A Preprandial Rise in Plasma Ghrelin Levels Suggests a Role in Meal Initiation in Humans

A Preprandial Rise in Plasma Ghrelin Levels Suggests a Role in Meal Initiation in Humans David E. Cummings 1 , Jonathan Q. Purnell 2 , R. Scott Frayo 1 , Karin Schmidova 1 , Brent E. Wisse 1 and David S. Weigle 1 1 University of Washington, VA Puget Sound Health Care System and Harborview Medical Center, Seattle, Washington 2 Oregon Health Sciences University, Portland, Oregon Abstract The recently discovered orexigenic peptide ghrelin is produced primarily by the stomach and circulates in blood at levels that increase during prolonged fasting in rats. When administered to rodents at supraphysiological doses, ghrelin activates hypothalamic neuropeptide Y/agouti gene–related protein neurons and increases food intake and body weight. These findings suggest that ghrelin may participate in meal initiation. As a first step to investigate this hypothesis, we sought to determine whether circulating ghrelin levels are elevated before the consumption of individual meals in humans. Ghrelin, insulin, and leptin were measured by radioimmunoassay in plasma samples drawn 38 times throughout a 24-h period in 10 healthy subjects provided meals on a fixed schedule. Plasma ghrelin levels increased nearly twofold immediately before each meal and fell to trough levels within 1 h after eating, a pattern reciprocal to that of insulin. Intermeal ghrelin levels displayed a diurnal rhythm that was exactly in phase with that of leptin, with both hormones rising throughout the day to a zenith at 0100, then falling overnight to a nadir at 0900. Ghrelin levels sampled during the troughs before and after breakfast correlated strongly with 24-h integrated area under the curve values ( r = 0.873 and 0.954, respectively), suggesting that these convenient, single measurements might serve as surrogates for 24-h profiles to estimate overall ghrelin levels. Circulating ghrelin also correlated positively with age ( r = 0.701). The clear preprandial rise and postprandial fall in plasma ghrelin levels support the hypothesis that ghrelin plays a physiological role in meal initiation in humans. Footnotes Address correspondence and reprint requests to David E. Cummings, Assistant Professor of Medicine, University of Washington, VA Puget Sound Health Care System, Seattle Division, 1660 S. Columbian Way, S-111-Endo, Seattle, WA 98108. E-mail: davidec{at}u.washington.edu . Received for publication 25 April 2001 and accepted in revised form 30 May 2001. Posted on the World Wide Web at www.diabetes.org/