Elevated Plasma Cholecystokinin at High Altitude: Metabolic Implications for the Anorexia of Acute Mountain Sickness

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Abstract
The aims of the present study were to measure the satiety neuropeptide cholecystokinin (CCK) in humans at terrestrial high altitude to investigate its possible role in the pathophysiology of anorexia, cachexia, and acute mountain sickness (AMS). Nineteen male mountaineers aged 38 ± 12 years participated in a 20 ± 5 day trek to Mt. Kanchenjunga basecamp (BC) located at 5100 m, where they remained for 7 ± 5 days. Subjects were examined at rest and during a maximal exercise test at sea-level before/after the expedition (SL1/SL2) and during the BC sojourn. There was a mild increase in Lake Louise AMS score from 1.1 ± 1.2 points at SL1 to 2.3 ± 2.3 points by the end of the first day at BC (P < 0.05). A marked increase in resting plasma CCK was observed on the morning of the second day at BC relative to sea-level control values (62.9 ± 42.2 pmol/L-1 vs. SL1: 4.3 ± 8.3 pmol/L-1, P < 0.05 vs. SL2: 26.5 ± 25.2 pmol/L-1, P < 0.05). Maximal exercise increased CCK by 78.5 ± 24.8 pmol/L-1, (P < 0.05 vs. resting value) during the SL1 test and increased the plasma concentration of non-esterified fatty acids and glycerol at BC (P < 0.05 vs. SL1/SL2). The CCK response was not different in five subjects who presented with anorexia on Day 2 compared with those with a normal appetite. While there was no relationship between the increase in CCK and AMS score at BC, a more pronounced increase in resting CCK was observed in subjects with AMS (≥3 points at the end of Day 1 at BC) compared with those without (+98.9 ± 1.4 pmol/L-1 vs. +67.6 ± 37.2 pmol/L-1, P < 0.05). Caloric intake remained remarkably low during the stay at BC (8.9 ± 1.4 MJ.d-1) despite a progressive decrease in total body mass (-4.5 ± 2.1 kg after 31 ± 13 h at BC, P < 0.05 vs. SL1/SL2), which appeared to be due to a selective loss of torso adipose tissue. These findings suggest that the satiogenic effects of CCK may have contributed to the observed caloric deficit and subsequent cachexia at high altitude despite adequate availability of palatable foods. The metabolic implications of elevated CCK in AMS remain to be elucidated.