Leptin and Ghrelin Levels in Children before and after Adenoidectomy or Adenotonsillectomy

Abstract

Background and Aim: Accelerated weight gain after (adeno)tonsillectomy has been reported in a number of studies. Whether (adeno)tonsillectomy is also a risk factor for development of overweight is unknown. We investigated serum leptin and plasma ghrelin levels before and 1 year after (adeno)tonsillectomy operation in children. Materials and Methods: We studied 31 patients and 29 age- and sex-matched healthy control children. Auxologic evaluation and biochemical investigations were performed before surgery and 1 year later. Results: One year after surgery, height SDS (p = 0.001) and weight SDS (p = 0.004) were significantly increased in both groups. No changes in BMI SDS (p = 0.105) were observed. Preoperative leptin levels were significantly higher in patients than controls (p < 0.001). IGF-1, IGFBP-3, HOMA-IR and ghrelin values were not significantly different between the groups. One year after surgery, IGF-1 (p = 0.001) and IGFBP-3 (p = 0.001) were significantly increased, while ghrelin (p < 0.001) was significantly decreased. Postoperative leptin levels of patients were also significantly higher than preoperative values (p = 0.036). Conclusion: Significantly higher leptin levels in patients compared to control both before and 1 year after an obstruction-relieving surgery suggested that higher levels might be due to leptin resistance in these patients. Based on our findings we recommend measurement of leptin levels longitudinally for at least 5 years after adenotonsillectomy.

Short-term weight gain after adenotonsillectomy in children with obstructive sleep apnoea: systematic review

“…In addition, subgroup analyses showed a statistically significant BMI z score increase in the intervention group children who were underweight and overweight at baseline compared to the control group. In contrast, the studies conducted by Karalok et al 20 . and Huang et al ., 21 which had longer follow-up times, of 12 months and 3 years respectively, did not show a significant weight gain; therefore, we do not know if this effect is sustained in the long term.…”

“…studied an underweight cohort with an average BMI z score of less than −1 pre-operatively, 22 whereas the other studies were all within 1 standard deviation pre-operatively. After surgical intervention, the mean BMI of the children had increased in four of the studies to fall into the normal range 20 – 23 . The study performed by Katz et al .…”

“…Three studies confirmed OSA with the help of polysomnography 19 , 21 , 24 and the other three studies established the diagnosis on clinical grounds (Table I). 20 , 22 , 23 …”

Role of sleep quality in the metabolic syndrome

“…However, OSA also predisposes to the worsening of obesity due to daytime sleepiness, decreased physical activity, and neuroendocrine changes, such as resistance to the anorexigenic hormone leptin;405–407 data regarding associations between OSA and levels of the orexigenic hormone ghrelin in children are inconsistent 406,407. Treatment of OSA (primarily T&A, but CPAP in one study) may improve leptin and possibly ghrelin levels, although again, data are somewhat contradictory 407.…”

Short-Term Weight Gain after Tonsillectomy Does Not Lead to Overweight: A Systematic Review

“…The PRISMA flow diagram ( Figure 1 ) summarizes the study screening process. A summary of the studies included in this systematic review and the grading of evidence is reported in Table 1 [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ].…”