth and tissue abnormalities in young people with cyanotic congenital heart disease receiving systemic-pulmonary artery shunts. The American Journal of Cardiology. 1983;52:349–352.

Freeman LM, Roubenoff R. The nutrition implications of cardiac cachexia. Nutrition Reviews. 1994;52:340–347.

Morrison WL, Edwards RHT. Cardiac cachexia. British Medical Journal. 1991;302:301–302.

Rosenthal, A. Nutritional conciderations in the prognosis treatment of children with congenital heart disease. In: Suskind RM, Levinter-Suskind L. , editors. Textbook of Pediatric Nutrition. New York, NY, USA: Raven Press; 1993. pp. 383– 3

McMurray J, Abdullah I, Dargie HJ, Shapiro D. Increased concentrations of tumor necrosis factor in ‘cachectic’ patients with severe chronic heart failure. British Heart Journal. 1991;66:356–358. Nagaya N, Uematsu M, Kojima M, et al. Elevated circulating level of ghrelin in cachexia associated with chronic heart failure: relationships between ghrelin and anabolic/catabolic factors. Circulation. 2001;104:2034–2038.