Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Adiponectin, insulin resistance and clinical expression of the metabolic syndrome in patients with Type 2 diabetes

International Journal of Obesity volume 31, pages 213–220 (2007)Cite this article

Abstract

Background:

Obesity and the metabolic syndrome have emerged as clinical and public health crises in many populations, but not all obese patients have the syndrome. As adipocytes produce several adipokines that modulate insulin action as well as glucose and lipid metabolism, we postulate that estimation of adipokines may be useful addition to the criteria used to identify obese individuals with the metabolic syndrome.

Objective:

To evaluate the determinants and associations of plasma adiponectin in relation to the metabolic syndrome in patients with Type 2 diabetes.

Design:

Cross-sectional study.

Setting:

General Teaching Hospital.

Patients:

One hundred and thirty five (57 M, 78 F) patients with Type 2 diabetes mellitus.

Measurements:

Adiponectin, leptin, high-sensitivity C-reactive protein (hs-CRP), fasting plasma insulin, glucose, glycated hemoglobin and full lipid profile. Patients were classified on the basis of the degree of adiposity, insulin resistance (IR) (homeostasis model assessment of insulin resistance (HOMA-IR)) and the number of the American Heart Association and the National Heart, Lung and Blood Institute criteria of the metabolic syndrome.

Results:

Adiponectin levels were inversely correlated with age, indices of obesity, IR and hs-CRP. Overweight/obese and non-obese insulin-sensitive patients had significantly higher (P<0.05) adiponectin levels than those with IR despite similar body mass index and waist circumference. Therefore, within each category of obesity stratification, lower adiponectin levels were associated with IR. Adiponectin showed stepwise decrease with increasing number of the criteria for diagnosis of the metabolic syndrome. Using multiple logistic regression, the odds ratio of the metabolic syndrome as predicted by adiponectin was 0.73 (95% confidence interval 0.53–0.96; P=0.04). At cutoff point of 18 ng/ml, the diagnostic sensitivity and specificity of adiponectin for the metabolic syndrome were 83 and 65%, respectively, in male patients and 92 and 41%, respectively, in female patients. Receiver operating characteristic analysis showed that adiponectin had significantly higher area under the curve compared with leptin, leptin:adiponectin ratio and triglycerides for the detection of the metabolic syndrome.

Conclusions:

In patients with Type 2 diabetes, adiponectin concentrations are closely related to IR and the components of the metabolic syndrome. Adiponectin concentration may be a useful addition to the criteria used for identifying obese subjects with the metabolic syndrome.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Al-Isa AN . Are Kuwaitis getting fatter? Nutr Health 2003; 17: 185–197.

    Article  Google Scholar 

  2. Amos AF, McCarty DJ, Zimmet P . The rising global burden of diabetes and its complications: estimates and projections to the year 2010. Diabet Med 1997; 14: S1–S85.

    Article  Google Scholar 

  3. Grundy SM . Metabolic syndrome scientific statement by the American Heart Association and the National Heart, Lung, and Blood Institute. Arterioscler Thromb Vasc Biol 2005; 25: 2243–2244.

    Article  CAS  Google Scholar 

  4. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo Jr JL et al. Roccella The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report. JAMA 2003; 289: 2560–2571.

    Article  CAS  Google Scholar 

  5. Josephson ME . Clinical Cardiac Electrophysiology: Techniques and Interpretations, 3rd edn. Lippincott Williams & Wilkins: Philadelphia, PA, 2001.

    Google Scholar 

  6. Wellens HJJ, Conover MB . The ECG in Emergency Decision-Making. W.B. Saunders: Philadelphia, PA, 1992.

    Google Scholar 

  7. Diabetes Trials Unit, Oxford, URL (2004). HOMA Calculator v2.2: http://www.dtu.ox.ac.uk/index.html?maindoc=/publications/ (accessed March 22 2005).

  8. Balkau B, Charles M, The European Group for the Study of Insulin Resistance (EGIR). Comment on the provisional report from the WHO Consultation. Diabet Med 1999; 16: 442–443.

    Article  CAS  Google Scholar 

  9. Mojiminiyi OA, Abdella N, Moussa MA, Akanji AO, Al Mohammedi H, Zaki M . Association of C-reactive protein with coronary heart disease risk factors in patients with type 2 diabetes mellitus. Diabetes Res Clin Pract 2002; 58: 37–44.

    Article  CAS  Google Scholar 

  10. Friedewald WT, Levy RT, Fredrickson DS . Estimation of the concentration of low density lipoprotein cholesterol in plasma without use of the ultracentrifuge. Clin Chem 1972; 18: 449–502.

    Google Scholar 

  11. Abdella NA, Mojiminiyi OA, Moussa MA, Zaki M, Al Mohammedi H, Al Ozairi ES et al. Plasma leptin concentration in patients with Type 2 diabetes: relationship to cardiovascular disease risk factors and insulin resistance. Diabet Med 2005; 22: 278–285.

    Article  CAS  Google Scholar 

  12. American Diabetes Association Standards of Medical Care in Diabetes. Standards of medical care in diabetes. Diabetes Care 2005; 28: S4–S36.

  13. Zweig MH, Campbell G . Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chem 1993; 39: 561–577.

    CAS  PubMed  Google Scholar 

  14. Looker HC, Krakoff J, Funahashi T, Matsuzawa Y, Tanaka S, Nelson RG et al. Adiponectin concentrations are influenced by renal function and diabetes duration in Pima Indians with Type 2 diabetes. J Clin Endocrinol Metab 2004; 89: 4010–4017.

    Article  CAS  Google Scholar 

  15. Weyer C, Funahashi T, Tanaka S, Hotta K, Matsuzawa Y, Pratley RE et al. Hypoadiponectinemia in obesity and type 2 diabetes: close association with insulin resistance and hyperinsulinemia. J Clin Endocrinol Metab 2001; 86: 1930–1935.

    Article  CAS  Google Scholar 

  16. Krakoff J, Funahashi T, Stehouwer CD, Schalkwijk CG, Tanaka S, Matsuzawa Y et al. Inflammatory markers, adiponectin, and risk of Type 2 diabetes in the Pima Indian. Diabetes Care 2003; 26: 1745–1751.

    Article  CAS  Google Scholar 

  17. Chandran M, Phillips SA, Ciaraldi T, Henry RR . Adiponectin: more than just another fat cell hormone? Diabetes Care 2003; 26: 2442–2450.

    Article  CAS  Google Scholar 

  18. Diez JJ, Iglesias P . The role of the novel adipocyte-derived hormone adiponectin in human disease. Eur J Endocrinol 2003; 148: 293–300 47, 49.

    Article  CAS  Google Scholar 

  19. Trayhurn P, Beattie JH . Physiological role of adipose tissue: white adipose tissue as an endocrine and secretory organ. Proc Nutr Soc 2001; 60: 329–339.

    Article  CAS  Google Scholar 

  20. Maison P, Byrne CD, Hales CN, Day NE, Wareham NJ . Do different dimensions of the metabolic syndrome change together over time? Evidence supporting obesity as the central feature. Diabetes Care 2001; 24: 1758–1763.

    Article  CAS  Google Scholar 

  21. Saad MF, Khan A, Sharma A, Michael R, Riad-Gabriel MG, Boyadjian R et al. Physiological insulinemia acutely modulates plasma leptin. Diabetes 1998; 47: 544–549.

    Article  CAS  Google Scholar 

  22. Abbasi F, Carantoni M, McLaughlin T, Reaven GM . Plasma insulin concentration is more tightly linked to plasma leptin concentration than is the body mass index. Metabolism 2000; 49: 544–547.

    Article  CAS  Google Scholar 

  23. Fasshauer M, Klein J, Neumann S, Eszlinger M, Paschke R . Hormonal regulation of adiponectin gene expression in 3T3-L1 adipocytes. Biochem Biophys Res Commun 2002; 290: 1084–1089.

    Article  CAS  Google Scholar 

  24. Halleux CM, Takahashi M, Delporte ML, Detry R, Funahashi T, Matsuzawa Y et al. Secretion of adiponectin and regulation of apM1 gene expression in human visceral adipose tissue. Biochem Biophys Res Commun 2001; 288: 1102–1107.

    Article  CAS  Google Scholar 

  25. Motoshima H, Wu X, Sinha MK, Hardy VE, Rosato EL, Barbot DJ et al. Differential regulation of adiponectin secretion from cultured human omental and subcutaneous adipocytes: effects of insulin and rosiglitazone. J Clin Endocrinol Metab 2002; 87: 5662–5667.

    Article  CAS  Google Scholar 

  26. Yu JG, Javorschi S, Hevener AL, Kruszynska YT, Norman RA, Sinha M et al. The effect of thiazolidinediones on plasma adiponectin levels in normal, obese, and type 2 diabetic subjects. Diabetes 2002; 51: 2968–2974.

    Article  CAS  Google Scholar 

  27. Mohlig M, Wegewitz U, Osterhoff M, Isken F, Ristow M, Pfeiffer AF et al. Insulin decreases human adiponectin plasma levels. Horm Metab Res 2002; 34: 655–658.

    Article  CAS  Google Scholar 

  28. Hulver MW, Zheng D, Tanner CJ, Houmard JA, Kraus WE, Slentz CA et al. Adiponectin is not altered with exercise training despite enhanced insulin action. Am J Physiol, Endocrinol Metab 2002; 283: E861–E865.

    Article  CAS  Google Scholar 

  29. Abbasi F, Lamendola C, McLaughlin T, Hayden J, Reaven GM, Reaven PD . Plasma adiponectin concentrations do not increase in association with moderate weight loss in insulin resistant, obese women. Metabolism 2004; 53: 280–283.

    Article  CAS  Google Scholar 

  30. Fasshauer M, Klein J, Neumann S, Eszlinger M, Paschke R . Hormonal regulation of adiponectin gene expression in 3T3-L1 adipocytes. Biochem Biophys Res Commun 2002; 290: 1084–1089.

    Article  CAS  Google Scholar 

  31. Yu JG, Javorschi S, Hevener AL, Kruszynska YT, Norman RA, Sinha M et al. The effect of thiazolidinediones on plasma adiponectin levels in normal, obese, and Type 2 diabetic subjects. Diabetes 2002; 51: 2968–2974.

    Article  CAS  Google Scholar 

  32. Fasshauer M, Klein J, Neumann S, Eszlinger M, Paschke R . Adiponectin gene expression is inhibited by beta-adrenergic stimulation via protein kinase A in 3T3-L1 adipocytes. FEBS Lett 2001; 507: 142–146.

    Article  CAS  Google Scholar 

  33. Maeda N, Takahashi M, Funahashi T, Kihara S, Nishizawa H, Kishida K et al. PPARγ ligands increase expression and plasma concentrations of adiponectin, an adipose-derived protein. Diabetes 2001; 50: 2094–2099.

    Article  CAS  Google Scholar 

  34. Fasshauer M, Kralisch S, Klier M, Lossner U, Bluher M, Klein J et al. Adiponectin gene expression and secretion is inhibited by interleukin-6 in 3T3-L1 adipocytes. Biochem Biophys Res Commun 2003; 301: 1045–1050.

    Article  CAS  Google Scholar 

  35. Maeda N, Takahashi M, Funahashi T, Kihara S, Nishizawa H, Kishida K et al. PPARγ ligands increase expression and plasma concentrations of adiponectin, an adipose-derived protein. Diabetes 2001; 50: 2094–2099.

    Article  CAS  Google Scholar 

  36. Nakamura T, Tokunaga K, Shimomura I, Nishida M, Yoshida S, Kotani K et al. Contribution of visceral fat accumulation to the development of coronary artery disease in non-obese men. Atherosclerosis 1994; 107: 239–246.

    Article  CAS  Google Scholar 

  37. Ribeiro-Filho FF, Faria AN, Kohlmann NE, Zanella MT, Ferreira SR . Two-hour insulin determination improves the ability of abdominal fat measurement to identify risk for the metabolic syndrome. [Journal Article] Diabetes Care 2003; 26: 1725–1730.

    Article  Google Scholar 

  38. Tsao TS, Murrey HE, Hug C, Lee DH, Lodish HF . Oligomerization state-dependent activation of NF-kB signaling pathway by Acrp30. J Biol Chem 2002; 277: 29359–29362.

    Article  CAS  Google Scholar 

  39. Pajvani UB, Du X, Combs TP, Berg AH, Rajala MW, Schulthess T et al. Structure-function studies of the adipocyte-secreted hormone Acrp30/adiponectin. Implications for metabolic regulation and bioactivity. J Biol Chem 2003; 78: 9073–9085.

    Article  Google Scholar 

  40. Duncan BB, Schmidt MI, Pankow JS, Ballantyne CM, Couper D, Vigo A et al. Low-grade systemic inflammation and the development of type 2 diabetes: the Atherosclerosis Risk in Communities study. Diabetes 2003; 52: 1799–1805.

    Article  CAS  Google Scholar 

  41. Tan CE, Ma S, Wai D, Chew SK, Tai ES . Can we apply the national cholesterol education program adult treatment panel definition of the metabolic syndrome to Asians? Diabetes Care 2004; 27: 1182–1186.

    Article  Google Scholar 

  42. Misra A, Wasir JS, Pandey RM . An evaluation of candidate definitions of the metabolic syndrome in adult Asian Indians. Diabetes Care 2005; 28: 398–403.

    Article  Google Scholar 

  43. Alberti KG, Zimmet P, Shaw J, for the IDF Epidemiology Task Force Consensus Group. The metabolic syndrome – a new worldwide definition. Lancet 2005; 366: 1059–1062.

    Article  Google Scholar 

  44. Kahn R, Buse J, Ferrannini E, Stern M . The metabolic syndrome: time for a critical appraisal: joint statement from the Am Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2005; 28: 2289–2304.

    Article  Google Scholar 

Download references

Acknowledgements

This project was funded in part by Kuwait University Grant Number MG 033. We thank Dr Sunila George, Mrs Cynthia Pinto, and Mrs Reema Matthews for technical assistance.

Author information

Authors and Affiliations

  1. Department of Pathology, Faculty of Medicine Kuwait University, Safat, Kuwait

    O A Mojiminiyi

  2. Department of Medicine, Faculty of Medicine Kuwait University, Safat, Kuwait

    N A Abdella

  3. Department of Ministry of Health, Safat, Kuwait

    M Al Arouj & A Ben Nakhi

Authors
  1. O A Mojiminiyi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N A Abdella
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M Al Arouj
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A Ben Nakhi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to O A Mojiminiyi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mojiminiyi, O., Abdella, N., Al Arouj, M. et al. Adiponectin, insulin resistance and clinical expression of the metabolic syndrome in patients with Type 2 diabetes. Int J Obes 31, 213–220 (2007). https://doi.org/10.1038/sj.ijo.0803355

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ijo.0803355

Keywords

This article is cited by

Search

Advanced search

Quick links