Serum leptin levels in alcoholic liver cirrhosis: relationship with gender, nutritional status, liver function and energy metabolism

Objective: To determine serum leptin levels in alcoholic liver cirrhosis an d the relationship with gender, nutritional status, liver function, energy metabolism, inflammatory state and refeeding. Subjects: Thirty-seven hospitalized alcoholic cirrhotic patients (M/F: 24/1 3), 27 hospitalized patients at risk of malnutrition but with normal liver function (M/F: 15/12) as control patients, and 31 healthy control subjects (M/F: 17/14) participated. Design: Liver function was assessed from Child-Pugh classification; anthrop ometric parameters and resting energy expenditure (REE) were measured; calo ric intake was evaluated over 5 days, and serum leptin and insulin were ass ayed. The same protocol was performed after 1 month refeeding in 22 patient s, Healthy Subjects were studied as controls for anthropometric parameters and serum leptin levels. Results: Serum leptin levels were higher in male cirrhotic patients than in the other two male groups (P = 0.0079) and in the same range in the female groups. They were higher in female than in male Subjects in the three grou ps. In female cirrhotic patients, logarithmically transformed serum leptin levels correlated significantly with fat mass (P=0.0043), insulin levels (P =0.0072), REE (P=0.0133), bilirubin levels (P <0.0001), prothrombin time (P =0.0003) and Pugh score (P=0.0266) in simple regression analysis and with i nsulin levels (P=0.0137), but not with fat mass (P=0.0761), Pugh score (P=0 .4472) and REE (P=0.4576) in multiple regression analysis. In the male cirr hotic and control patients, log (leptin) levels correlated with CRP (C reac tive protein) (r=0.365, P = 0.0223). Log (leptin) levels did not correlate with caloric intake in any of the groups, Leptin levels (P < 0.05) and fat mass (P < 0.02) increased with refeeding while liver function improved (P < 0.01), Conclusion: There is a gender difference in regulation of serum leptin leve l in alcoholic liver cirrhosis. Insulin level is the best determinant of le ptin level in female patients while inflammatory state related to alcoholic hepatitis seems to have a greater influence in male patients. Although lep tin levels positively correlated with REE in female patients, there is no e vidence that leptin reduces caloric intake and fat stores in these patients .