Dietary Macronutrient Regulation Of Acyl And Desacyl Ghrelin Concentrations In Children With Prader-Willi Syndrome (Pws)

Background The effects of dietary macronutrients on orexigenic and anorexigenic hormones in children are poorly understood. Objective To explore effects of varying dietary macronutrients on appetite-regulating hormones [acyl ghrelin (AG) and desacyl ghrelin (DAG), glucagon-like peptide 1 (GLP-1), peptide tyrosine tyrosine (PYY) and insulin] in children with PWS and healthy children (HC). Design Randomized, cross-over experiments compared two test diets [high protein-low carbohydrate(HP-LC)and high protein-low fat (HP-LF)] to aSTANDARDmeal (55% carbohydrate, 30% fat, 15% protein). Experiment 1 included ten children with PWS (median age 6.63 years; BMI z 1.05); experiment 2 had seven HC (median age 12.54 years; BMIz0.95). Blood samples were collected at baseline and at 60-minute intervals for 4 hours. Independent linear mixed models were adjusted for age, sex and BMIz-score. Results Fasting and post-prandial AG and DAG concentrations are elevated in PWS children; the ratio of AG/DAG is normal. Food consumption reduced AG and DAG concentrations in both PWS and HC. GLP-1 levels were higher in PWS after theHP-LCand HP-LF meals than theSTANDARDmeal (P = .02-0.04). The fasting proinsulin to insulin ratio (0.08 vs 0.05) was higher in children with PWS (P = .05) than in HC. Average appetite scores in HC declined after all three meals (P = .02) but were lower after theHP-LCand HP-LF meals than theSTANDARDmeal. Conclusion Altered processing of proinsulin and increased GLP-1 secretion in children with PWS after a high protein meal intake might enhance satiety and reduce energy intake.