Effects of visceral obesity on cytokine and hormonal regulation in patients with gastroesophageal reflux disease

Background. In recent years, pathogenetic mechanisms underlying the association of gastroesophageal reflux disease (GERD) and metabolic syndrome have caused considerable interest among researchers. The purpose is to determine the features of cytokine balance, carbohydrate metabolism, leptin and ghrelin levels depending on the amount of visceral fat in patients with GERD. Materials and methods. Fifty-six patients with GERD were examined. According to the results of bioimpedance analysis, they were divided into the groups: 23 patients with a dangerous and 33 with a safe amount of visceral fat. The levels of tumor necrosis factor α, interleukin-6, interleukin-10, ghrelin and leptin were determined in the blood serum of all patients by the enzyme immunoassay method. Also, the levels of glucose, insulin were determined and the insulin resistance index (HOMA-IR) was calculated in patients with GERD. Results. In the group of GERD patients with a dangerous amount of visceral fat, an increase in the concentration of the pro-inflammatory cytokine interleukin-6 by 12 % was found with a simultaneous decrease in the level of the anti-inflammatory cytokine interleukin-10 by 22 % (p < 0.05), an increase in the HOMA-IR median by 1.3 times (p < 0.05) compared to the patients with a safe amount of visceral fat. The median level of ghrelin in patients with a dangerous visceral fat amount increased significantly, by 2.0 times (p < 0.05) compared to the control group. Correlation analysis showed an association between visceral fat and leptin (r = 0.37; p = 0.0008), interleukin-10 (r = –0.28; p = 0.0116), insulin (r = 0.41; p = 0.001), HOMA-IR (r = 0.48; p = 0.00001). Conclusions. In GERD patients, an increase in the amount of visceral fat was associated with a violation of the cytokine balance, carbohydrate metabolism, increased level of ghrelin. The determined statistically significant correlation between the amount of visceral fat and the level of leptin indicates a functional relationship between the body composition according to bioimpedance analysis and the hormonal activity of adipose tissue in patients with GERD.