To the Editor: Adiponectin, an adipose tissue–derived protein, is an important regulator of insulin sensitivity and inflammation. The hormone plays a role in the suppression of the metabolic derangements that may result in type 2 diabetes mellitus (DM), obesity, atherosclerosis, and nonalcoholic fatty liver disease, and is an independent risk factor for metabolic syndrome.1 Adiponectin circulates in three isoforms: a trimer (low molecular weight (LMW)), a hexamer (trimer-dimer) of medium molecular weight (MMW), and a larger multimeric high-molecular-weight (HMW) isoform. Various studies have demonstrated that the HMW adiponectin isoform is primarily responsible for direct associations between adiponectin and several metabolic parameters, including insulin sensitivity and lower abdominal fat accumulation.2,3 We read with great interest the recently published study by Rizza and colleagues4 on adiponectin isoforms in elderly patients with or without coronary artery disease. The data from this study confirmed that adiponectin isoform levels are higher in older adults with coronary heart disease. The special importance of this article is that LMW adiponectin may have a protective role in this special group, but there are several points that merit discussion. As shown in the study design section, subjects without known type 2 DM underwent an oral glucose tolerance test, but the participants with prediabetes were evaluated as patients without DM, not as a separate group. This is important because circulating blood adiponectin levels are altered in subjects with disordered glucose metabolism.5 Smoking has been known to affect adipocytokines and to cause decreases in adiponectin levels. Moderate alcohol consumption is associated with higher adiponectin concentrations in healthy individuals.6 Furthermore, physically active older women have higher adiponectin concentrations,7 but Rizza and colleagues, in their research, did not check lifestyle-related factors, which may affect adipocytokine status.4 For these reasons, we would like to ask the authors whether they can present some new results by categorizing the patients according to confounders such as glucose tolerance status and lifestyle factors. This may provide readers with clearer information about adiponectin isoforms in older populations. We hope that this letter might prompt them to provide additional perspective on these questions. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: All authors contributed to the interpretation of the examined article and preparation of the letter. Sponsor's Role: None.
Read full abstract