Ghrelin Does Not Predict Adaptive Hyperphagia in Patients With Short Bowel Syndrome

Background: Adaptive hyperphagia is associated with reduced dependence on parenteral nutrition in patients with short bowel syndrome, but mechanisms have not been described. Ghrelin (GHR) has orexigenic effects, whereas peptide YY (PYY) reduces intake. GHR also acts as a hormone to control body fat stores. The authors evaluated whether GHR or PYY was related to caloric intake or absorption in patients with short bowel syndrome and whether GHR was associated with body mass index. Methods: Patients were admitted twice for nutrient balance. Height and body weight were obtained using standardized protocols. Energy intake >40 kcal/kg/day was defined as adaptive hyperphagia. Fasting plasma PYY and GHR were assayed in duplicate with Linco enzyme-linked immunosorbent assay kits. Results: The median age of the 7 study participants was 62 (range, 45-66) years, time with short bowel syndrome was 6.6 (range, 2-29) years, and body mass index was 21.2 kg/m2 (range, 19-27.7). Five patients had adaptive hyperphagia. Neither GHR nor PYY was significantly related to energy intake or absorption (GHR: R = 0.22 and R = –0.233, PYY: R = 0.10 and R = –0.13). Body mass index trended toward an inverse association with GHR (GHR: R = –0.540, P = .211). Conclusion: The rigorous adaptive hyperphagia seen in these patients with short bowel syndrome was not related to fasting GHR or PYY, suggesting the need to explore other mechanisms.