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Shaheen N, Shaheen A, Diab RA, Saad AM, Abdelwahab OA, Soliman S, Hefnawy MT, Ramadan A, Meshref M, Nashwan AJ. Association of serum leptin and ghrelin levels with smoking status on body weight: a systematic review and meta-analysis. Front Psychiatry 2023; 14:1296764. [PMID: 38111614 PMCID: PMC10725976 DOI: 10.3389/fpsyt.2023.1296764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/20/2023] [Indexed: 12/20/2023] Open
Abstract
Background and aims Smoking cigarettes is a major global health problem that affects appetite and weight. The aim of this systematic review was to determine how smoking affected plasma leptin and ghrelin levels. Methods A comprehensive search of PubMed, Scopus, Web of Science, and Ovid was conducted using a well-established methodology to gather all related publications. Results A total of 40 studies were included in the analysis of 11,336 patients. The overall effect showed a with a mean difference (MD) of -1.92[95%CI; -2.63: -1.20] and p = 0.00001. Subgroup analysis by study design revealed significant differences as well, but with high heterogeneity within the subgroups (I2 of 82.3%). Subgroup by sex showed that there was a significant difference in mean difference between the smoking and non-smoking groups for males (MD = -5.75[95% CI; -8.73: -2.77], p = 0.0002) but not for females (MD = -3.04[95% CI; -6.6:0.54], p = 0.10). Healthy, pregnant, diabetic and CVD subgroups found significant differences in the healthy (MD = -1.74[95% CI; -03.13: -0.35], p = 0.01) and diabetic (MD = -7.69[95% CI, -1.64: -0.73], p = 0.03). subgroups, but not in the pregnant or cardiovascular disease subgroups. On the other hand, the meta-analysis found no statistically significant difference in Ghrelin serum concentration between smokers and non-smokers (MD = 0.52[95% CI, -0.60:1.63], p = 0.36) and observed heterogeneity in the studies (I2 = 68%). Conclusion This study demonstrates a correlation between smoking and serum leptin/ghrelin levels, which explains smoking's effect on body weight. Systematic review registration https://www.crd.york.ac.uk/ prospero/display_record.php, identifier (Record ID=326680).
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Affiliation(s)
- Nour Shaheen
- Alexandria Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed Shaheen
- Alexandria Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Rehab Adel Diab
- Faculty of Medicine, Al-Azhar University, Medical Research Group of Egypt, Cairo, Egypt
| | | | - Omar Ahmed Abdelwahab
- Faculty of Medicine, Al-Azhar University, Medical Research Group of Egypt, Cairo, Egypt
| | - Sama Soliman
- Faculty of Medicine, The Pavlov First State Medical University of St. Petersburg, St. Petersburg, Russia
| | - Mahmoud Tarek Hefnawy
- Faculty of Medicine, Zagazig University, Medical Research Group of Egypt, Cairo, Egypt
| | - Alaa Ramadan
- Faculty of Medicine, South Valley University, Qena, Egypt
| | - Mostafa Meshref
- Neurology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Halverson SJ, Warhoover T, Mencio GA, Lovejoy SA, Martus JE, Schoenecker JG. Leptin Elevation as a Risk Factor for Slipped Capital Femoral Epiphysis Independent of Obesity Status. J Bone Joint Surg Am 2017; 99:865-872. [PMID: 28509827 PMCID: PMC5426400 DOI: 10.2106/jbjs.16.00718] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Slipped capital femoral epiphysis (SCFE) is strongly associated with childhood obesity, yet the prevalence of obesity is orders of magnitude greater than the prevalence of SCFE. Therefore, it is hypothesized that obesity is not, by itself, a sufficient condition for SCFE, but rather one component of a multifactorial process requiring preexisting physeal pathology. Leptin elevation is seen to varying degrees in patients with obesity, and as leptin has been shown to cause physeal pathology similar to the changes seen in SCFE, we propose that leptin may be a factor distinguishing between patients with SCFE and equally obese children without hip abnormalities. METHODS Serum leptin levels were obtained from 40 patients with SCFE and 30 control patients with approximate body mass index (BMI) matching. BMI percentiles were calculated according to Centers for Disease Control and Prevention population data by patient age and sex. Patients were compared by demographic characteristics, leptin levels, odds of leptin elevation, and odds of SCFE. RESULTS The odds of developing SCFE was increased by an odds ratio of 4.9 (95% confidence interval [CI], 1.31 to 18.48; p < 0.02) in patients with elevated leptin levels, regardless of obesity status, sex, and race. When grouping patients by their obesity status, non-obese patients with SCFE showed elevated median leptin levels at 5.8 ng/mL compared with non-obese controls at 1.7 ng/mL (p = 0.006). Similarly, obese patients with SCFE showed elevated median leptin levels at 17.9 ng/mL compared with equally obese controls at 10.5 ng/mL (p = 0.039). Serum leptin levels increased in association with obesity (p < 0.001), with an increase in leptin of 0.17 ng/mL (95% CI, 0.07 to 0.27 ng/mL) per BMI percentile point. CONCLUSIONS To our knowledge, this study is the first to clinically demonstrate an association between elevated serum leptin levels and SCFE, regardless of BMI. This adds to existing literature suggesting that SCFE is a multifactorial process and that leptin levels may have profound physiological effects on the development of various disease states. Despite a strong association with adiposity, leptin levels vary between patients of equal BMI and may be a vital resource in prognostication of future obesity-related comorbidities. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Schuyler J. Halverson
- Monroe Carell Jr. Children’s Hospital at Vanderbilt Medical Center, Nashville, Tennessee
| | - Tracy Warhoover
- Monroe Carell Jr. Children’s Hospital at Vanderbilt Medical Center, Nashville, Tennessee
| | - Gregory A. Mencio
- Monroe Carell Jr. Children’s Hospital at Vanderbilt Medical Center, Nashville, Tennessee
| | - Steven A. Lovejoy
- Monroe Carell Jr. Children’s Hospital at Vanderbilt Medical Center, Nashville, Tennessee
| | - Jeffrey E. Martus
- Monroe Carell Jr. Children’s Hospital at Vanderbilt Medical Center, Nashville, Tennessee
| | - Jonathan G. Schoenecker
- Monroe Carell Jr. Children’s Hospital at Vanderbilt Medical Center, Nashville, Tennessee,E-mail address for J.G. Schoenecker:
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Abstract
BACKGROUND Exposure to nicotine via tobacco smoking may influence leptin release and decrease food intake among smokers. However, the effect of nicotine exposure on leptin and food intake among different nicotine dependent groups is unclear. OBJECTIVE We aimed to measure leptin and calorie intake among different nicotine dependent groups. DESIGN Cross-sectional study. SETTING Research department in school of medical sciences. PATIENTS AND METHODS Subjects were selected by purposive (non-probability) sampling and categorized as having low, moderate and high nicotine dependency based on the Fagerstrom Test for Nicotine Dependence (FTND) score. Diet was recorded by interview. Anthropometry, blood pressure, body composition, lipid profile, and physical activity level were measured accordingly. Fasting serum leptin was measured using a commercial ELISA kit. MAIN OUTCOME MEASURE(S) Nicotine dependency, 24-hour diet, clinical anthropometric and clinical measurements. RESULTS In 107 Malay male smokers leptin concentration was inversely correlated with nicotine dependence. However, body weight, smoking period, blood pressure, body composition, lipid profile and physical activity level were not significantly different among low, moderately and highly dependent smoking groups. Leptin concentration and total calorie intake were also not significantly different among these groups. CONCLUSION Leptin concentration was inversely correlated with nicotine dependence, but leptin concentration and total calorie intake status were not significantly different among our different nicotine dependency subjects. LIMITATIONS Purposive sampling for subject recruitment and inaccurate information in the self-administered questionnaire.
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Affiliation(s)
| | | | | | - Harmy Mohamed Yusoff
- Prof. Dr. Harmy Mohamed Yusoff, Faculty of Medicine and Health Sciences,, Universiti Sultan Zainal Abidin, City Campus,, 20400 Kuala Terengganu, Terengganu, Malaysia, T: +609 627 5771, F: +609 667 5583, , ORCID: http://orcid. org/0000-0001-6918-1549
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Sanip ZB, Suhaimi MZ, Man CN, Rasool AH, Yusoff HB. Relationship between hair nicotine levels with blood pressure, body composition, lipid profile and leptin among healthy male smokers in Kelantan. J Taibah Univ Med Sci 2016. [DOI: 10.1016/j.jtumed.2015.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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al'Absi M, Lemieux A, Nakajima M, Hatsukami DK, Allen S. Circulating leptin and pain perception among tobacco-dependent individuals. Biol Psychol 2015; 107:10-5. [PMID: 25720946 DOI: 10.1016/j.biopsycho.2015.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 02/15/2015] [Accepted: 02/16/2015] [Indexed: 12/21/2022]
Abstract
Recent preclinical evidence suggests that leptin may modulate the stress response and may increase nociception. In this study, we examined for the first time the extent to which cigarette smoking is associated with leptin levels during an extended rest period and in response to noxious stimuli. Repeated blood samples were collected during a laboratory session from smokers and nonsmokers and assayed for leptin. Pain experiences, as well as neuroendocrine and cardiovascular measures, were collected across cold pressor and thermal heat pain tests. Both analysis of variance and correlations confirmed that smokers demonstrated dysregulations in leptin responsivity and association with pain relative to nonsmokers. The flat pattern of leptin release and the weak associations of this hormone with pain in smokers suggest a long-term effect of tobacco dependence on this regulatory hormone. In light of leptin's influence on reward pathways, further investigation of leptin's involvement in nicotine dependence is warranted.
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Affiliation(s)
- Mustafa al'Absi
- University of Minnesota Medical School, Duluth, MN, USA; Department of Psychiatry, University of Minnesota, Twin Cities, Minneapolis, MN, USA; Department of Family Medicine and Community Health, University of Minnesota, Twin Cities, Minneapolis, MN, USA.
| | | | | | - Dorothy K Hatsukami
- Department of Psychiatry, University of Minnesota, Twin Cities, Minneapolis, MN, USA
| | - Sharon Allen
- Department of Family Medicine and Community Health, University of Minnesota, Twin Cities, Minneapolis, MN, USA
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Hilawe EH, Yatsuya H, Li Y, Uemura M, Wang C, Chiang C, Toyoshima H, Tamakoshi K, Zhang Y, Kawazoe N, Aoyama A. Smoking and diabetes: is the association mediated by adiponectin, leptin, or C-reactive protein? J Epidemiol 2014; 25:99-109. [PMID: 25400076 PMCID: PMC4310870 DOI: 10.2188/jea.je20140055] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Although the association between cigarette smoking and risk of type 2 diabetes is well established, its mechanisms are yet to be clarified. This study examined the possible mediating effects of adiponectin, leptin, and C-reactive protein (CRP) concentrations on the smoking-diabetes association. Methods Between 2002 and 2011, we followed 3338 Japanese workers, aged 35–66 years, who were enrolled in the second Aichi workers’ cohort study. We used multivariable-adjusted Cox regression models to determine the hazard ratios and respective 95% confidence intervals (CIs) of the association between smoking status and risk of diabetes. A multiple mediation model with bootstrapping was used to estimate the magnitude and the respective bias-corrected (BC) 95% CIs of the indirect effects of smoking on diabetes through the three biomarkers. Results Relative to never smokers, the risk of diabetes was significantly elevated in current (hazard ratio 1.75, 95% CI 1.25–2.46) and ex-smokers (hazard ratio 1.54, 95% CI 1.07–2.22). The indirect effects of smoking on diabetes through adiponectin levels were statistically significant among light (point estimate 0.033, BC 95% CI 0.005–0.082), moderate (point estimate 0.044, BC 95% CI 0.010–0.094), and heavy smokers (point estimate 0.054, BC 95% CI 0.013–0.113). In contrast, neither the indirect effects of smoking on diabetes through leptin nor CRP levels were significant, as the corresponding BC 95% CIs included zero. Conclusions In our analysis, adiponectin concentration appeared to partially mediate the effect of smoking on diabetes, while leptin and CRP levels did not.
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Affiliation(s)
- Esayas Haregot Hilawe
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine
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Potretzke S, Nakajima M, Cragin T, al'Absi M. Changes in circulating leptin levels during acute stress and associations with craving in abstinent smokers: a preliminary investigation. Psychoneuroendocrinology 2014; 47:232-40. [PMID: 24954303 PMCID: PMC4087053 DOI: 10.1016/j.psyneuen.2014.05.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 05/03/2014] [Accepted: 05/13/2014] [Indexed: 01/08/2023]
Abstract
Recent research suggests a role for the appetite hormone leptin in cigarette smoking. This study examined patterns of change in leptin in response to stress and associations with craving during the initial phase of a quit attempt. Thirty-six smokers (average age±SEM, 33.4±2.4) interested in smoking cessation set a quit day and were required to be abstinent for 24h. After, they completed a laboratory session including public speaking and cognitive challenges, and attended 4 weekly post-cessation assessments. Blood samples and self-report measures were collected throughout the laboratory session. The results indicated that leptin levels significantly increased following exposure to acute stress. We also found positive correlations between leptin and craving for cigarettes. No differences were observed in leptin levels between smokers who maintained abstinence for 4 weeks and those who relapsed during this period. These findings suggest that leptin levels may change in response to stress and that leptin could be a useful marker of craving for smoking.
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Affiliation(s)
| | | | | | - Mustafa al'Absi
- University of Minnesota School of Medicine, 1035 University Drive, Duluth, MN 55812-2487, USA.
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Smoking is associated with reduced leptin and neuropeptide Y levels and higher pain experience in patients with fibromyalgia. Mediators Inflamm 2014; 2014:627041. [PMID: 25197167 PMCID: PMC4150510 DOI: 10.1155/2014/627041] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 07/03/2014] [Accepted: 07/28/2014] [Indexed: 01/10/2023] Open
Abstract
Smoking deregulates neuroendocrine responses to pain supporting production of neuropeptide Y (NpY) by direct stimulation of nicotinic receptors or by inhibiting adipokine leptin.
Present study addressed the effect of cigarette smoking on adipokines and pain parameters, in 62 women with fibromyalgia (FM) pain syndrome with unknown etiology. Pain was characterized by a visual analogue scale, tender point (TP) counts, pressure pain threshold, and neuroendocrine markers NpY and substance P (sP). Levels of IGF-1, leptin, resistin, visfatin, and adiponectin were measured in blood and cerebrospinal fluid. Current smokers (n = 18) had lower levels of leptin compared to ex-smokers (n = 25, P = 0.002), while the expected NpY increase was absent in FM patients. In smokers, this was transcribed in higher VAS-pain (P = 0.04) and TP count (P = 0.03), lower pain threshold (P = 0.01), since NpY levels were directly related to the pain threshold (rho = 0.414) and inversely related to TP counts (rho = −0.375). This study shows that patients with FM have no increase of NpY levels in response to smoking despite the low levels of leptin. Deregulation of the balance between leptin and neuropeptide Y may be one of the essential mechanisms of chronic pain in FM.
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Kratzer A, Salys J, Nold-Petry C, Cool C, Zamora M, Bowler R, Koczulla AR, Janciauskiene S, Edwards MG, Dinarello CA, Taraseviciene-Stewart L. Role of IL-18 in second-hand smoke-induced emphysema. Am J Respir Cell Mol Biol 2013; 48:725-32. [PMID: 23392573 DOI: 10.1165/rcmb.2012-0173oc] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Chronic second-hand smoke (SHS) exposure comprises the main risk factor for nonsmokers to develop chronic obstructive pulmonary disease (COPD). However, the mechanisms behind the chronic inflammation and lung destruction remain incompletely understood. In this study, we show that chronic exposure of Sprague-Dawley rats to SHS results in a significant increase of proinflammatory cytokine IL-18 and chemokine (C-C motif) ligand 5 in the bronchoalveolar lavage fluid (BALF) and a significant decrease of vascular endothelial growth factor (VEGF) in the lung tissue. SHS exposure resulted in progressive alveolar airspace enlargement, cell death, pulmonary vessel loss, vessel muscularization, collagen deposition, and right ventricular hypertrophy. Alveolar macrophages displayed a foamy phenotype and a decreased expression of the natural inhibitor of IL-18, namely, IL-18 binding protein (IL-18BP). Moreover, IL-18 down-regulated the expression of VEGF receptor-1 and VEGFR receptor-2, and induced apoptosis in pulmonary microvascular endothelial cells in vitro. We also observed a trend toward increased concentrations of IL-18 in the BALF of patients with COPD. Our findings suggest that IL-18-mediated endothelial cell death may contribute to vascular destruction and disappearance in SHS-induced COPD. Moreover, IL-18 and IL-18BP are potential new targets for therapeutics.
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Affiliation(s)
- Adelheid Kratzer
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado at Denver, Aurora, CO 80045, USA
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Yoon HH, Lewis MA, Shi Q, Khan M, Cassivi SD, Diasio RB, Sinicrope FA. Prognostic impact of body mass index stratified by smoking status in patients with esophageal adenocarcinoma. J Clin Oncol 2011; 29:4561-7. [PMID: 21990414 PMCID: PMC3236656 DOI: 10.1200/jco.2011.37.1260] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 08/12/2011] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Given that smoking affects body mass index (BMI) and survival, stratification by smoking status may be required to determine the true prognostic impact of BMI. Although obesity increases risk for developing esophageal adenocarcinoma (EAC), the prognostic influence of obesity and its potential modification by smoking status is unknown in this disease. PATIENTS AND METHODS All patients (N = 778) underwent potentially curative esophagectomy. BMI was calculated using measured height and weight at surgery and categorized as obese (≥ 30 kg/m(2)), overweight (25 to 29.9 kg/m(2)), or normal (18.5 to 24.9 kg/m(2)). Cigarette smoking was categorized as never or ever. The association of BMI with disease-specific survival (DSS), disease-free survival (DFS), and overall survival (OS) was determined by Cox regression. RESULTS Excess BMI was significantly associated with DSS in a manner that differed substantially by smoking status (P for interaction = .023). Among never smokers, obesity was significantly associated with adverse DSS (hazard ratio [HR] = 2.11; 95% CI, 1.31 to 3.43; P = .002), DFS (HR = 2.03; 95% CI, 1.30 to 3.18; P = .002), and OS (HR = 1.97; 95% CI, 1.24 to 3.14; P = .004), as compared with normal weight, after adjusting for covariates. By contrast, among ever smokers, obesity was not prognostic, and overweight status was significantly associated with favorable survival in univariate, but not multivariate, analysis. CONCLUSION Obesity among never smokers was independently associated with two-fold worsening of DSS, DFS, and OS after surgery for EAC, after adjusting for known prognostic factors. These data, in one of the largest reported resected EAC cohorts, are the first to show an adverse prognostic impact of obesity in EAC.
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Affiliation(s)
- Harry H Yoon
- Division of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA.
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al'Absi M, Hooker S, Fujiwara K, Kiefer F, von der Goltz C, Cragin T, Wittmers LE. Circulating leptin levels are associated with increased craving to smoke in abstinent smokers. Pharmacol Biochem Behav 2010; 97:509-13. [PMID: 20951159 DOI: 10.1016/j.pbb.2010.10.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 09/22/2010] [Accepted: 10/06/2010] [Indexed: 10/18/2022]
Abstract
The adipocyte hormone leptin regulates satiety and energy expenditure. Recent evidence suggests that leptin is associated with increased craving for alcohol and with shorter length of abstinence during alcohol treatment. This study examined leptin's associations with craving for cigarettes and smoking relapse among smokers interested in cessation. Participants (32 smokers; 14 women) attended a laboratory session 24h following their designated quit day where circulating leptin levels and craving for smoking were assessed. Other measures of withdrawal symptoms, affect, physical symptoms, as well as neuroendocrine and cardiovascular measures were collected before and after performing two stress tasks (public speaking and cognitive tasks). High circulating leptin levels were associated with increased craving, withdrawal symptoms, negative affect, physical symptoms, and reduced positive affect. Circulating leptin levels were not related to cardiovascular and neuroendocrine measures, responses to acute stressors, or to smoking relapse. These results indicate that circulating leptin is a promising biological marker of craving for smoking and warrant further investigation of the links between appetite regulation and nicotine dependence.
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Affiliation(s)
- Mustafa al'Absi
- Duluth Medical Research Institute and Department of Behavioral Sciences, University of Minnesota Medical School, Duluth, MN 55812, USA.
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