Recent research has emphasized the importance of the metabolic cluster, which includes glucose intolerance, dyslipidemia, and high blood pressure, as a strong predictor of the obesity-related morbidities and premature mortality. Fundamental to this association, commonly referred to as the metabolic syndrome, is the close interaction between abdominal fat patterning, total body adiposity, and insulin resistance. As the initial step in identifying major genetic loci influencing these phenotypes, we performed a genomewide scan by using a 10-centiMorgan map in 2,209 individuals distributed over 507 nuclear Caucasian families. Pedigreebased analysis using a variance components linkage model demonstrated a quantitative trait locus (QTL) on chromosome 3 (3q27) strongly linked to six traits representing these fundamental phenotypes [logarithm of odds (lod) scores ranged from 2.4 to 3.5]. This QTL exhibited possible epistatic interaction with a second QTL on chromosome 17 (17p12) strongly linked to plasma leptin levels (lod ‫؍‬ 5.0). Situated at these epistatic QTLs are candidate genes likely to influence two biologic precursor pathways of the metabolic syndrome. O besity is a common and chronic disorder associated with decreased longevity and increased morbidity from a variety of diseases, including type 2 diabetes mellitus, hypertension, stroke, and coronary heart disease (1). Fat distribution, specifically the pattern known as upper-body, abdominal, or visceral obesity, is a major predictor of the adverse metabolic profile predisposing to these health risks (2). Thus, abdominal-visceral fat size has emerged as a significant precursor of glucose intolerance, hyperinsulinemia, elevated plasma triglycerides, decreased high density lipoprotein-cholesterol, and increased blood pressure (3). Fundamental to this metabolic milieu are close interactions between total body adiposity, abdominalvisceral fat size, and insulin resistance. Reaven (4) provided evidence to suggest that resistance to insulin-stimulated glucose uptake is associated with a series of related metabolic variables, termed ''syndrome X,'' which cluster in the same individual and include glucose intolerance, disturbed plasma lipids, and high blood pressure (4). Because of close similarities of these features with those associated with abdominal obesity, the more collective term metabolic syndrome was introduced (5).The etiology of the abdominal obesity-metabolic syndrome is complex and is thought to involve metabolic, neuroendocrine, and genetic interactions. A metabolic-neuroendocrine cascade has been proposed in which increased free fatty acid flux from the highly lipolytic visceral adipocytes, together with imbalances in sex hormones, could cause the insulin resistance and hyperinsulinemia, with their metabolic consequences (6). Weight gain with preferential deposition of adipocytes in the abdominal-visceral region is considered secondary to adoption of Westernized diet, activity lifestyle, and reactivity to emotional, intellectual, and physical stresses (5...

Although muscle is considered to be the most important site for postprandial glucose disposal, the metabolic fate of oral glucose taken up by muscle remains unclear. We, therefore, employed the dual isotope technique (intravenous, [6-3HJ-glucose; oral, l1-'4Clglucose), indirect calorimetry, and forearm balance measurements of glucose, lactate, alanine, pyruvate, 02, and CO2 in nine normal volunteers to determine the relative importance of muscle glycogenic, glycolytic, and oxidative pathways in disposal of an oral glucose load. During the 5 h after glucose ingestion (1 g/kg), 37±3% (24.9±2.3 g) of the load was oxidized and 63±3% (42.8±2.7 g) was stored. At least 29% (19.4±1.3 g) was taken up by splanchnic tissues. Muscle took up 26% (17.9±2.9 g) of the oral glucose coincident with a 50% reduction in its oxidation of fat. 15% of the oral glucose taken up by muscle (2.5±0.9 g) was released as lactate, alanine, or pyruvate; 50% (8.9±1.4 g) was oxidized, and 35% (6.4±2.3 g) was available for storage. We conclude that muscle and splanchnic tissues take up a comparable percentage of an oral glucose load and that oxidation is the predominant fate of glucose taken up by muscle, with storage in muscle accounting for < 10% of the oral load. Thus, contrary to the prevailing view, muscle is neither the major site of storage nor the predominant site of disposal of an oral glucose load.

SONNENBERG, GABRIELE E., GLENN R. KRAKOWER, AND AHMED H. KISSEBAH. A novel pathway to the manifestations of metabolic syndrome. Obes Res. 2004;12:180 -186. Pathways leading from obesity to the manifestations of metabolic syndrome involve a number of metabolic risk factors, as well as adipokines, mediators of inflammatory response, thrombogenic and thrombolytic parameters, and vascular endothelial reactivity. Increased adipose tissue mass contributes to augmented secretion of proinflammatory adipokines, particularly tumor necrosis factor-␣ (TNF␣), along with diminished secretion of the "protective" adiponectin. In our view, TNF␣ and adiponectin are antagonistic in stimulating nuclear transcription factor-B (NF-B) activation. Through this activation, TNF␣ induces oxidative stress, which exacerbates pathological processes leading to oxidized low-density lipoprotein and dyslipidemia, glucose intolerance, insulin resistance, hypertension, endothelial dysfunction, and atherogenesis. NF-B activation further stimulates the formation of additional inflammatory cytokines, along with adhesion molecules which promote endothelial dysfunction. Elevated free fatty acid, glucose, and insulin levels enhance this NF-B activation and further downstream modulate specific clinical manifestations of metabolic syndrome.

Here we present the first genetic analysis of adiponectin levels, a newly identified adipocyte-derived protein. Recent work has suggested that adiponectin may play a role in mediating the effects of body weight as a risk factor for coronary artery disease. For this analysis we assayed serum levels of adiponectin in 1100 adults of predominantly northern European ancestry distributed across 170 families. Quantitative genetic analysis of adiponectin levels detected an additive genetic heritability of 46%. The maximum LOD score detected in a genome wide scan for adiponectin levels was 4.06 (P = 7.7 x 10(-6)), 35 cM from pter on chromosome 5. The second largest LOD score (LOD = 3.2; P = 6.2 x 10(-5)) was detected on chromosome 14, 29 cM from pter. The detection of a significant linkage with a quantitative trait locus on chromosome 5 provides strong evidence for a replication of a previously reported quantitative trait locus for obesity-related phenotypes. In addition, several secondary signals offer potential evidence of replications for additional previously reported obesity-related quantitative trait loci on chromosomes 2 and 10. Not only do these results identify quantitative trait loci with significant effects on a newly described, and potentially very important, adipocyte-derived protein, they also reveal the emergence of a consistent pattern of linkage results for obesity-related traits across a number of human populations.