Decreased Plasma Leptin Concentrations in Tuberculosis Patients Are Associated with Wasting and Inflammation

• Published in: The journal of clinical endocrinology and metabolism 2002-02, Vol.87 (2), p.758-763
• Main Authors: van Crevel, Reinout, Karyadi, Elvina, Netea, Mihai G., Verhoef, Hans, Nelwan, Ronald H. H., West, Clive E., van der Meer, Jos W. M.
• Format: Article
• Language: English
• Subjects: Adipose Tissue - pathology; Adult; Afdeling Humane voeding; Antitubercular Agents - therapeutic use; Appetite; Bacterial diseases; Biological and medical sciences; Body Weight; Cytokines - metabolism; Female; Functional investigation of endocrine glands and genital system; Human bacterial diseases; Human Nutrition; Human Nutrition & Health; Human Nutrition (HNE); Humane Voeding; Humane Voeding & Gezondheid; Humans; Infectious diseases; Inflammation - blood; Investigative techniques, diagnostic techniques (general aspects); Leptin - blood; Male; Medical sciences; Osmolar Concentration; Reference Values; Tuberculosis - blood; Tuberculosis - drug therapy; Tuberculosis - pathology; Tuberculosis - physiopathology; Tuberculosis and atypical mycobacterial infections; VLAG
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jcem.87.2.8228

Tuberculosis patients often suffer from severe weight loss, which is considered to be immunosuppressive and a major determinant of severity and outcome of disease. Because leptin is involved in weight regulation and cellular immunity, its possible role in tuberculosis-associated wasting was investigated. In an urban clinic in Indonesia, plasma leptin concentrations, indicators of adipocyte mass, appetite, C-reactive protein (CRP), tuberculin reactivity, and cytokine response were measured in tuberculosis patients and healthy controls. Plasma leptin concentrations were lower in patients than in controls (615 vs. 2,550 ng/liter; P < 0.001). Multivariate regression analysis showed that body fat mass and inflammation were two independent factors determining plasma leptin concentrations; there was a positive correlation between fat and leptin, whereas, unexpectedly, leptin was inversely associated with CRP and tumor necrosis factor-α production. Concentrations of both CRP and leptin were independently associated with loss of appetite. Our results do not support the concept that weight loss in tuberculosis is caused by enhanced production of leptin. Rather, loss of body fat leads to low plasma leptin concentrations, and prolonged inflammation may further suppress leptin production. Because leptin is important for cell-mediated immunity, low leptin production during active tuberculosis may contribute to increased disease severity, especially in cachectic patients.