Abstract
Metabolic syndrome (MetS) has an important epidemiological relevance due to its increasing prevalence and association with type 2 diabetes and cardiovascular disease. Insulin resistance is a core feature of the MetS. HOMA-IR is a robust clinical and epidemiological marker of MetS. Adiponectin is an adipokine with insulin-sensitizing and anti-inflammatory functions; its levels decrease as number of components of MetS increases. High-molecular weight adiponectin (HMWA) is the multimer responsible for the relationship of adiponectin with insulin sensitivity. HOMA-IR and HMWA are suitable candidates for MetS biomarkers. The ratio of adiponectin to HOMA-IR has been validated as a powerful index of MetS and considered a better marker of its presence, than either HOMA-IR or adiponectin alone, in selected homogeneous populations. We compared the strength of association between HMWA, HOMA-IR and HMWA/HOMA-IR ratio with MetS and its key components. Our data have shown that the median (25th, 75th percentile) of HMWA/HOMA-IR ratio was lower in subjects with MetS [0.51 (0.33, 1.31)] as compared to those without it [2.19 (1.13, 4.71)]. The correlation coefficient (r) was significantly higher for HMWA/HOMA-IR ratio as compared to HMWA for waist circumference (-0.65; -0.40, respectively); mean blood pressure (-0.27; -0.14, respectively); fasting glucose (-0.38; -0.19, respectively); HDL-cholesterol (0.44; 0.40, respectively); and triglycerides (-0.35; -0.18, respectively). In a multivariable logistic regression analysis, the HMWA/HOMA-IR ratio was a sensitive predictor for MetS, being the only marker that was significantly associated with each and all the individual components of the syndrome. These results expand on previous studies in that we used the active circulating form of adiponectin, i.e. HMWA, and represent a typical Brazilian cohort characterized by intense interethnic admixture. Thus, the HMWA/HOMA-IR ratio is a minimally invasive biomarker for MetS that could be clinically useful in prognosing patient outcome.
Highlights
The metabolic syndrome (MetS), as defined by the Joint Interim Statement of the International Diabetes Federation (IDF), American Heart Association (AHA), National Heart, Lung and Blood Institute (NHLBI) and other international societies [1], has been considered a useful construct because its multiple components cluster with a greater than chance expectation [2]
BMI, waist circumference (WC), waist-to-hip ratio (WHR), blood pressure, glucose, total and LDL-cholesterol, triglycerides, insulin, HOMA-insulin resistance (IR) and high sensitive C-reactive protein (hsCRP) were significantly higher in cases with the MetS compared to those without it
Contrariwise, HDL-cholesterol, High-molecular weight adiponectin (HMWA) and HMWA/HOMA-IR ratio were significantly higher in cases without MetS
Summary
The metabolic syndrome (MetS), as defined by the Joint Interim Statement of the International Diabetes Federation (IDF), American Heart Association (AHA), National Heart, Lung and Blood Institute (NHLBI) and other international societies [1], has been considered a useful construct because its multiple components cluster with a greater than chance expectation [2]. MetS has important epidemiological relevance due to its increasing prevalence and association with more life-threatening pathologies, including type-2 diabetes (T2DM) and cardiovascular disease (CVD) [3,4,5,6]. Hypoadiponectinemia has been associated with IR [11] and T2DM [12], and with the several components of MetS and with MetS per se [13,14]. Adiponectin decreases as number of components of MetS increases [14]. Adiponectin circulates as oligomeric [high molecular weight (HMW)], hexameric [middle molecular weight (MMW)], and trimeric [low molecular weight (LMW)] forms [15]
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