Diet-induced Fasting Ghrelin Elevation Reflects the Recovery of Insulin Sensitivity and Visceral Adiposity Regression

Oct 13, 2021The Journal of clinical endocrinology and metabolism

Increased Ghrelin During Diet Fasting May Reflect Improved Insulin Sensitivity and Loss of Belly Fat

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Abstract

Among 294 participants, lower fasting ghrelin levels were associated with unfavorable cardiometabolic parameters.

Participants exhibited a body mass index of 31.3 kg/m2 and an average fasting ghrelin level of 504 ± 208 pg/mL.
Higher visceral adipose tissue, intrahepatic fat, leptin, and blood pressure correlated with lower fasting ghrelin levels.
Changes in fasting ghrelin levels after 18 months varied by sex, with men showing an increase of +7.3% and women a decrease of -9.2%.
Fasting ghrelin levels rose by 10.5% in the green-MED group compared to 1.3% in the healthy dietary guidelines group.
In men, increases in fasting ghrelin levels were associated with improvements in insulin resistance and reductions in visceral fat, independent of weight loss.

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CONTEXT: Lower fasting ghrelin levels (FGL) are associated with obesity and metabolic syndrome.

OBJECTIVE: We aimed to explore the dynamics of FGL during weight loss and its metabolic and adiposity-related manifestations beyond weight loss.

METHODS: This was a secondary analysis of a clinical trial that randomized participants with abdominal obesity/dyslipidemia to 1 of 3 diets: healthy dietary guidelines (HDG), Mediterranean diet (MED), or green-MED diet, all combined with physical activity (PA). Both MED diets were similarly hypocaloric and included 28 g/day walnuts. The green-MED group further consumed green tea (3-4 cups/day) and a Wolffia globosa (Mankai) plant green shake. We measured FGL and quantified body fat depots by magnetic resonance imaging at baseline and after 18 months.

RESULTS: Among 294 participants (body mass index = 31.3 kg/m2; FGL = 504 ± 208 pg/mL; retention rate = 89.8%), lower FGL was associated with unfavorable cardiometabolic parameters such as higher visceral adipose tissue (VAT), intrahepatic fat, leptin, and blood pressure (P < 0.05 for all; multivariate models). The ∆FGL18-month differed between men (+7.3 ± 26.6%) and women (-9.2% ± 21.3%; P = 0.001). After 18 months of moderate and similar weight loss among the MED groups, FGL increased by 1.3%, 5.4%, and 10.5% in HDG, MED, and green-MED groups, respectively (P = 0.03 for green-MED vs HDG); sex-stratified analysis revealed similar changes in men only. Among men, FGL18-month elevation was associated with favorable changes in insulin resistance profile and VAT regression, after adjusting for relative weight loss (HbA1c: r = -0.216; homeostatic model of insulin resistance: r = -0.154; HDL-c: r = 0.147; VAT: r = -0.221; P < 0.05 for all). Insulin resistance and VAT remained inversely related with FGL elevation beyond that explained by weight loss (residual regression analyses; P < 0.05).

CONCLUSION: Diet-induced FGL elevation may reflect insulin sensitivity recovery and VAT regression beyond weight loss, specifically among men. Green-MED diet is associated with greater FGL elevation.

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Diet-induced Fasting Ghrelin Elevation Reflects the Recovery of Insulin Sensitivity and Visceral Adiposity Regression

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