As mentioned above, plasma GH and ghrelin concentrations are elevated in patients with chronic heart failure associated with cachexia, but they are positively correlated with BMI, plasma tumor necrosis factor-α, and plasma GH concentrations (54), suggesting that ghrelin functions in a compensatory manner in the pathogenesis of cachexia, in which energy metabolism tends toward catabolism. This evidence concerns the gene GHRL and congestive heart failure.