Appetite and ghrelin levels in iron deficiency anemia and the effect of parenteral iron therapy: A longitudinal study.

Hanin Ghrayeb,Jeries Nashashibi,Adi Elias,Awni Youssef,Masalha Refaat,Liala Mahagna,Mari Manal,Mazen Elias,Naama Schwartz,Emanuele Bobbio

doi:10.1371/journal.pone.0234209

Abstract

BackgroundIron deficiency anemia (IDA) is associated with decreased appetite. The ghrelin hormone is one of the major regulators of appetite.ObjectivesTo evaluate appetite and ghrelin levels in patients with IDA, and to investigate the change in appetite and ghrelin following intravenous iron therapy.MethodsA total of 56 IDA patients and 51 controls were included in the study. Both appetite and ghrelin were assessed at baseline and following intravenous iron therapy. These were assessed at corresponding time intervals in the control group. Appetite was assessed by the SNAQ score (Simplified Nutritional Appetite Questionnaire) and fasting ghrelin levels were assessed by acylated ghrelin (AG), unacylated ghrelin (UAG) and their respective ratio AG/UAG.ResultsIDA patients had significantly lower SNAQ scores, yet higher AG levels and higher AG/UAG ratios compared to healthy controls; the mean SNAQ scores were 12.56 ± 3.45 and 16.1 ± 2, respectively (P<0.01); the median AG levels were 57.5 pg/ml and 43 pg/ml respectively (P = 0.007); and the median AG/UAG ratios were 0.48 and 0.25 respectively (P = 0.04). On multivariate linear regression analysis, IDA remained independently associated with decreased SNAQ score (β = -0.524, P<0.001) and increased acylated ghrelin (β = 0.289, P = 0.013). After IDA was treated, SNAQ scores increased significantly by a mean of 2 points. AG and AG/UAG ratios decreased significantly by a mean of -18.44 pg/ml and -0.2 respectively. The control group showed no significant change in SNAQ scores or ghrelin at corresponding time intervals.ConclusionsIDA patients have a reduced appetite and paradoxically elevated ghrelin hormone activity compared to healthy controls. Treating IDA enhances appetite and lowers ghrelin levels. Future studies are needed to explore the mechanism of this paradoxical ghrelin activity.

Highlights

The prevalence of anemia in 2010 was estimated to be about one third of the word global population [1]
Appetite was assessed by the simplified nutrition assessment questionnaire (SNAQ) score (Simplified Nutritional Appetite Questionnaire) and fasting ghrelin levels were assessed by acylated ghrelin (AG), unacylated ghrelin (UAG) and their respective ratio AG/ UAG
Iron deficiency anemia (IDA) patients had significantly lower SNAQ scores, yet higher AG levels and higher AG/UAG ratios compared to healthy controls; the mean SNAQ scores were 12.56 ± 3.45 and 16.1 ± 2, respectively (P

Summary

Introduction

The prevalence of anemia in 2010 was estimated to be about one third of the word global population [1]. Iron deficiency anemia (IDA) is the leading cause of anemia in both developed and developing countries [2,3]. It is caused by increased body requirements as in pregnant women or thriving children, or in pathologic conditions, such as reduced iron intake, chronic blood loss, or gastrointestinal malabsorption [4]. Oral iron therapy increases the incidence of gastrointestinal adverse events, such as abdominal pain and impaired appetite, which lead to low patient adherence [5]. Iron deficiency anemia (IDA) is associated with decreased appetite. The ghrelin hormone is one of the major regulators of appetite

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Conclusion