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      Eating Behavior and Gastric Emptying in Adults with Prader-Willi Syndrome

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          Abstract

          Background/Aims: Prader-Willi syndrome (PWS) is a complex genetic disorder characterized by distinctive physical, behavioral and psychiatric features. One cardinal symptom is excessive eating, often leading to extreme obesity. The etiology of the hyperphagia is unknown, but eating behaviors and gastrointestinal motility could play a pivotal role. In this pilot study, we therefore sought to give a closer description of the two. Methods: 12 PWS adults, 6 men and 6 women, 17–37 years of age with a median BMI of 34.9 were evaluated. Computerized monitoring of eating behavior and assessment of gastric emptying using paracetamol absorption were analyzed. Gastric emptying rate was compared to the rate in normal and obese controls. Results: Eating behavior pattern was nonhomogeneous in the PWS patients, but they experienced both hunger and satiation. In PWS gastric emptying was similar to lean subjects (p > 0.05), but longer than in obese subjects (p < 0.05). Conclusions: Despite obesity, this group of adults with PWS did not display overeating in the test situation and gastric emptying rate was normal. Numbers are small, but the results are important for the treatment of obesity in this special group of patients.

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          Elevated plasma ghrelin levels in Prader Willi syndrome.

          Michael W. Schwartz, Molly E. Cummings, Karine Clément … (2002)
          Article 0 comments Cited 92 times – based on 0 reviews     Review now
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            Ghrelin stimulates gastric emptying and hunger in normal-weight humans.

            Mindy F Levin, J Rehfeld, E Näslund … (2006)
            Ghrelin is produced primarily by enteroendocrine cells in the gastric mucosa and increases gastric emptying in patients with gastroparesis. The objective of the study was to evaluate the effect of ghrelin on gastric emptying, appetite, and postprandial hormone secretion in normal volunteers. This was a randomized, double-blind, crossover study. Subjects included normal human volunteers and patients with GH deficiency. Intervention included saline or ghrelin (10 pmol/kg.min) infusion for 180 min after intake of a radioactively labeled omelette (310 kcal) or GH substitution in GH-deficient patients. Measures consisted of gastric empty-ing parameters and postprandial plasma levels of ghrelin, cholecystokinin, glucagon-like peptide-1, peptide YY, and motilin. The emptying rate was significantly faster for ghrelin (1.26 +/- 0.1% per minute), compared with saline (0.83% per minute) (P < 0.001). The lag phase (16.2 +/- 2.2 and 26.5 +/- 3.8 min) and half-emptying time (49.4 +/- 3.9 and 75.6 +/- 4.9 min) of solid gastric emptying were shorter during ghrelin infusion, compared with infusion of saline (P < 0.001). The postprandial peak in plasma concentration for cholecystokinin and glucagon-like peptide-1 occurred earlier and was higher during ghrelin infusion. There was no significant effect of ghrelin on plasma motilin or peptide YY. There was no difference in gastric emptying before and after GH substitution. Our results demonstrate that ghrelin increases the gastric emptying rate in normal humans. The effect does not seem to be mediated via GH or motilin but may be mediated by the vagal nerve or directly on ghrelin receptors in the stomach. Ghrelin receptor agonists may have a role as prokinetic agents.
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              High circulating ghrelin: a potential cause for hyperphagia and obesity in prader-willi syndrome.

              A Salbe, Angelo DelParigi, Barbora Vozarova … (2002)
              Prader-Willi syndrome (PWS) is a genetic disorder occurring in 1 of 10,000-16,000 live births and is characterized by excessive appetite with progressive massive obesity as well as short stature and mental retardation. Most patients have GH deficiency and hypogonadotropic hypogonadism. The causes of the hyperphagia and abnormal GH secretion are unknown. To determine whether ghrelin, a novel GH secretagogue with orexigenic properties, is elevated in PWS, we measured fasting plasma ghrelin concentration; body composition (dual-energy x-ray absorptiometry); and subjective ratings of hunger (visual analog scale) in seven subjects (6 males and 1 female; age, 26 +/- 7 yr; body fat, 39 +/- 11%, mean +/- SD) with PWS (diagnosis confirmed by genetic test) and 30 healthy subjects (reference population, 15 males and 15 females; age, 32 +/- 7 yr; body fat, 36 +/- 11%) fasted overnight. All subjects were weight stable for at least 6 months before admission to the study. The mean plasma ghrelin concentration was higher in PWS than in the reference population (307 +/- 164 vs. 109 +/- 24 fmol/ml; P < 0.001), and this difference remained significant after adjustment for percentage body fat (P < 0.001). Plasma ghrelin was also higher (P = 0.0004) in PWS than in five healthy subjects fasted for 36 h. A positive correlation was found between plasma ghrelin and subjective ratings of hunger (r = 0.71; P = 0.008). Furthermore, in subjects with PWS, the concentration of the hormone was not different before and after ingestion of 2 ml and a satiating amount of the same liquid meal (ghrelin concentrations: 307 +/- 164 vs. 306 +/- 205 vs. 260 +/- 134 fmol/ml, respectively; ANOVA for repeated measures, P = 0.56). This is the first evidence that ghrelin, a novel orexigenic hormone, is elevated in subjects with PWS. Our finding suggests that ghrelin may be responsible, at least in part, for the hyperphagia observed in PWS.
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                Author and article information

                Journal
                Journal ID (publisher-id): ANM
                Journal ID (nlm-ta): Ann Nutr Metab
                Journal ID (doi): 10.1159/issn.0250-6807
                Title: Annals of Nutrition and Metabolism
                Publisher: S. Karger AG
                ISSN (Print): 0250-6807
                ISSN (Electronic): 1421-9697
                Publication date Subscription-year: 2007
                Publication date (Print): August 2007
                Publication date (Electronic): 09 July 2007
                Volume: 51
                Issue: 3
                Pages: 264-269
                Affiliations
                aDepartment of Endocrinology, Metabolism and Diabetology, Karolinska University Hospital, Solna, bObesity Unit, Karolinska University Hospital, Huddinge, cDivision of Surgery, Danderyd Hospital, Danderyd, and dDepartment of Medicine, Unit of Gastroenterology and Hepatology, Karolinska University Hospital, Solna, Sweden
                Article
                Publisher ID: 105447 Other ID: Ann Nutr Metab 2007;51:264–269
                DOI: 10.1159/000105447
                PubMed ID: 17622785
                SO-VID: 8f635ae6-b049-47c1-be52-1af0c7f5dc33
                Copyright © © 2007 S. Karger AG, Basel
                License:

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Date received : 25 April 2006
                Date accepted : 13 February 2007
                Page count
                Figures: 3, References: 22, Pages: 6
                Categories
                Subject: Original Paper

                ScienceOpen disciplines: Nutrition & Dietetics,Health & Social care,Public health
                Keywords: Obesity,Eating behavior,Gastric emptying,Prader-Willi syndrome
                Data availability:
                ScienceOpen disciplines: Nutrition & Dietetics, Health & Social care, Public health
                Keywords: Obesity, Eating behavior, Gastric emptying, Prader-Willi syndrome

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