Active ghrelin levels and active to total ghrelin ratio in cancer-induced cachexia

J Clin Endocrinol Metab. 2005 May;90(5):2920-6. doi: 10.1210/jc.2004-1788. Epub 2005 Feb 15.


Anorexia and weight loss are negative prognostic factors in patients with cancer. Although total ghrelin levels are increased in energy-negative states, levels of the biologically active octanoylated ghrelin and the anorexigenic peptide YY (PYY) have not been reported in patients with cancer-induced cachexia. We hypothesized that abnormal ghrelin and/or PYY levels contribute to cancer-induced cachexia. We evaluated 21 patients with cancer-induced cachexia; 24 cancer patients without cachexia; and 23 age-, sex-, race-, and BMI-matched subjects without cancer. Active ghrelin levels and the active to total ghrelin ratio were significantly increased in subjects with cancer-induced cachexia, compared with cancer and noncancer controls. PYY levels were similar among groups. Appetite measured by a visual analog scale was not increased in subjects with cachexia. The increase in active ghrelin levels is likely to be a compensatory response to weight loss. Cachexia may be a state of ghrelin resistance because appetite does not correlate with ghrelin levels. Changes in the active to total ghrelin ratio suggest that a mechanism other than increased secretion must be responsible for the increase in active ghrelin levels. PYY is unlikely to play an important role in cancer-induced cachexia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Appetite
  • Cachexia / blood*
  • Cachexia / etiology
  • Ghrelin
  • Humans
  • Insulin Resistance
  • Insulin-Like Growth Factor I / analysis
  • Interleukin-6 / blood
  • Middle Aged
  • Neoplasms / blood
  • Neoplasms / complications*
  • Peptide Hormones / blood*
  • Peptide YY / blood
  • Serum Albumin / analysis
  • Tumor Necrosis Factor-alpha / analysis


  • Ghrelin
  • Interleukin-6
  • Peptide Hormones
  • Serum Albumin
  • Tumor Necrosis Factor-alpha
  • Peptide YY
  • Insulin-Like Growth Factor I