Hyperleptinemia in patients with gastroesophageal reflux disease and obesity: approaches to the assessment and prevention of leptin resistance

Background. Gastroesophageal reflux disease (GERD) and obesity remain the most common comorbid pathology, which significantly affects the deterioration of the quality of life of patients. Many studies have been conducted to determine the factors contributing to the development of these diseases, but the role of leptin remains the most debatable issue. Currently, there are no clear criteria for effective assessment of leptin sensitivity in clinical settings, although some researchers consider hyperleptinemia to be a key marker of leptin resistance. The aim is to substantiate approa­ches to the assessment and prevention of leptin resistance in patients with GERD and obesity. Materials and methods. Sixty men with GERD and obesity were examined and divided into three groups depending on the leptin level. All patients had serum levels of tumor necrosis factor alpha, interleukin 6, leptin, insulin, total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, very low-density lipoprotein cholesterol, atherogenic index and insulin resistance index calculated. To assess anxiety syndrome and body exhaustion, precise diagnostics was used on the CONTEC 8000GW cardiograph. Body composition analysis was performed using TANITA MC-780MA scale analy­zers (Japan). Results. 38.2 % of patients with hyperleptinemia were diagnosed with anxiety syndrome, 52.9 % with exhaustion, 44.1 % with sleep disorders, and 64.7 % had a dangerous amount of visceral fat. Direct correlations of leptin with hyperinsulinemia (r = 0.316; p = 0.015), insulin resistance (r = 0.302; p = 0.020), increased levels of triglycerides (r = 0.414; p = 0.003), very low-density lipoprotein cholesterol (r = 0.381; p = 0.006) and interleukin 6 (r = 0.507; p < 0.001) were found. To assess leptin resistance, the ratio of leptin to triglyceride level was used, which in patients with GERD with degree 1 obesity was (6.07 ± 0.81) conventional units, with degree 2 obesity — (11.64 ± 1.44) conventional units, with degree 3 obesity — (14.54 ± 2.26) conventional units (F = 11.67; p < 0.0001). In the presence of a dangerous amount of visceral fat, the leptin resistance coefficient increased by 1.6 times compared to patients with GERD with a safe level of visceral fat (t = 2.80; p = 0.008). Insulin resistance was associated with a significant increase in the leptin resistance coefficient — by 2.5 times (t = 4.98; p < 0.0001). According to the results of regression analysis, it was found that the ratio of leptin to triglyceride level above 8.43 conventional units with a sensitivity of 62.9 % and a specificity of 96.0 % can be used as a minimally invasive marker for assessing leptin resistance. Conclusions. Reasoned approaches to the assessment and prevention of leptin resistance in patients with GERD and obesity will contribute to increasing the effectiveness of treatment measures.