AG and DAG plasma concentrations in AN-R in the undernourished and refed states after an overnight fast or during the course of a meal. (A) Baseline morning plasma concentration of both ghrelin isoforms in a sample of 13 AN-R patients in the undernourished state and after refeeding. (B) Experimental paradigm of multiple blood sampling during the course of a meal to evaluate ultradian variations of ghrelin isoforms; each arrow indicates a blood sample. (C–J) Ultradian variations of AG, DAG and insulin plasma concentrations in relation with appetite and food motivation in 3 patients with AN-R. (C–F) Plasma concentrations of AG, DAG and insulin around lunchtime in undernourished conditions (IMC = 16,1 kg/m2, C or IMC = 14.5 kg/m2, E), immediately after refeeding (100% target BMI, IMC = 20,5 kg/m2, D, patient matched to panel C) or 6-months following refeeding (IMC = 19.0 kg/m2, F). (G-J) Feeling of hunger and eating desire evaluated on a 1–10 scale in undernourished conditions (G, I), immediately after refeeding (H) or 6-months following refeeding (J). Lunchtime lasted 30-40 min (yellow shade). Asterisks indicate significant differences for AG (**p < 0.001). Hashtag indicates significant differences for DAG (#p < 0.05). AG, DAG and insulin plasma concentrations are represented in pmol/L. AG: acyl-ghrelin;DAG: desacyl-ghrelin; undernourished condition (admission)vs refed(100% target BMI).