The negative association of lower body fat mass with cardiometabolic disease risk factors is partially mediated by adiponectin.

Gluteofemoral fat correlates negatively with a number of cardiometabolic disease risk factors, but the mechanisms involved in these relationships are unknown. The aim of this study was to test the hypothesis that gluteofemoral fat attenuates the risk of cardiometabolic disease by increasing blood adiponectin levels. This was a cross-sectional study in which arm, leg, gluteofemoral, abdominal s.c. and visceral fat levels were measured by dual-energy X-ray absorptiometry in 648 African females. Fasting serum adiponectin, lipid, insulin and plasma glucose levels and blood pressure were measured. Relationships between variables were analysed using multivariable linear regression and structural equation modelling. Adiponectin correlated positively (ß = 0.45, P < 0.0001) with gluteofemoral fat in a multivariable regression model that included age, height, and arm, s.c. and visceral fat levels. In further regression models, there was a negative correlation of gluteofemoral fat with fasting glucose (ß = -0.28; P < 0.0001) and triglyceride levels (ß = -0.29; P < 0.0001) and insulin resistance (HOMA; ß = -0.26; P < 0.0001). Structural equation modelling demonstrated that adiponectin mediated 20.7% (P < 0.01) of the association of gluteofemoral fat with insulin resistance and 16.1% (P < 0.01) of the association with triglyceride levels but only 6.67% (P = 0.31) of the association with glucose levels. These results demonstrate that gluteofemoral and leg fat are positively associated with adiponectin levels and that the negative association of lower body fat with insulin resistance and triglyceride levels may partially be mediated by this adipokine. Further studies are required to determine other factors that mediate the effect of lower body fat on cardiometabolic disease risk factors.

Evaluation of markers of fibrinolysis and coagulation in pregnant women with human immunodeficiency virus.

INTRODUCTION: Human immunodeficiency virus (HIV) in pregnant women is characterized by immune activation and inflammation despite suppressive antiretroviral therapy (ART). The extent to which ongoing inflammation contributes to activation of coagulation and fibrinolysis is unknown. MATERIALS AND METHODS: This cross-sectional study included pregnant women in the following three groups: HIV negative (n = 109), HIV infected virologically suppressed (n = 109) and HIV infected with HIV viral load (VL) of >50 copies/mL (n = 80). Fibrinolytic activity was evaluated by measuring d-dimer and plasminogen activator inhibitor-1 (PAI-1) as well as thrombin-antithrombin (TAT) complex concentrations, as an index of coagulation, in the first, second and third trimesters. RESULTS: In this population, with a mean age of 33 ± 6 years, pregnancy outcomes were recorded for 277 (93.0 %) participants with live births. HIV infected participants with virological suppression and VL of >50 copies/mL showed significantly increasing levels of d-dimer and PAI-1 in the first, second and third trimesters, as compared to HIV negative participants. No significant differences were observed between HIV infected participants with virological suppression and HIV infected participants with VL > 50 copies/mL for levels of first and third trimester d-dimer and PAI-1 in each trimester. In addition, TAT complex levels in the first trimester were significantly increased in HIV infected virologically suppressed participants as compared to HIV negative participants. CONCLUSION: HIV infected virologically suppressed pregnant women show evidence of persistently impaired markers of fibrinolysis. Future research should explore the risk of adverse pregnancy complications among HIV infected pregnant women in the modern era of ART.

Relationship of Visceral Fat and Adipokines with Cardiometabolic Diseases in Psoriasis.

As part of a larger cross-sectional, case-control study on cardiometabolic diseases in psoriasis this study investigated the association of visceral fat and serum adipokines with psoriasis and cardiometabolic diseases. A total of 103 patients with psoriasis and 98 controls, matched for body mass index, ethnicity and sex, were recruited over 15 months. Abdominal visceral fat was measured by computerized tomo-graphy. Logistic regression analysis revealed that visceral fat was associated with psoriasis (odds ratio (95% confidence interval): 1.56 (1.15, 2.11)), hyper-triglyceridaemia (1.67 (1.22, 2.28)), low high-density lipoprotein (1.63 (1.19, 2.22)) and type 2 diabetes (1.77 (1.24, 2.54)), (p < 0.005 for all). These respective associations were linked to serum interleukin-6, adiponectin, tumour necrosis factor and insulin resistance. Psoriasis was associated with type 2 diabetes (7.94 (2.64, 23.9)), independent of visceral fat. These data suggest that visceral fat and its mediators play a key role in psoriasis-associated cardiometabolic diseases. Psoriasis itself is associated with an increased risk of type 2 diabetes.

Body composition in the Study of Women Entering and in Endocrine Transition (SWEET): A perspective of African women who have a high prevalence of obesity and HIV infection.

OBJECTIVES: Little data are available for sub-Saharan African women on changes in body composition in menopause transition (MT). The study aimed to determine whether there are differences in body adiposity, lean muscle mass, and bone mineral density (BMD) across MT groups in urban African women, who have a high prevalence of obesity and HIV infection, and if this is related to an altered hormonal milieu. DESIGN: Participants were 702 black urban women. Menopause stage was defined using STRAW+10 criteria. Levels of follicle stimulating hormone (FSH), estradiol (E2), dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEAS), testosterone (T) and sex hormone blinding globulin (SHBG) were measured. Body composition was measured with dual-energy X-ray absorptiometry (DXA) and ultrasound scans. RESULTS: Whole body lean mass (p=0.002) and BMD (p<0.0005) were significantly lower in postmenopausal compared to premenopausal groups. Estradiol (p<0.0005), SHBG (p<0.0005) and DHEAS (p=0007) were significantly lower in post- than premenopausal groups, while FSH was higher (p<0.0005). FSH correlated negatively (ß=-2.06, p<0.0005) with total lean mass while E2 correlated positively (ß=20.0, p=0.002) with BMD. Use of antiretroviral therapy (ART) correlated negatively with total fat mass (ß=-2.92, p=0.008) and total bone mineral content (BMC; ß=-78.8, p=0.003). CONCLUSIONS: The MT in this population is characterized by lower whole body lean mass and BMD in post- compared to premenopausal subjects but there are minimal differences in fat mass. Lower lean mass and BMD were associated with higher FSH and lower E2 serum levels, respectively. Use of ART was associated with lower fat mass and BMC.

Influence of catch-up growth on glucose tolerance and beta-cell function in 7-year-old children: results from the birth to twenty study.

OBJECTIVE: The aim of this study was to investigate the effect of catch-up growth occurring at different stages of childhood on glucose levels and beta-cell function at 7 years of age. METHODS: Oral glucose tolerance tests were performed on 152 7-year-old children. Anthropometric data were available from birth to 7 years of age. Children were split into catch-up, catch-down, and normal-growth groups on the basis of growth rates between birth and 1 year, birth and 5 years, and birth and 7 years. Fasting and 30- and 120-minute blood samples collected during the oral glucose tolerance tests were assayed for glucose, insulin, proinsulin, and des-31,32-proinsulin levels, and area-under-the-curve values were calculated. RESULTS: Children with catch-up growth between birth and 5 years or birth and 7 years had greater area-under-the-curve insulin levels than the children with catch-down growth. Children with catch-up growth only between birth and 7 years exhibited higher proinsulin levels and a greater insulin secretory response to glucose than those who experienced catch-up growth between both birth and 1 year and birth and 7 years of age. Low birth weight children with no catch-up growth between birth and 7 years had the highest glucose and lowest insulinogenic index levels, whereas children with high birth weight and catch-up growth had the highest insulin levels. CONCLUSIONS: Extremes of birth weight in conjunction with extremes of postnatal growth are all detrimental to childhood metabolism. The negative metabolic effects of catch-up growth between birth and 7 years may be attenuated if catch-up growth also occurs between birth and 1 year of age.

Metabolic response to a mixed meal in obese and lean women from two South african populations.

OBJECTIVE: Lower lipid and insulin levels are found during a glucose-tolerance test in obese black than obese white South African women. Therefore, beta-cell function and lipid metabolism were compared in these populations during a mixed meal. RESEARCH METHODS AND PROCEDURES: Blood concentrations of glucose, free fatty acids (FFAs), insulin, lipograms, and in vivo FFA oxidation were determined at fasting and for 7 hours after oral administration of a mixed emulsion containing glucose-casein-sucrose-lipid and [1-(13)C] palmitic acid in 8 lean black women (LBW), 10 obese black women (OBW), 9 lean white women (LWW), and 10 obese white women (OWW). Subcutaneous and visceral fat mass was assessed by computerized tomography. RESULTS: Visceral fat area was higher in OWW (152.7 +/- 17.0 cm(2)) than OBW (80.0 +/- 6.7 cm(2); p < 0.01). In OBW, 30-minute insulin levels were higher (604.3 +/- 117.6 pM) than OWW (311.0 +/- 42.9 pM; p < 0.05). Total triglyceride was higher in OWW (706.7 +/- 96.0 mM x 7 hours) than OBW (465.7 +/- 48.2 mM x 7 hours; p < 0.05) and correlated with visceral fat area (beta = 0.38, p = 0.05). Palmitate oxidation was higher in lean than obese women in both ethnic groups and correlated negatively with fat mass (beta = -0.58, p < 0.005). DISCUSSION: The higher 30-minute insulin response in OBW may reflect a higher insulinotropic effect of FFAs or glucose. The elevated triglyceride level of OWW may be due to their higher visceral fat mass and possibly reduced clearance by adipose tissue.