Adipocytokines as features of the metabolic syndrome determined using confirmatory factor analysis

Adipocytokine correlates of childhood and adolescent mental health: A systematic review

The objective of this systematic review was to determine the current state of the literature regarding how adipocytokines associate with mental health symptoms/disorders in youth. Findings summarized in this review suggested that in neurodevelopmental disorders, higher levels of leptin, ghrelin, resistin, and visfatin as well as lower levels of adiponectin, retinol-binding protein 4, and progranulin predicted increased risk for or were conflated with autism spectrum disorder. Adipocytokine correlates of attention-deficit hyperactivity disorder and related symptoms included higher apelin, higher leptin-to-adiponectin ratio, and lower adiponectin. Evidence from studies examining anxiety symptoms evinced mixed results regarding leptin, and one study suggested higher levels of ghrelin. Depressive symptoms correlated with higher leptin and ghrelin. Research examining posttraumatic stress symptoms found higher levels of ghrelin. In research examining broadband symptoms, conflicting results emerged for associations between internalizing symptoms (i.e., symptoms of emotional stress) and leptin in youth. Low levels of adiponectin and high levels of leptin predicted externalizing symptoms. Total symptom difficulties were associated with a higher leptin-to-adiponectin ratio. Our findings suggest that adipocytokines may be an important set of biomarkers to consider as underlying mechanisms contributing to developmental psychopathology.

Traditional and Emerging Sex-Specific Risk Factors for Cardiovascular Disease in Women

Cardiovascular disease (CVD) remains a major health threat in women. While traditional CVD risk factors such as hypertension, hyperlipidemia, diabetes, and smoking have been recognized for over 50 years, optimal control of these risk factors remains a major challenge. Unique sex-specific risk factors such as adverse pregnancy outcomes, premature menopause and low estrogen states, and chronic autoimmune inflammatory disorders also contribute to increased CVD risk in women. In addition, psychological risk factors such as stress, depression, and social determinants of health may have a disproportionately adverse impact in women. An improved understanding of traditional and emerging sex-specific CVD risk factors and management of modifiable factors is critical for clinicians who provide care for women. Early recognition and treatment of risk factors may alter the trajectory of adverse CVD events. A multi-disciplinary approach with team-based care involving multiple specialists and improved, targeted educational efforts are needed to reduce CVD risk factors and its adverse consequences in women.

TG: HDL-C Ratio as Insulin Resistance Marker for Metabolic Syndrome in Children With Obesity

Insulin resistance (IR) is an important variable in the diagnosis of metabolic syndrome (MetS). Currently, IR is not part of the existing pediatric definition of MetS, instead elevated fasting blood glucose (FBG) is measured as an indicator of hyperglycemia. Arguably, many obese children with severe IR are still able to regulate their FBG well. Hence, this study aimed to assess the utility of triglyceride-to-high-density lipoprotein cholesterol (TG : HDL-C) ratio as an IR marker in the modeling of pediatric MetS among children with obesity using structural equation modeling (SEM). A total of 524 blood samples from children with obesity (age 10-16 years old) were analyzed for FBG, lipids, insulin, leptin, and adiponectin. Both exploratory (EFA) and confirmatory factor analysis (CFA) were used to examine TG : HDL-C ratio as an IR marker in pediatric MetS. EFA shows that TG: HDL-C ratio (standardized factor loading = 0.904) groups together with homeostasis model assessment-estimated insulin resistance (HOMA-IR) (standardized factor loading = 0.664), indicating a strong correlation to the IR factor. Replacing FBG with TG: HDL-C ratio improved the modeling of MetS structure in children with obesity. Our MetS model of TG: HDL-C ratio as IR component shows comparable model fitness indices (goodness of fit, Akaike's information criterion, and Bayesian information criterion) with leptin:adiponectin ratio (platinum standard for adiposity:IR marker) model. The least model fit was seen when using FBG as an IR surrogate. TG : HDL-C ratio performed better as IR surrogate in MetS structures (standardized factor loading = 0.39) compared to FBG (standardized factor loading = 0.27). TG: HDL-C ratio may be considered as an IR component in pediatric MetS.

Blood Adipokins in Young People with Early Ischemic Heart Disease on the Background of Abdominal Obesity

Aim      To study blood adipokines spectrum in people aged 25-44 years with early ischemic heart disease (IHD), including that associated with abdominal obesity (AO).Material and methods  A cross-sectional study was performed on a random sample of the population aged 25-44 years in Novosibirsk. 1457 subjects (653 men, 804 women) were evaluated. This study included 123 people divided into four study subgroups: subgroup 1, with IHD associated with AO (n=24); subgroup 2, with IHD and without AO (n=25); subgroup 3, without IHD and with AO (n=44); and subgroup 4, without either IHD or AO (n=30). Concentrations of serum adipokines were measured simultaneously by multiplex assay with a Luminex MAGPIX flow fluorometer and by immune enzyme assay with a MULTISCAN analyzer.Results Subjects with early IHD had lower blood concentrations of adipsin and visfatin than subjects without IHD. Subjects with early IHD associated with AO had higher blood concentrations of adipsin, plasminogen activator inhibitor-1, and leptin and lower concentrations of monocyte chemoattractant protein-1 (MCP-1) and visfatin compared to subjects with early IHD and without AO. The multivariate logistic regression analysis showed that lower blood concentrations of MCP-1 were associated with a likelihood of early IHD.Conclusion      In young people aged 25-44 years, lower blood concentrations of MCP-1 were associated with a likelihood of early IHD, including that associated with AO.

Maternal HIV, antiretroviral timing, and spontaneous preterm birth in an urban Zambian cohort: the role of local and systemic inflammation

OBJECTIVE

To assess plasma and vaginal inflammation in three antenatal groups (HIV-uninfected women, HIV-infected women entering care on preconceptional ART, and HIV-infected women not on preconceptional ART) and whether these measures are associated with spontaneous preterm birth (sPTB).

DESIGN

Case--control study nested within a pregnancy cohort in Lusaka, Zambia.

METHODS

We analyzed 11 pro-inflammatory and two anti-inflammatory markers in 207 women with paired plasma and vaginal specimens collected between 16 and 20 gestational weeks. Among 51 HIV-infected women, we repeated the assays in 24-34-week samples. We used confirmatory factor analysis to create inflammation scores and compared them among the three groups.

RESULTS

At baseline, HIV-infected women not on ART had higher vaginal pro-inflammatory scores than HIV-uninfected women [mean 0.37 (95% CI -0.06 to 0.80) vs. -0.02 (-0.32 to 0.27), P = 0.02]. In repeat testing, women not on preconceptional ART had an increase in vaginal inflammation between the baseline and 24-34-week visits compared with those continuing preconceptional ART [mean 0.62 (95% CI -0.80 to 4.20) vs. -0.07 (-2.78 to 2.11), P = 0.04]. In multivariate analyses, baseline vaginal inflammation predicted sPTB (aOR 1.5; 95% CI 1.0-2.3; P = 0.02). Plasma inflammation did not differ by HIV or ART exposure and was not associated with sPTB.

CONCLUSION

Women not receiving ART at entry into pregnancy care had more vaginal inflammation than women entering on treatment. They also experienced an increase in vaginal inflammation between the two sampling timepoints, possibly as a consequence of ART initiation. Vaginal (but not systemic) inflammation was associated with sPTB and offers a potential mechanistic insight into this important adverse birth outcome.

The Role of Secretory Activity Molecules of Visceral Adipocytes in Abdominal Obesity in the Development of Cardiovascular Disease: A Review

Adipose tissue is considered one of the endocrine organs in the body because of its ability to synthesize and release a large number of hormones, cytokines, and growth and vasoactive factors that influence a variety of physiological and pathophysiological processes, such as vascular tone, inflammation, vascular smooth muscle cell migration, endothelial function, and vascular redox state. Moreover, genetic factors substantially contribute to the risk of obesity. Research into the biochemical effects of molecules secreted by visceral adipocytes as well as their molecular genetic characteristics is actively conducted around the world mostly in relation to pathologies of the cardiovascular system, metabolic syndrome, and diabetes mellitus. Adipokines could be developed into biomarkers for diagnosis, prognosis, and therapeutic targets in different diseases. This review describes the relevance of secretory activity molecules of visceral adipocytes in cardiovascular disease associated abdominal obesity.

Strong parent-child correlation in circulating vitamin B12 levels and its association with inflammatory markers in Saudi families

Vitamin B12 deficiency leads to adverse effects on human health, but limited information is available as to whether abnormal vitamin B12 levels are associated between parents and offspring. The present study aimed to assess the association between circulating levels of vitamin B12 in Saudi parents and their children as well as its association with pro-inflammatory markers. A total of 104 Saudi families: 49 fathers, 63 mothers, 94 sons and 79 daughters were selected for the study. Fasting blood samples and anthropometrics were collected. Biochemical parameters, various pro-inflammatory markers and vitamin B12 were measured. Results showed a significant positive correlation between B12 levels in most parent-offspring pairs: mother-daughter (N = 46 pairs, r = 0.72, p < 0.0001); father-daughter (N = 39, r = 0.62, p < 0.0001) and mother-son (N = 51, r = 0.42, p < 0.01). This association was absent in father-son pairs (N = 48, r = 0.26, p = 0.09). Also, B12 was inversely associated with tumor necrosis factor-α and plasminogen activator inhibitor-1 in parents (r = -0.32; p < 0.01 and r = -0.31; p < 0.01 respectively) and children (r = -0.14; p < 0.01 and r = -0.19; p < 0.01 respectively). A significant inverse correlation was found between vitamin B12 and leptin in mothers (r = -0.31, p < 0.05). Our study suggests a strong familial component between B12 levels indicating a possible genetic influence on individual B12 status. Our study also suggests an inverse correlation between circulating levels of vitamin B12 and pro-inflammatory markers. The present study highlights the importance of extending screening in families of patients with abnormal B12 levels and expanding treatment, if necessary, to maximize clinical benefits.

Analysis of risk factors of metabolic syndrome using a structural equation model: a cohort study

PURPOSE

We aimed to use a structural equation model (SEM) to determine the interrelations between various risk factors, including latent variables, involved in the development of metabolic syndrome(MetS).

METHODS

This study used data derived from the MJ Longitudinal Health Check-up Population Database for participants aged 20 to 70 years, who were asymptomatic for MetS at enrollment and were followed up for 5 years. A SEM was applied to investigate the attributions of MetS and the interrelations between different risk factors.

RESULTS

Socioeconomic status (SES), living habits, components of metabolic syndrome (COMetS), and blood pressure had a diverse impact on the onset of MetS, directly and (or) indirectly. When investigating the latent risk factors and the interrelations between different risk factors. The standardized total effect (the sum of the direct and indirect effects, β_t) of SES, living habits, blood pressure and COMetS on the onset of MetS was 0.084, -0.179, 0.154, and 0.353, respectively. SES, as a distal risk factor, directly influenced living habits, blood pressure, and COMetS with standardized regression coefficients (β_r) of -0.079 (P < 0.001), 0.200 (P < 0.001), and -0.163 (P < 0.001) respectively. Unfavorable living habits exerted an inverse effect on blood pressure and COMetS (β_r = -0.101, P < 0.001; β_r = -0.463, P < 0.001), which was an important path way for developing MetS.

CONCLUSIONS

These results demonstrate that individuals with a higher level of SES are susceptible to high blood pressure and are at increased risk for MetS. Additionally, there is a decrease in exercise and an increase in smoking and consumption of alcohol corresponded to an increase in metabolic risk factors.

Causal Effect of Plasminogen Activator Inhibitor Type 1 on Coronary Heart Disease

Background

Plasminogen activator inhibitor type 1 (PAI‐1) plays an essential role in the fibrinolysis system and thrombosis. Population studies have reported that blood PAI‐1 levels are associated with increased risk of coronary heart disease (CHD). However, it is unclear whether the association reflects a causal influence of PAI‐1 on CHD risk.

Methods and Results

To evaluate the association between PAI‐1 and CHD, we applied a 3‐step strategy. First, we investigated the observational association between PAI‐1 and CHD incidence using a systematic review based on a literature search for PAI‐1 and CHD studies. Second, we explored the causal association between PAI‐1 and CHD using a Mendelian randomization approach using summary statistics from large genome‐wide association studies. Finally, we explored the causal effect of PAI‐1 on cardiovascular risk factors including metabolic and subclinical atherosclerosis measures. In the systematic meta‐analysis, the highest quantile of blood PAI‐1 level was associated with higher CHD risk comparing with the lowest quantile (odds ratio=2.17; 95% CI: 1.53, 3.07) in an age‐ and sex‐adjusted model. The effect size was reduced in studies using a multivariable‐adjusted model (odds ratio=1.46; 95% CI: 1.13, 1.88). The Mendelian randomization analyses suggested a causal effect of increased PAI‐1 level on CHD risk (odds ratio=1.22 per unit increase of log‐transformed PAI‐1; 95% CI: 1.01, 1.47). In addition, we also detected a causal effect of PAI‐1 on elevating blood glucose and high‐density lipoprotein cholesterol.

Conclusions

Our study indicates a causal effect of elevated PAI‐1 level on CHD risk, which may be mediated by glucose dysfunction.

Association of Vitamin B12 with Pro-Inflammatory Cytokines and Biochemical Markers Related to Cardiometabolic Risk in Saudi Subjects

Background: This study aimed to examine the relationship between changes in systemic vitamin B12 concentrations with pro-inflammatory cytokines, anthropometric factors and biochemical markers of cardiometabolic risk in a Saudi population. Methods: A total of 364 subjects (224 children, age: 12.99 ± 2.73 (mean ± SD) years; BMI: 20.07 ± 4.92 kg/m² and 140 adults, age: 41.87 ± 8.82 years; BMI: 31.65 ± 5.77 kg/m²) were studied. Fasting blood, anthropometric and biochemical data were collected. Serum cytokines were quantified using multiplex assay kits and B12 concentrations were measured using immunoassay analyzer. Results: Vitamin B12 was negatively associated with TNF-α (r = −0.14, p < 0.05), insulin (r = −0.230, p < 0.01) and HOMA-IR (r = −0.252, p < 0.01) in all subjects. In children, vitamin B12 was negatively associated with serum resistin (r = −0.160, p < 0.01), insulin (r = −0.248, p < 0.01), HOMA-IR (r = −0.261, p < 0.01). In adults, vitamin B12 was negatively associated with TNF-α (r = −0.242, p < 0.01) while positively associated with resistin (r = 0.248, p < 0.01). Serum resistin was the most significant predictor for circulating vitamin B12 in all subjects (r² = −0.17, p < 0.05) and in children (r² = −0.167, p < 0.01) while HDL-cholesterol was the predictor of B12 in adults (r² = −0.78, p < 0.05). Conclusions: Serum vitamin B12 concentrations were associated with pro-inflammatory cytokines and biochemical markers of cardiometabolic risks in adults. Maintaining adequate vitamin B12 concentrations may lower inflammation-induced cardiometabolic risk in the Saudi adult population.

Factor analysis of metabolic syndrome components and predicting type 2 diabetes: Results of 10-year follow-up in a Middle Eastern population

BACKGROUND

The relationship among components of metabolic syndrome (MetS) and their association with diabetes is unclear in West Asia. The aim of the present study was to conduct factor analysis of MetS components and the effect these factors have on the incidence of type 2 diabetes (T2D) in a population-based cohort study of the Tehran Lipid and Glucose Study (TLGS).

METHODS

The present study enrolled 1861 men and 2706 women (20-60 years of age), from Tehran (Iran) who were free of diabetes at baseline and followed them for 10 years. A principal component analysis was performed to extract standardized factors from MetS components. Logistic regression was used to detect associations between the extracted factors and the incidence of diabetes. A propensity score was used to correct differential selection bias resulting from loss to follow-up.

RESULTS

Factor analysis identified three factors (blood pressure, lipids and glycemia). Waist circumference was shared in three all factors. Blood pressure, lipids and glycemia were related to the incidence of diabetes with odds ratios (95% confidence intervals) of 2.23 (1.31-3.78), 1.89 (1.27-3.67), and 7.54 (4.09-13.91), respectively, in men and 2.13 (1.34-3.40), 2.06 (1.35-3.15), and 13.91 (7.29-26.51), respectively, in women for the third versus the first tertile of these standardized factors.

CONCLUSIONS

Central adiposity may have a pivotal role in MetS linking other risk factors together. Glycemia had a high impact on the incidence of diabetes, whereas blood pressure and lipid had a similar moderate effect on the incidence of diabetes.

The role of multicomponent therapy in the metabolic syndrome, inflammation and cardiovascular risk in obese adolescents

Obesity is characterised by low-grade inflammation, which increases the metabolic syndrome (MetS) and cardiovascular risks. The aim of the present study was to verify the role of multicomponent therapy in controlling the MetS, inflammation and carotid intima-media thickness (cIMT) in obese adolescents. The second aim was to investigate the relationships between adipokines, the MetS parameters and cIMT. A total of sixty-nine obese adolescents participated in the present study and completed 1 year of multicomponent therapy (a combination of strategies involving nutrition, psychology, physical exercise and clinical therapy), and were divided according to their MetS diagnosis as follows: MetS (n 19); non-MetS (n 50). Blood analyses of glucose, lipid and adipokine concentrations (adiponectin, leptin, plasminogen activator inhibitor 1 (PAI-1) and C-reactive protein) were collected. Insulin resistance was assessed using the homeostasis model assessment for insulin resistance, quantitative insulin sensitivity check index and homeostasis model assessment-adiponectin. cIMT and visceral and subcutaneous fat were estimated using ultrasonography. At baseline, the MetS group presented higher waist circumference, glucose and insulin levels, and systolic and median blood pressures compared with the non-MetS group. After therapy, both groups showed improvements in the anthropometric profile, body composition, insulin level, insulin resistance, insulin sensibility, TAG and VLDL-cholesterol, adiponectin, leptin and PAI-1 levels, blood pressure and cIMT. The prevalence of the MetS was reduced from 27·5 to 13·0 %. Metabolic syndrome patients showed resistance in the attenuation of total cholesterol and LDL-cholesterol (LDL-C) levels and leptin:adiponectin and adiponectin:leptin ratios. In the MetS group, the variation in the adiponectin:leptin ratio was correlated with variations in glucose, insulin sensibility, total cholesterol, LDL-c and systolic blood pressure. Additionally, the number of MetS parameters was correlated with the carotid measurement. Moreover, the variation in cIMT was correlated with the variations in insulin sensibility, total cholesterol and LDL-c. For the entire group, the number of MetS alterations was correlated with the leptin level and leptin:adiponectin ratio and adiponectin:leptin ratio after therapy. In conclusion, multicomponent therapy was effective in controlling the MetS, inflammation and cIMT in the obese adolescents. However, the MetS patients showed resistance in the attenuation of the atherogenic lipid profile and leptin:adiponectin ratio and adiponectin:leptin ratio. These results suggest that the MetS patients have increased cardiovascular risks, and that it is important to attempt to control the inflammatory process that occurs due to obesity in clinical practice in order to improve the health of adolescents.

Effects of adenotonsillectomy on plasma inflammatory biomarkers in obese children with obstructive sleep apnea: A community-based study

Background

Obesity and obstructive sleep apnea syndrome (OSA) are highly prevalent and frequently overlapping conditions in children that lead to systemic inflammation, the latter being implicated in the various end-organ morbidities associated with these conditions.

Aim

To examine the effects of adenotonsillectomy (T&A) on plasma levels of inflammatory markers in obese children with polysomnographically diagnosed OSA who were prospectively recruited from the community.

Methods

Obese children prospectively diagnosed with OSA, underwent T&A and a second overnight polysomnogram (PSG) after surgery. Plasma fasting morning samples obtained after each of the 2 PSG were assayed for multiple inflammatory and metabolic markers including interleukin-6 (IL-6), IL-18, plasminogen activator inhibitor-1 (PAI-1), monocyte chemoattractant protein-1 (MCP-1), matrix metalloproteinase- (MMP-9), adiponectin, apelin C, leptin and osteocrin.

Results

Out of 122 potential candidates, 100 obese children with OSA completed the study with only 1/3 exhibiting normalization of their PSG after T&A (i.e., AHI≤1/hrTST). However, overall significant decreases in MCP-1, PAI-1, MMP-9, IL-18 and IL-6, and increases in adropin and osteocrin plasma concentrations occurred after T&A. Several of the T&A responsive biomarkers exhibited excellent sensitivity and moderate specificity to predict residual OSA (i.e., AHI≥/hrTST).

Conclusions

A defined subset of systemic inflammatory and metabolic biomarkers is reversibly altered in the context of OSA among community-based obese children, further reinforcing the concept on the interactive pro-inflammatory effects of sleep disorders such as OSA and obesity contributing to downstream end-organ morbidities.

Interaction between paraoxonase 1 polymorphism and prenatal pesticide exposure on metabolic markers in children using a multiplex approach

Prenatal environmental exposures may influence the risk of cardio-metabolic diseases later in life. This study used a multiplex approach to investigate non-fasting serum levels of metabolic markers in a cohort of school-aged children for whom associations between prenatal pesticide exposure and body fat content and blood pressure were previously found to be dependent on paraoxonase1 (PON1) Q192R genotype. In children with the PON1 192 R-allele, leptin, glucagon, and plasminogen activator inhibitor-1 (PAI-1) were positively associated with prenatal pesticide exposure. For PON1 192 QQ-homozygote children none of the biomarkers were significantly affected by prenatal pesticide exposure. In children with the R-allele, leptin was associated with both body fat measures and prenatal pesticide exposure and seems to mediate body fat accumulation in exposed children. These findings support our previous results of an adverse cardio-metabolic risk profile associated with prenatal pesticide exposure in children with the PON1 192 R-allele.

Inflammatory markers and obstructive sleep apnea in obese children: the NANOS study

Introduction. Obesity and obstructive sleep apnea syndrome (OSA) are common coexisting conditions associated with a chronic low-grade inflammatory state underlying some of the cognitive, metabolic, and cardiovascular morbidities. Aim. To examine the levels of inflammatory markers in obese community-dwelling children with OSA, as compared to no-OSA, and their association with clinical and polysomnographic (PSG) variables. Methods. In this cross-sectional, prospective multicenter study, healthy obese Spanish children (ages 4–15 years) were randomly selected and underwent nocturnal PSG followed by a morning fasting blood draw. Plasma samples were assayed for multiple inflammatory markers. Results. 204 children were enrolled in the study; 75 had OSA, defined by an obstructive respiratory disturbance index (RDI) of 3 events/hour total sleep time (TST). BMI, gender, and age were similar in OSA and no-OSA children. Monocyte chemoattractant protein-1 (MCP-1) and plasminogen activator inhibitor-1 (PAI-1) levels were significantly higher in OSA children, with interleukin-6 concentrations being higher in moderate-severe OSA (i.e., AHI > 5/hrTST; P < 0.01), while MCP-1 levels were associated with more prolonged nocturnal hypercapnia (P < 0.001). Conclusion. IL-6, MCP-1, and PAI-1 are altered in the context of OSA among community-based obese children further reinforcing the proinflammatory effects of sleep disorders such as OSA. This trial is registered with ClinicalTrials.gov NCT01322763.