Abstract
Adiponectin (Ad) is a cytokine produced by adipocytes that acts on specific receptors of several tissues through autocrine, paracrine, and endocrine signaling mechanisms. Ad is involved in the regulation of cell survival, cell growth, and apoptosis. Furthermore, Ad plays an important pathophysiological role in metabolic activities by acting on peripheral tissues involved in glucose and lipid metabolism such as skeletal muscle, and the liver. Adiponectin has anti-inflammatory, anti-atherogenic, and insulin-sensitizing effects. For this reason, low levels of Ad are associated with the development of cardiovascular complications of obesity in adulthood. Numerous studies have shown that, even in children and adolescents, Ad is associated with risk factors for cardiovascular diseases. In obese children, reduced levels of Ad have been reported and Ad plasma levels are inversely related with abdominal obesity. Moreover, lower Ad concentrations are associated with the development of metabolic syndrome, insulin resistance and hypertension in pediatric subjects. In addition to a higher prevalence of cardiovascular risk factors, plasma values of Ad are also inversely associated with early organ damage, such as an increase in carotid intima-media thickness. It has been suggested that low Ad levels in childhood might predict the development of atherosclerosis in adulthood, suggesting the possibility of using Ad to stratify cardiovascular risk in obese children. Some evidence suggests that lifestyle modification may increase Ad plasma levels. The aim of this review is to summarize the evidence on the relationship between Ad, obesity, metabolic alterations and hypertension in children and adolescents, and to address the possibility that Ad represents an early marker of cardiovascular risk in pediatric subjects. Furthermore, the effects of non-pharmacological treatment (weight loss and physical activity) on Ad levels are considered.
Highlights
The discovery, in the mid-1990s, that adipose tissue is an important endocrine organ that secretes a number of biologically active adipokines into the bloodstream was a big step forward in understanding human metabolic mechanisms
This observation was subsequently confirmed by Yin and colleagues who showed that in a population of obese children, the presence of arterial hypertension was associated with a significant reduction in plasma levels of Ad
A recent study showed that in a population of 240 Mexican children serum levels of Ad, but not those of other adipocytokines, were inversely associated with high blood pressure (BP) values. These results were confirmed after adjustment for BMI and waist circumference [86,87]. All these findings strongly suggest an association between low Ad levels and hypertension, which is independent of obesity
Summary
The discovery, in the mid-1990s, that adipose tissue is an important endocrine organ that secretes a number of biologically active adipokines into the bloodstream was a big step forward in understanding human metabolic mechanisms. Adiponectin (Ad) is one of the main cytokines produced by adipose tissue. The metabolic effects of Ad have not yet been fully clarified. Numerous experimental and clinical observations clearly suggest that a decrease in Ad bioactivity is involved in the pathophysiology of cardiovascular diseases. The reduction of anti-inflammatory, antiatherogenic, and insulin-sensitizing effects of Ad increases the risk of developing cardiovascular risk factors such as as obesity, insulin-resistance, and hypertension in adults [1]. More and more evidence points to an interaction between Ad levels and cardiovascular risk playing a role from childhood onwards
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