OBJECTIVE -Adiponectin is an adipose tissue-derived protein. Low levels are associated with obesity, insulin resistance, and type 2 diabetes. Our objective was to investigate the prospective association between adiponectin levels and the 6.4-year risk of type 2 diabetes and of impaired glucose metabolism (IGM).
RESEARCH DESIGN AND METHODS -The Hoorn Study is a cohort study amongCaucasians, aged 50 -75 years. BMI, waist-to-hip ratio (WHR), fasting glucose, 2-h glucose, triglycerides, HDL cholesterol, LDL cholesterol, alanine aminotransferase, leptin, and adiponectin were measured at baseline. Lifestyle (alcohol intake, smoking, and physical activity) was assessed by questionnaires. After a mean follow-up of 6.4 years, glucose tolerance was assessed by a 75-g oral glucose tolerance test. Analyses were performed in 1,264 subjects (584 men and 680 women) without type 2 diabetes at baseline. For analyses of incident IGM, 239 subjects with IGM at baseline and/or type 2 diabetes at follow-up were excluded.
RESULTS
CONCLUSIONS-A high adiponectin level was strongly associated with a lower risk of IGM and type 2 diabetes, particularly in women. These results suggest that adiponectin is involved in the pathophysiology linking obesity to type 2 diabetes.
Diabetes Care 29:2498 -2503, 2006T he pathophysiology linking obesity to type 2 diabetes is not completely understood, but adipokines are thought to be involved (1). Adiponectin is a recently discovered protein that seems to be exclusively secreted by adipocytes and is the most abundant adipose tissuederived protein (2,3). In contrast to other adipokines (such as leptin and interleukin-6) that are often elevated in obese subjects, adiponectin is reduced (3-6).In animal studies, adiponectin has been shown to have insulin-sensitizing properties. Adiponectin knockout mice are insulin resistant in a gene-dose fashion (7,8). Overexpression of adiponectin prevented diabetes in transgenic mice (9), and administration of adiponectin reversed insulin resistance in various mouse models of obesity and diabetes (10). Adiponectin increased insulin action via effects on hepatic glucose production and by increasing fat oxidation and lowering circulating free fatty acids (10 -13).In humans, several cross-sectional studies showed that adiponectin correlates negatively with measures of insulin resistance and type 2 diabetes, but cause or consequence cannot be distinguished. Results from a few prospective studies suggest that a low adiponectin level is predictive of insulin resistance or diabetes in Pima Indians (14), Asian Indians (15), and Japanese subjects (16,17). Some of these studies are rather small (14,15) or had a short follow-up period (15,17). To our knowledge, the only prospective study in Caucasians was a nested casecontrol study based on self-reported diabetes after a follow-up of 2-3 years (18). All of these previous prospective studies were performed in relatively young subjects.The objective of the present study was to investigate the association between adiponectin and subs...