Leptin-adiponectin imbalance as a marker of metabolic syndrome among Chinese children and adolescents: The BCAMS study.

Ge Li,Qian Zhang,Lujiao Li,Shan Gao,Jie Mi,Ming Li,Junling Fu,Xinhua Xiao,Yanglu Zhao,Changhong Li,Naishi Li,Linxin Xu,Yang-Ching Chen

doi:10.1371/journal.pone.0186222

Abstract

PurposeLeptin and adiponectin have opposite effects on subclinical inflammation and insulin resistance, both involved in the development of metabolic syndrome (MS). We aimed to investigate whether leptin/adiponectin ratio (L/A), as a marker of these two adipokines imbalance, may improve diagnosis of MS in children and adolescents, and determined its cut-off value in the diagnosis of MS.MethodsA total of 3,428 subjects aged 6–18 years were selected from Beijing Child and Adolescent Metabolic Syndrome study. Adipokine leptin and adiponectin were measured using enzyme-linked immunosorbent assay. Odds ratio of MS per 1 z-score of adipokine was examined using logistic regression. Diagnosis accuracy was assessed using c-statistics (AUC) and net reclassification index.ResultsThe levels of leptin and L/A increased with number of positive MS components, while the levels of adiponectin declined in both boys and girls (all P <0.001). AUCs for diagnosis of MS in girls were 0.793, 0.773, and 0.689 using L/A, leptin and adiponectin, respectively; and AUCs in boys were 0.822, 0.798, and 0.697 for L/A, leptin and adiponectin, respectively. Notably, L/A outperformed individual leptin or adiponectin in discriminating a diagnosis of MS (all P < 0.02 in AUC comparisons). In addition, the optimal cut-offs of L/A by ROC curve differed by genders and pubertal stages, which were 1.63, 1.28, 1.95 and 1.53 ng/ug for total, pre-, mid- and postpubertal boys, respectively and 2.19, 0.87,1.48 and 2.27 ng/ug for total, pre-, mid- and postpubertal girls, respectively, yielding high sensitivity and moderate specificity for a screening test.ConclusionsIn this pediatric population, leptin-adiponectin imbalance, as reflected by an increase in L/A level, was found to be a better diagnostic biomarker for MS than leptin or adiponectin alone. Future longitudinal studies are needed to further validate the gender-specific cutoff values.

Highlights

Metabolic syndrome (MS) is characteristic as a cluster of cardiometabolic risk factors, including central obesity, glucose intolerance, hypertension and dyslipidemia
The levels of leptin and leptin/adiponectin ratio (L/A) increased with number of positive MS components, while the levels of adiponectin declined in both boys and girls
MS is associated with insulin resistance (IR), type 2 diabetes (T2D) as well as cardiovascular disease (CVD) [1]

Summary

Introduction

Metabolic syndrome (MS) is characteristic as a cluster of cardiometabolic risk factors, including central obesity, glucose intolerance, hypertension and dyslipidemia. MS is associated with insulin resistance (IR), type 2 diabetes (T2D) as well as cardiovascular disease (CVD) [1]. Obesity is the most common cause of IR in children, thereby the increasing prevalence of childhood obesity calls more attention to pediatric MS worldwide [2]. The available definitions of pediatric MS vary between guidelines [2, 3]. Not all overweight or obese children develop MS, T2D, or CVD. Many potential indicators beyond the traditional adiposity measures that may better reflect the function of adipose tissue, such as adipokines, are considered to be included in the expansion of MS definition and would hopefully provide further improvement for MS diagnosis [3, 4]

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