Predictive ability of serum high-molecular-weight adiponectin in combination with serum insulin and serum C-reactive protein for the presence of metabolic syndrome

Can biomarkers be used to improve diagnosis and prediction of metabolic syndrome in childhood cancer survivors? A systematic review

Childhood cancer survivors (CCS) are at increased risk to develop metabolic syndrome (MetS), diabetes, and cardiovascular disease. Common criteria underestimate adiposity and possibly underdiagnose MetS, particularly after abdominal radiotherapy. A systematic literature review and meta-analysis on the diagnostic and predictive value of nine newer MetS related biomarkers (adiponectin, leptin, uric acid, hsCRP, TNF-alpha, IL-1, IL-6, apolipoprotein B (apoB), and lipoprotein(a) [lp(a)]) in survivors and adult non-cancer survivors was performed by searching PubMed and Embase. Evidence was summarized with GRADE after risk of bias evaluation (QUADAS-2/QUIPS). Eligible studies on promising biomarkers were pooled. We identified 175 general population and five CCS studies. In the general population, valuable predictive biomarkers are uric acid, adiponectin, hsCRP and apoB (high level of evidence), and leptin (moderate level of evidence). Valuable diagnostic biomarkers are hsCRP, adiponectin, uric acid, and leptin (low, low, moderate, and high level of evidence, respectively). Meta-analysis showed OR for hyperuricemia of 2.94 (age-/sex-adjusted), OR per unit uric acid increase of 1.086 (unadjusted), and AUC for hsCRP of 0.71 (unadjusted). Uric acid, adiponectin, hsCRP, leptin, and apoB can be alternative biomarkers in the screening setting for MetS in survivors, to enhance early identification of those at high risk of subsequent complications.

Higher and increased concentration of hs-CRP within normal range can predict the incidence of metabolic syndrome in healthy men

AIMS

To determine whether hs-CRP level and interval change of hs-CRP could predict the development of metabolic abnormalities in healthy subjects in a longitudinal study.

METHODS

A cohort of 3748 male who had normal hs-CRP level without evidence of any component of metabolic syndrome were studied. At each visit, hs-CRP level and metabolic abnormalities were measured. Interval change of hs-CRP for each subject was calculated. COX proportional hazard model and logistic regression analysis were used.

RESULTS

Cumulative incidence and incidence density of metabolic syndrome were 3.96% and 7.17 per 1000 person-year, respectively. Cumulative incidence of metabolic syndrome was significantly increased according to hs-CRP tertile level. This significance remained after adjusting age, smoking, drinking, and exercise. Although the hazard ratio of metabolic syndrome for incidence density was increased significantly as hs-CRP increased, such trend disappeared after adjusting for confounding variables. The risk of metabolic syndrome was significantly higher (1.48 times) in the hs-CRP increased group than that in the decreased or unchanged group. This significance remained after controlling for covariates.

CONCLUSION

Relatively higher hs-CRP level within normal range may predict the increase of metabolic syndrome compared to lower hs-CRP. Increased hs-CRP level may increase the incidence of metabolic syndrome.

High-normal levels of hs-CRP predict the development of non-alcoholic fatty liver in healthy men

We performed a follow-up study to address whether high sensitivity C-reactive protein (hs-CRP) levels within the normal range can predict the development of non-alcoholic fatty liver disease (NAFLD) in healthy male subjects. Among15347 male workers between 30 and 59 years old who received annual health check-ups in 2002, a NAFLD-free cohort of 4,138 was followed through December 2009. Alcohol consumption was assessed with a questionnaire. At each visit, abdominal ultrasonography was performed to identify fatty liver disease. The COX proportional hazard model was used to evaluate the relationship between hs-CRP and incident NAFLD. During the follow-up period, 28.8% (1191 of 4138) of participants developed NAFLD. The hazard ratios of NAFLD were increased by hs-CRP categories within the normal range in the non-adjusted model and age-adjusted model. After adjusting for age, exercise, smoking, BMI, systolic BP, triglyceride, and fasting glucose, these incidences were only increased between the lowest and the highest hs-CRP categories. The risk for NAFLD increased as the hs-CRP level increased (p< 0.001). As the hs-CRP level increased within the healthy cohort, the risk of developing NAFLD increased. This trend remained true even if the hs-CRP level remained within the normal range. hs-CRP can be used as a predictor of NAFLD, as well as other obesity-associated diseases. Therefore, individuals with higher hs-CRP levels (even within the normal range) may require appropriate follow-up and management to prevent NAFLD development.

Relationship between sleep-disordered breathing and metabolic syndrome after adjustment with cardiovascular risk factors

AIMS

It is important to identify the risk factors for metabolic syndrome (MetS) in order to prevent the development of cardio-/cerebrovascular diseases. The authors estimated the risk factors for the development of MetS with special emphasis on the severity of sleep-disordered breathing (SDB).

METHODS

We conducted as a cross-sectional study in subjects undergoing intensive health examination (581 men aged 33-84 years). Diagnosis of MetS was based on the criteria of the National Cholesterol Education Program Expert Panel.

RESULTS

The prevalence of MetS in subjects with severe SDB, which was defined as an apnea-hypopnea index (AHI) of 30 or higher, was 40.7%, which was significantly higher than that in the subjects without severe SDB (29.3%). The odds ratio (OR) (95% confidence interval [CI]) of the logarithmic-transformed AHI for MetS was 1.6 (1.1-2.4) after adjustments for age, serum uric acid, logarithmic-transformed serum C-reactive protein, smoking history, exercise history and alcohol history. When the subjects were categorized by the severity of SDB, the OR (95% CI) of severe SDB, which was the only category that showed significant association, was 2.2 (1.2-4.0).

CONCLUSION

A significant association was observed between severe SDB and the presence of MetS in the subjects (all male) of this study.

Lifestyle-induced decrease in fat mass improves adiponectin secretion in obese adults

PURPOSE

Several studies have identified relationships between weight loss and adipokine levels; however, none have looked at the combined effect of aerobic exercise training with the consumption of a low- or a high-glycemic diet. We examined the effects of 12 wk of aerobic exercise combined with either a low-glycemic index diet (∼40 U) plus exercise (LoGIX) or a high-glycemic index diet (∼80 U) diet plus exercise (HiGIX) on plasma leptin and adiponectin (total and high molecular weight [HMW]) in 27 older obese adults (age = 65 ± 0.5 yr, body mass index = 34.5 ± 0.7 kg·m).

METHODS

Insulin sensitivity was calculated from an oral glucose tolerance test. Fasting HMW adiponectin and leptin were quantified from plasma samples obtained before the insulin sensitivity index obtained from the oral glucose tolerance test. Glucose and insulin measures were obtained before and every 30 min during the test. Dual-energy x-ray absorptiometry and computerized tomography were used to determine body composition and to quantify subcutaneous and visceral abdominal adiposity, respectively.

RESULTS

Fasting leptin was significantly decreased in both groups (LoGIX: preintervention = 33.8 ± 4.7, postintervention = 19.2 ± 4.5; HiGIX: preintervention = 27.9 ± 4.2, postintervention = 11.9 ± 2.2 ng·mL; P = 0.004), and HMW adiponectin was significantly increased (LoGIX: preintervention = 1606.9 ± 34.6, postintervention = 3502.3 ± 57; HiGIX: preintervention = 3704.8 ± 38.1, postintervention = 4284.3 ± 52.8 pg·mL; P = 0.003) after the 12-wk intervention. Total body fat was reduced after both interventions. Visceral fat mass was inversely correlated with HMW adiponectin, whereas subcutaneous fat correlated with leptin.

CONCLUSIONS

The data suggest that exercise training, independent of dietary glycemic index, favorably alters HMW adiponectin and leptin secretion and that a reduction in visceral fat mass is a key factor regulating HMW adiponectin in older obese persons.

Effect of Walking Exercise on Changes in Cardiorespiratory Fitness, Metabolic Syndrome Markers, and High-molecular-weight Adiponectin in Obese Middle-aged Women

[Purpose] The purpose of this study was to assess the effect of a 24-week exercise intervention on cardiorespiratory fitness, metabolic syndrome markers, and high-molecular-weight (HMW) adiponectin among obese middle-aged women. [Subjects] The subjects were 14 obese middle-aged women. [Methods] The exercise program involved walking at 50–60% of the maximum oxygen consumption, 3 times a week, for 24 weeks. Body composition analysis, blood pressure measurements, and blood analysis were performed before the exercise program and at weeks 6, 12, 18, and 24. [Results] The results showed that after 24 weeks in the exercise program, the obesity indices and metabolic risk factors, namely, weight, body fat, body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, and triglycerides decreased significantly, whereas HDLC, a metabolic improvement factor, increased significantly. Additionally, VO_2max increased significantly, together with the level of total and HMW adiponectins. Correlation analysis of the changes in measured variables (∆ score) during resulting from the 24-week exercise program showed that body fat had a significant negative correlation and VO_2max had a significant positive correlation with HMW adiponectin. [Conclusion] Among obese middle-aged women, regular exercise increases cardiorespiratory fitness and HMW adiponectin expression and therefore can be effective in the prevention and treatment of obesity and metabolic syndrome.