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Ghrelin, Amylin, Gastric Inhibitory Peptide and Cognition in Middle-Aged HIV-Infected and Uninfected Women: The Women’s Interagency HIV Study

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      To explore the gut-brain axis by examining gut hormone levels and cognitive test scores in women with (HIV+) and without (HIV−) HIV infection.


      Participants included 356 women (248 HIV+, 108 at risk HIV−) in the Brooklyn Women’s Interagency HIV Study (WIHS) with measured levels of ghrelin, amylin and gastric inhibitory peptide (GIP), also known as glucose-dependent insulinotropic polypeptide. Cross-sectional analyses using linear regression models estimated the relationship between gut hormones and Trails A, Trails B, Stroop interference time, Stroop word recall, Stroop color naming and reading, and Symbol Digit Modalities Test (SDMT) with consideration for age, HIV infection status, Wide Range Achievement Test score (WRAT), CD4 count, insulin resistance, drug use, and race/ethnicity.


      Among women at mid-life with chronic (at least 10 years) HIV infection or among those at risk, ghrelin, amylin and GIP were differentially related to cognitive test performance by cognitive domain. Better performance on cognitive tests was generally associated with higher ghrelin, amylin and GIP levels. However, the strength of association varied, as did significance level by HIV status.


      Previous analyses in WIHS participants have suggested that higher BMI, waist, and WHR are associated with better cognitive function among women at mid-life with HIV infection. This study indicates that higher gut hormone levels are also associated with better cognition. Gut hormones may provide additional mechanistic insights regarding the association between obesity and Type 2 diabetes and cognition in middle-aged HIV+ and at risk HIV− women. In addition, measuring these hormones longitudinally would add to the understanding of mechanisms of actions of these hormones and their use as potential clinical tools for early identification and intervention on cognitive decline in this vulnerable population.

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      Most cited references 74

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      Studies of interference in serial verbal reactions.

       J. R. Stroop (1935)
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        Ghrelin is a growth-hormone-releasing acylated peptide from stomach.

        Small synthetic molecules called growth-hormone secretagogues (GHSs) stimulate the release of growth hormone (GH) from the pituitary. They act through GHS-R, a G-protein-coupled receptor for which the ligand is unknown. Recent cloning of GHS-R strongly suggests that an endogenous ligand for the receptor does exist and that there is a mechanism for regulating GH release that is distinct from its regulation by hypothalamic growth-hormone-releasing hormone (GHRH). We now report the purification and identification in rat stomach of an endogenous ligand specific for GHS-R. The purified ligand is a peptide of 28 amino acids, in which the serine 3 residue is n-octanoylated. The acylated peptide specifically releases GH both in vivo and in vitro, and O-n-octanoylation at serine 3 is essential for the activity. We designate the GH-releasing peptide 'ghrelin' (ghre is the Proto-Indo-European root of the word 'grow'). Human ghrelin is homologous to rat ghrelin apart from two amino acids. The occurrence of ghrelin in both rat and human indicates that GH release from the pituitary may be regulated not only by hypothalamic GHRH, but also by ghrelin.
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          No adjustments are needed for multiple comparisons.

           K Rothman,  Rup Phukan (1990)
          Adjustments for making multiple comparisons in large bodies of data are recommended to avoid rejecting the null hypothesis too readily. Unfortunately, reducing the type I error for null associations increases the type II error for those associations that are not null. The theoretical basis for advocating a routine adjustment for multiple comparisons is the "universal null hypothesis" that "chance" serves as the first-order explanation for observed phenomena. This hypothesis undermines the basic premises of empirical research, which holds that nature follows regular laws that may be studied through observations. A policy of not making adjustments for multiple comparisons is preferable because it will lead to fewer errors of interpretation when the data under evaluation are not random numbers but actual observations on nature. Furthermore, scientists should not be so reluctant to explore leads that may turn out to be wrong that they penalize themselves by missing possibly important findings.

            Author and article information

            [1 ]Department of Medicine, Division of Endocrinology, State University of New York - Downstate Medical Center, Brooklyn, NY, USA
            [2 ]Department of Health Sciences Research, Division of Epidemiology, and Department of Neurology Mayo Clinic, Rochester, MN, USA
            [3 ]Empire Clinical Research Program (ECRIP) fellow, Department of Neurology, State University of New York - Downstate Medical Center, Brooklyn, NY, USA
            [4 ]Blood Systems Research Institute, San Francisco, CA, USA
            [5 ]Department of Medicine/STAR Program, State University of New York - Downstate Medical Center, Brooklyn, NY, USA
            [6 ]Maimonides Hospital, Brooklyn, NY, USA
            [7 ]Department of Obstetrics and Gynecology, State University of New York - Downstate Medical Center, Brooklyn, NY, USA
            [8 ]Department of Neurology, State University of New York - Downstate Medical Center, Brooklyn, NY, USA
            [9 ]Neuropsychiatric Epidemiology Unit, University of Gothenburg, Gothenburg, Sweden
            Author notes
            [* ]Corresponding author: Deborah R Gustafson, Department of Neurology, SUNY Downstate Medical Center, Box 1213, 450 Clarkson Ave, Brooklyn, NY 11203, USA, Tel: 718-270-1581; Fax: 718-221-5761; deborah.gustafson@
            J Neurol Neurophysiol
            J Neurol Neurophysiol
            Journal of neurology & neurophysiology
            21 April 2017
            8 February 2017
            February 2017
            05 July 2017
            : 8
            : 1
            5497768 10.4172/2155-9562.1000413 NIHMS866514

            This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.



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