Serum visfatin is associated with type 2 diabetes mellitus independent of insulin resistance and obesity
Introduction
Excess obesity is regarded as the most important risk factor for type 2 diabetes mellitus [1]. Visceral adipose tissue seems to have more insidious effects than subcutaneous fat [2], [3] and removal of visceral fat results in improvement of insulin sensitivity [4], [5]. Adipose tissue, particularly visceral fat is, nowadays, considered as an active metabolic organ releasing different adipocytokines including leptin, adiponectin and visfatin [6], [7].
Adiponectin, the most profusely expressed adipocytokine, is inversely associated with obesity [7], [8], and is suggested to have insulin sensitizing, anti-hypertensive, and anti-inflammatory effects [9], [10], [11]. It is generally supposed that adiponectin prevents endothelial dysfunction and the development of atherosclerosis by acting as an anti-inflammatory, antioxidant and vasodilator agent [12].
By contrast, leptin is directly related to obesity [13]. Leptin resistance reflected by hyperleptinemia is suggested to link obesity to hypertension, impaired glucose metabolism and pro-atherogenic status [14]. In this respect, leptin signaling is responsible for modulation of food intake and energy expenditure [13], [14]. Leptin to adiponectin ratio is regarded as a potent atherogenic index and an excellent predictor of insulin resistance in diabetic patients [15], [16].
An initial study showed that visfatin, as an adipocytokine, has insulin-mimetic effects including inhibition of hepatic glucose release, augmentation of glucose uptake in adipocytes and myocytes and increase in triglyceride synthesis and its accumulation in pre-adipocytes [17]. However, since the results of this study were not confirmed by subsequent analyses, it was in part retracted [18]. In addition, visfatin is identified as a pre-B cell colony stimulating factor [19]. It has been shown that circulating visfatin is more strongly correlated with visceral fat compared to subcutaneous fat [17], [20]. Weight loss reduces elevated visfatin levels in morbidly obese subjects [21].
Although due to aforementioned findings obesity, adipocytokines and type 2 diabetes are strongly interrelated, the mechanism by which obesity leads to insulin resistance is obscure and the role of adipocytokines in this pathologic process remains to be fully determined. Particularly, the association between serum visfatin and diabetes in the context of the role of obesity or insulin resistance in establishment of diabetes is not well understood. It would be an interesting topic to evaluate the association between diabetes mellitus and different adipocytokines when the potent affect of body adiposity and insulin resistance in establishment of diabetes is restrained, in a well-balanced study. In this study, we aimed to evaluate and compare the associations of adiponectin, leptin and visfatin with diabetes mellitus and use different adjustment models to evaluate the independent association between diabetes and these adipocytokines.
Section snippets
Participants
Seventy six newly diagnosed diabetic patients who were referred to Vali-Asr hospital, a general hospital affiliated to Tehran University of Medical Sciences, were enrolled in this study. The control group was comprised of healthy subjects, who were regularly visited at our general clinic of the same hospital, and were individually matched with diabetic patients in age, body mass index (BMI) and sex ratio. Subjects with underlying disease (e.g. cancer, glumerolonephritis, inflammatory or
Results
Principal characteristics of diabetic and non-diabetic participants are presented in Table 1. There was no significant difference between diabetic and non-diabetic participants regarding mean age (50.1 ± 9.6 vs. 50.6 ± 7.9 years), BMI (28.7 ± 4.1 vs. 27.7 ± 3.3 kg/m2) and male to female ratio (40/36 vs. 42/34). Diabetic subjects had higher visfatin and leptin levels and lower adiponectin level compared to non-diabetic subjects (P < 0.01).
Anthropometric measures (i.e. BMI and waist circumference) were
Discussion
Diabetic subjects had higher levels of leptin and visfatin and lower levels of adiponectin compared to non-diabetic participants. The correlation coefficients of leptin and adiponectin with obesity measures reached significant levels. Regression analysis revealed that all adipocytokines are associated with diabetes status and this association remains after adjustment for BMI and waist circumference. However, after adjustment for HOMA-IR, only visfatin was independently associated with diabetes.
Conflict of interests
There are no conflicts of interest.
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