Does Active Nutritional Interventions Affect Adipokine Secretion in Hip Fracture Operated Elderly Patients?

Background: Adipokines such as ghrelin, leptin, resistin and adiponectin have been proposed as being involved in energetic balance and bone turnover. There is scarce knowledge as to adipokine activity in hip fractured elderly patients in acute settings. We evaluated whether active nutritional support may reflect on adipokines levels and affect outcomes. Methods: A randomized controlled study measuring adipokine (ghrelin, leptin, resistin and adiponectin) levels in hip fractured geriatric patients receiving active nutritional support was conducted in the Ortho-Geriatric Unit Rabin Medical Center, Israel. The intervention group's energy goal was calculated by repeated resting energy requirements whereas the control group received only standard nutritional support. Measurements were taken pre-operation, 48 h post-operative and on day 7 post-op. Results: Ghrelin and adiponectin levels showed significant changes in both study groups with no significant change between groups. Ghrelin levels were also significantly higher on day 7 in patients without complications (p=0.035). Leptin levels differed between groups (p=0.038). In the intervention group, leptin levels decreased initially, then sharply increased, whereas the control group's levels consistently decreased in all 3 measurements. Resistin levels did not change significantly over time. Conclusion: Ghrelin and adiponectin may play a role in hip fractured patients irrespective of nutritional status whereas, ghrelin levels may also indicate post-operative complications. Leptin may be affected by energetic balance.