Adipokines Are Markers of Metabolic Health

Abstract

Background: Heterogeneity in metabolic risk among individuals in similar weight categories is linked to differential cardiovascular risk. Adipokines secreted from adipose tissue are linked to metabolic activity, but it is unknown whether they distinguish between individuals with similar weight who are metabolically “healthy” versus unhealthy.

Methods: We conducted a cross-sectional analysis of 10,906 ARIC participants (1990-1992) using logistic regression to evaluate the associations of adipokines (leptin, adiponectin, and leptin/adiponectin ratio) with metabolic syndrome (MetS) components and with three levels of metabolic risk: metabolically healthy (no metabolic syndrome [MetS]), metabolically unhealthy (MetS present), and metabolically healthy with diabetes. Analyses were performed in the overall population and stratified by obesity (BMI ≥30 kg/m2), with tests for interaction.

Results: Among all participants, 51% (n=5580) were metabolically healthy, 37% (n=3997) were metabolically unhealthy, and 12% (n=238) were metabolically unhealthy with diabetes. The top versus the bottom tertile of adiponectin was strongly associated with a lower likelihood of being metabolically unhealthy (OR: 0.14, 95% CI: 0.13, 0.17) or metabolically unhealthy with diabetes (OR: 0.04, 95% CI: 0.03, 0.05) relative to being metabolically healthy. Conversely, the top versus the bottom leptin tertile was associated with higher likelihood of being metabolically unhealthy (OR: 5.10, 95% CI: 4.29, 6.06) and metabolically unhealthy with diabetes (OR: 2.32, 95% CI: 1.72, 3.13). The strongest metabolic risk associations were seen for the leptin/adiponectin ratio (OR: 19.7, 95% CI: 14.7, 26.3 for metabolically unhealthy with diabetes versus metabolically healthy). Interactions with obesity status were seen for leptin and leptin/adiponectin ratio (p<0.0001), with stronger association among those without obesity.

Conclusions: Adipokines may help to differentiate individuals in the same weight category with different degrees of metabolic risk. Future studies should examine the utility of targeting adipokines to improve metabolic health and reduce cardiovascular risk.