Abstract
Results from previous prospective studies assessing the relation between adiponectin and type 2 diabetes (T2D) were not entirely consistent, and evidence in Chinese population is scarce. Moreover, the last meta-analysis did not examine the impact of metabolic variables on the adiponectin-T2D association. Therefore, we prospectively evaluated the adiponectin-T2D association among 571 T2D cases and 571 age-sex-matched controls nested within the Singapore Chinese Health Study (SCHS). Furthermore, we conducted an updated meta-analysis by searching prospective studies on Pubmed till September 2016. In the SCHS, the odds ratio of T2D, comparing the highest versus lowest tertile of adiponectin levels, was 0.30 (95% confidence interval: 0.17, 0.55) in the fully-adjusted model. The relation was stronger among heavier participants (body mass index ≥23 kg/m2) compared to their leaner counterparts (P for interaction = 0.041). In a meta-analysis of 34 prospective studies, the pooled relative risk was 0.53 (95% confidence interval: 0.47, 0.61) comparing the extreme tertiles of adiponectin with moderate heterogeneity (I2 = 48.7%, P = 0.001). The adiponectin-T2D association remained unchanged after adjusting for inflammation and dyslipidemia markers, but substantially attenuated with adjustment for insulin sensitivity and/or glycaemia markers. Overall evidence indicates that higher adiponectin levels are associated with decreased T2D risk in Chinese and other populations.
Highlights
Adiponectin, a major adipokine secreted by adipose tissue[1], has attracted much attention due to its antiinflammatory and insulin-sensitizing properties as well as its beneficial role in glucose metabolism[2]
The shape of the association, and its potential confounders or modifying factors are unclear in a Chinese population
No significant publication bias was detected (P = 0.12 in the Egger’s test). In this nested case-control study, we found a strong dose-dependent association between higher plasma adiponectin levels and lower type 2 diabetes (T2D) risk, which seemed to be independent of established T2D risk factors, including lipids, inflammatory biomarker, random glucose and insulin
Summary
Adiponectin, a major adipokine secreted by adipose tissue[1], has attracted much attention due to its antiinflammatory and insulin-sensitizing properties as well as its beneficial role in glucose metabolism[2]. Association between adiponectin levels (binary variable) and T2D risk in a Hong Kong Chinese population in the context of T2D prediction model[26]. The last meta-analysis pooled risk estimates from models that did not adjust for metabolic variables such as lipids, markers of inflammation, glycaemia and insulin sensitivity[5]. In this context, we first conducted a case-control study nested within the prospective, population-based cohort, the Singapore Chinese Health Study (SCHS), to quantify the association between plasma adiponectin levels and risk of incident T2D in a Chinese population. We further conducted an updated meta-analysis of published reports on circulating adiponectin and T2D, involving another 33 population-based longitudinal studies. We performed comprehensive stratified analysis to explore the heterogeneity among different subgroups and examined the dose-response relationship between adiponectin and T2D risk in the updated meta-analysis
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