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*OMIM
*Compound via MeSH
*Substance via MeSH
Medline Plus Health Information
*Obesity
*Weight Control
*Weight Loss Surgery
The Journal of Clinical Endocrinology & Metabolism Vol. 86, No. 8 3815-3819
Copyright © 2001 by The Endocrine Society


Other Original Articles

Weight Reduction Increases Plasma Levels of an Adipose-Derived Anti-Inflammatory Protein, Adiponectin

Wei-Shiung Yang, Wei-Jei Lee, Tohru Funahashi, Sachiyo Tanaka, Yuji Matsuzawa, Chia-Ling Chao, Chi-Ling Chen, Tong-Yuan Tai and Lee-Ming Chuang

Department of Internal Medicine (W.-S.Y., C.-L.C., T.-Y.T., L.-M.C.), Graduate Institute of Clinical Medicine (W.-S.Y., L.-M.C.), College of Medicine, and Institute of Epidemiology (C.-L.C.), College of Public Health, National Taiwan University, Taipei 100; Department of Surgery (W.-J.L.), En Chu Kong Hospital, Taipei Hsien 237, Taiwan; and Department of Internal Medicine and Molecular Science (T.F., S.T., Y.M.), Graduate School of Medicine, Osaka University, 565-0871, Osaka, Japan

Address all correspondence and requests for reprints to: Lee-Ming Chuang, M.D., Ph.D., Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 100, Taiwan. E-mail: leeming{at}ha.mc.ntu.edu.tw

Abstract

Adiponectin, an adipose tissue-specific plasma protein, was recently revealed to have anti-inflammatory effects on the cellular components of vascular wall. Its plasma levels were significantly lower in men than in women and lower in human subjects with obesity, type 2 diabetes mellitus, or coronary artery disease. Therefore, it may provide a biological link between obesity and obesity-related disorders such as atherosclerosis, against which it may confer protection. In this study, we observed the changes of plasma adiponectin levels with body weight reduction among 22 obese patients who received gastric partition surgery. A 46% increase of mean plasma adiponectin level was accompanied by a 21% reduction in mean body mass index. The change in plasma adiponectin levels was significantly correlated with the changes in body mass index (r = -0.5, P = 0.01), waist (r = -0.4, P = 0.04) and hip (r = -0.6, P = 0.0007) circumferences, and steady state plasma glucose levels (r = -0.5, P = 0.04). In multivariate linear regression models, the increase in adiponectin as a dependent variable was significantly related to the decrease in hip circumference (ß = -0.16, P = 0.028), after adjusting body mass index and waist circumference. The change in steady state plasma glucose levels as a dependent variable was related to the increase of adiponectin with a marginal significance (ß = -0.92, P = 0.053), after adjusting body mass index and waist and hip circumferences. In conclusion, body weight reduction increased the plasma levels of a protective adipocytokine, adiponectin. In addition, the increase in plasma adiponectin despite the reduction of the only tissue of its own synthesis suggests that the expression of adiponectin is under feedback inhibition in obesity.

OBESITY IS A pan-endemic health problem in both developed and developing countries. It increases risk for many common diseases, including coronary artery disease (CAD), type 2 diabetes mellitus (DM), hypertension, gallbladder disease, and osteoarthritis (1). Consequently, obesity increases total mortality (2, 3). Despite that its deleterious health effects are well recognized, how obesity is biologically linked to the pathogenesis of these disorders, especially atherosclerosis, remains obscure.

Adipose tissue, long being misconstrued as a mere tissue of fat storage, is now acknowledged to be an active participant in energy homeostasis and other physiological functions. The term "adipocytokines" was recently coined to describe the adipose-derived bioactive factors that modulate the physiological functions of the other tissues in our body (4, 5). Some well known examples among these factors include leptin, plasminogen activator inhibitor-1, and TNF{alpha} (6, 7, 8). It is highly possible that some of the adipocytokines may, in fact, mediate the systemic effects of obesity on health.

One of the most abundant adipose tissue-specific adipocytokines, adiponectin, was recently shown to modulate a wide array of biological functions (9, 10). Adiponectin has been shown to reduce TNF{alpha}-induced monocyte attachment to cultured human aortic endothelial cells by inhibiting the expression of vascular cell adhesion molecule, intercellular adhesion molecule, and E-selectin in endothelial cells (11). A cross-talk between adiponectin and TNF{alpha}-induced nuclear factor {kappa}B signaling may be mediated through cAMP-protein kinase A pathway (12). Furthermore, adiponectin was demonstrated to suppress phagocytic activity and lipopolysaccharide-induced TNF{alpha} production in cultured macrophages (13). It may also induce apoptosis of cells in myelomonogenic lineages (13). Taken together, these studies suggest that adiponectin may have anti-inflammatory effects, especially in endothelial cells and macrophages. In animal model, adiponectin was detected only in catheter-injured vessel wall, but not in intact vessels (14). The plasma levels of adiponectin were also demonstrated to be lower in men than in women and lower in subjects with obesity, CAD, and type 2 DM as well (11, 15, 16). For example, mean plasma adiponectin levels were 3.7 µg/ml and 8.9 µg/ml, respectively, for obese [mean body mass index (BMI), 31.9 kg/m2] and nonobese (mean BMI, 22.8 kg/m2) subjects in a previous study (15). These observations indicate that adiponectin may be a protective adipocytokine against atherosclerosis. Therefore, any measure that could be taken to increase adiponectin may be beneficial.

Expression of adipoQ, the mouse homologue of adiponectin, was detectable by Northern blot on d 4 during the differentiation of 3T3-L1 fibroblasts into adipocytes (17). We have also shown that the steady state mRNA of adipoQ was increased in 3T3-L1 adipocytes after 24-h treatment of a peroxisome proliferator-activated receptor {gamma} agonist, rosiglitazone (18). However, plasma adiponectin levels were found to be lower in obese human subjects (15). In ob/ob mice, the steady state mRNA of adipoQ was found to be down-regulated as well (17). It is plausible that the expression of adiponectin is activated during adipogenesis, but a feedback inhibition on its production may be imposed in the development of obesity. In fact, the expression of adipogenic genes was recently reported to decrease in the development of obesity in mice (19).

In this study, we have intended to observe the changes of plasma adiponectin levels with body weight loss in obese patients who received gastric partition surgery (20). First, we argued that a significant increase of this anti-inflammatory protein might at least partially explain the beneficial effects of weight reduction (21, 22). Second, we argued that if adiponectin were under feedback inhibition in obesity, body weight loss would also result in an increase of its plasma levels, despite losing the tissue of synthesis.

Subjects and Methods

Subjects

Twenty-two severely obese patients (age, 34.0 ± 11.4 yr old; 15 females and 7 males) who met the criteria for surgery according to the NIH consensus were recruited for this study (23). All patients were evaluated with series of physical examination and routine tests for hematology, biochemistry, electrolytes, cardiopulmonary functions, and endocrine functions (including thyroid-stimulating hormone, T4), and plasma glucose concentrations. Gastric partition surgery was performed at En-Chu-Kong Hospital, Taipei Hsien, as described previously (20). Written informed consent was obtained from each individual, and the study was reviewed and approved by the Institutional Review Board.

Biochemical measurements

A 75-g oral glucose tolerance test (OGTT) and an insulin suppression test were given to all subjects before and 3–12 months after the surgery on two separate days after overnight fasting. The insulin suppression test was used to assess insulin-mediated glucose disposal as reflected by the steady state plasma glucose (SSPG) as described previously (24). The concentrations of plasma glucose, total cholesterol, and triglyceride were measured in fasting samples by an autoanalyzer (Hitachi 7250 special; Hitachi, Tokyo, Japan). Serum insulin levels were determined by a microparticle enzyme immunoassay using AxSYM system from Abbott Diagnostics (Abbott Laboratories, Dainabot Co. Ltd., Tokyo, Japan). The homeostasis model assessment is applied to estimate the degree of insulin resistance [HOMA IR = Insulin/22.5e-In(Glucose)] and ß cell function [HOMA ß = 20x Insulin/(Glucose - 3.5)], where insulin in pmol/liter and glucose in mM (25). Plasma levels of adiponectin were determined by an ELISA system as described (15). All the measurements, except those of adiponectin, were presented in System International units because the molecular weight of adiponectin has not been precisely determined.

Statistical analyses

Data were presented in means and SD. Statistical analyses including paired t test, correlation analysis, and multivariate linear regression analysis were performed by using the PC version of the Statistical Analysis System (6.12 edition; SAS Institute, Inc., Cary, NC). Differences in selected clinical characteristics between those before and after the gastric partition surgery were tested by paired t test. Correlation matrix of all the changes in clinical characteristics and changes in plasma adiponectin levels before and after the surgery was performed. Several multivariate linear regression models were performed that included age, gender, changes in plasma adiponectin levels, BMI, waist circumference, and hip circumference as independent variables; and changes in plasma adiponectin levels and SSPG as dependent variables, respectively.

Results

Twenty-two obese patients received gastric partition surgery and were followed for a mean of 7.7 (±3.5) months. The changes of selected characteristics in these patients are shown in Table 1Go. Reductions in body weight, BMI, waist circumference, hip circumference, and waist to hip ratio were 23.3 kg (±11.5), 8.35 kg/m2 (±3.8), 19.5 cm (±13.0), 13.9 cm (±7.6), and 0.02 (±0.02), respectively. The differences between the means of these variables before and after surgery were highly significant.


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Table 1. Mean and SD of selected characteristics before and after gastric partition surgery in 22 obese patients

 
The changes in fasting (1.09 ± 1.28 mmol/liter) and 2-h postglucose load (3.05 ± 2.02 mmol/liter) plasma glucose levels as well as the area under curve (AUC) (3.75 ± 3.60 mmol h/liter) of plasma glucose during an OGTT were significantly reduced after gastric partition surgery, suggesting a beneficial effect of body weight loss on carbohydrate metabolism (Table 1Go). Mean fasting plasma insulin level (119.8 ± 80.4 pmol/liter) was significantly reduced, whereas the changes of 2-h postglucose load plasma insulin and AUC of plasma insulin were not statistically significant. In fact, the AUC of plasma insulin slightly increased with body weight loss, mainly due to the elevated insulin levels at 1 h during an OGTT. This indicates that insulin secretion in response to glucose stimulation was not impaired with weight reduction. On the other hand, the significant decrease both in insulin resistance index (7.46 ± 6.53) by HOMA and in SSPG (1.54 ± 3.38 mmol/liter) was consistent with increased insulin sensitivity with weight reduction among these obese subjects. Significant changes with weight loss among the other variables included reduction in plasma triglyceride levels and systolic blood pressure.

Along with all the changes described above, plasma levels of adiponectin were increased by a mean of 2.1 (±1.8) µg/ml (46% of the mean presurgical level) with a 21% reduction in BMI (Table 1Go). The change in plasma levels of adiponectin was significantly correlated with those of BMI ({gamma} = -0.5, P = 0.01), waist circumference ({gamma} = -0.4, P = 0.04), hip circumference ({gamma} = -0.6, P = 0.0007), and SSPG ({gamma} = -0.5, P = 0.04) (Fig. 1Go). In a multivariate linear regression model, the change of plasma adiponectin levels as a dependent variable was significantly related to hip circumference only, while adjusting age, sex, changes in BMI, and waist circumference (Table 2Go). Before adjusting changes in waist and hip circumferences, the change in BMI was also significantly related to that of plasma adiponectin (data not shown). On the other hand, the change in SSPG as the dependent variable was related to the change of plasma adiponectin with a marginal statistical significance, while adjusting age, sex, and changes in BMI, and waist and hip circumferences (Table 2Go).



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Figure 1. The change ({Delta}) of plasma adiponectin levels before and after gastric partition surgery plotted against the changes ({Delta}) in SSPG (A), BMI (B), waist circumference (C), and hip circumference (D) in 22 subjects.

 

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Table 2. Multivariate linear models showing regression coefficients ± SE of changes ({Delta}) of plasma adiponectin levels and SSPG as dependent variables with age, gender, and changes in plasma adiponectin, BMI, waist circumference (W), and hip circumference (H) as independent variables in a group of 22 subjects

 
Discussion

Adiponectin is an adipose tissue-specific plasma protein. It was recently demonstrated to modulate a variety of biological functions (11, 12, 13). It decreased TNF{alpha}-induced macrophage attachment to endothelial cells by reducing the expression of adhesion molecules in endothelial cells through protein kinase A-mediated interference of nuclear factor {kappa}B signaling (11, 12). It was also shown to suppress TNF{alpha} production and phagocytic activity in macrophages (13). These indicate that adiponectin has anti-inflammatory properties. In addition, adiponectin was detectable in catheter-injured vessel wall, rather than in intact vessels in animal models (14). This suggests that it may participate in the pathogenesis of atherosclerosis. In fact, it was documented that lower levels of plasma adiponectin was associated with CAD and risk factors of CAD, including male sex, obesity, and type 2 DM (11, 15, 16). Therefore, adiponectin provides a direct biological link between obesity and atherosclerosis. Body weight loss, a common medical practice to reduce the risk of CAD, type 2 DM, and hypertension, would be expected to increase plasma adiponectin levels, if it were to mediate the beneficial effects of weight reduction. In this study, we demonstrated that this was indeed the case.

Recently, it was demonstrated that iv injection of the C-terminus globular domain of the mouse homologue of adiponectin reduced plasma fatty acid levels and diet-induced weight gain in mice (26). This indicates that adiponectin may participate in fatty acid and energy homeostasis. We observed a significant decrease in triglyceride levels after weight reduction in this study. Whether this is in part caused by altered fatty acid metabolism secondary to the increase in plasma adiponectin remains unknown. We did not assay plasma fatty acid levels in this study.

In obesity, plasma adiponectin levels were lower despite that adipose tissue is the only tissue of its synthesis, suggesting a negative feedback on its production. Consequently, body weight reduction would result in at least transient disinhibition, therefore, an elevation of plasma adiponectin. Recent demonstration by microarray that the expression of adipogenic genes was suppressed in the development of obesity and DM in mice argues for the existence of a feedback inhibitory pathway (19). In addition, the expression of adipoQ, the mouse homologue of adiponectin, and adiponectin was down-regulated, respectively, in ob/ob obese mice and in obese human subjects (17). This is also consistent with the existence of a negative feedback pathway.

The mechanisms of regulating plasma adiponectin levels by body weight change are still not known. The fact that the steady state mRNA of adipoQ (the mouse homologue of adiponectin) decreased in ob/ob mice compared with those of wild type indicates that the level of regulation is, in part, at transcription or mRNA stability (17). It was also shown that the steady state mRNA of adiponectin in adipose tissue seems to be reduced in obese human subjects (17). Because the weight reduction in this study was accomplished by gastric partition surgery, it is highly possible that some neuro-hormonal factors, especially gut peptides like gastrin, cholecystokinin, and so on, may be involved in regulating the expression of adiponectin expression. Exactly what biological signals that modulate the expression of adiponectin during weight reduction merit further studies. So far, the only hormone known to regulate adiponectin expression is insulin (27).

In this study, we also showed that elevation of plasma adiponectin levels was correlated with the change in SSPG. In multivariate linear regression model, the change of plasma adiponectin was related to the change in SSPG with a marginal statistical significance, after those of BMI and waist and hip circumferences were adjusted. This implies that adiponectin may have a direct effect on insulin sensitivity or vice versa. Adiponectin was clearly demonstrated to reduce TNF{alpha} production and TNF{alpha}-induced biological effects on certain cells. Therefore, it is highly plausible that it may enhance insulin sensitivity by interfering with TNF{alpha} production and signaling. This awaits further investigation.

In conclusion, we have convincingly showed that body weight reduction increased plasma adiponectin levels. This provides a novel biological explanation for the beneficial effect of body weight loss on reducing cardiovascular risk in obese patients. The result is also compatible with the speculation that adiponectin might be under a strict feedback regulation by body fat mass.

Footnotes

This work was supported by Program for Promoting Academic Excellence of Universities (89-B-FA01-1-4) from the Department of Education and a grant from the National Science Council (NSC89-2314-B-002-065) of the Republic of China.

Abbreviations: AUC, Area under curve; BMI, body mass index; CAD, coronary artery disease; DM, diabetes mellitus; HOMA, homeostasis model assessment; OGTT, oral glucose tolerance test; SSPG, steady state plasma glucose.

Received February 12, 2001.

Accepted April 27, 2001.

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Lifestyle Intervention and Adipokine Levels in Subjects at High Risk for Type 2 Diabetes: The Study on Lifestyle intervention and Impaired glucose tolerance Maastricht (SLIM)
Diabetes Care, December 1, 2007; 30(12): 3125 - 3127.
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Analytical Validation and Biological Evaluation of a High Molecular-Weight Adiponectin ELISA
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L. Hojbjerre, M. Rosenzweig, F. Dela, J. M Bruun, and B. Stallknecht
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S. Ahmadizad, A. H. Haghighi, and M. R. Hamedinia
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M. H Rokling-Andersen, J. E Reseland, M. B Veierod, S. A Anderssen, D. R Jacobs Jr, P. Urdal, J.-O. Jansson, and C. A Drevon
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B. Gustafson, A. Hammarstedt, C. X. Andersson, and U. Smith
Inflamed Adipose Tissue: A Culprit Underlying the Metabolic Syndrome and Atherosclerosis
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K. A. Varady, D. J. Roohk, Y. C. Loe, B. K. McEvoy-Hein, and M. K. Hellerstein
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V. Vu, W. Kim, X. Fang, Y.-T. Liu, A. Xu, and G. Sweeney
Coculture with Primary Visceral Rat Adipocytes from Control But Not Streptozotocin-Induced Diabetic Animals Increases Glucose Uptake in Rat Skeletal Muscle Cells: Role of Adiponectin
Endocrinology, September 1, 2007; 148(9): 4411 - 4419.
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Circulating Adiponectin Levels and Mortality in Elderly Men With and Without Cardiovascular Disease and Heart Failure
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V. B. O'Leary, A. E. Jorett, C. M. Marchetti, F. Gonzalez, S. A. Phillips, T. P. Ciaraldi, and J. P. Kirwan
Enhanced adiponectin multimer ratio and skeletal muscle adiponectin receptor expression following exercise training and diet in older insulin-resistant adults
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C. M. de Souza Batista, R.-Z. Yang, M.-J. Lee, N. M. Glynn, D.-Z. Yu, J. Pray, K. Ndubuizu, S. Patil, A. Schwartz, M. Kligman, et al.
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O. Y. Bang, J. L. Saver, B. Ovbiagele, Y. J. Choi, S. R. Yoon, and K. H. Lee
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C. Menzaghi, V. Trischitta, and A. Doria
Genetic Influences of Adiponectin on Insulin Resistance, Type 2 Diabetes, and Cardiovascular Disease
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Adiponectin Levels in Prepubertal Children with Prader-Willi Syndrome before and during Growth Hormone Therapy
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Increases in Adiponectin Predict Improved Liver, but Not Peripheral, Insulin Sensitivity in Severely Obese Women During Weight Loss
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M. A. Potenza, F. L. Marasciulo, M. Tarquinio, M. J. Quon, and M. Montagnani
Treatment of Spontaneously Hypertensive Rats With Rosiglitazone and/or Enalapril Restores Balance Between Vasodilator and Vasoconstrictor Actions of Insulin With Simultaneous Improvement in Hypertension and Insulin Resistance
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G. G. Gosman, H. I. Katcher, and R. S. Legro
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N. Bansal, V. Charlton-Menys, P. Pemberton, P. McElduff, J. Oldroyd, A. Vyas, A. Koudsi, P. E. Clayton, J. K. Cruickshank, and P. N. Durrington
Adiponectin in Umbilical Cord Blood Is Inversely Related to Low-Density Lipoprotein Cholesterol But Not Ethnicity
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Genome-Wide Linkage of Plasma Adiponectin Reveals a Major Locus on Chromosome 3q Distinct From the Adiponectin Structural Gene: The IRAS Family Study
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Endocrine responses to acute and chronic high-altitude exposure (4,300 meters): modulating effects of caloric restriction
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Increased Plasma Visfatin Concentrations in Morbidly Obese Subjects Are Reduced after Gastric Banding
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Energy Expenditure and Body Composition of Chronically Maintained Decerebrate Rats in the Fed and Fasted Condition
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Mice Lacking Adiponectin Show Decreased Hepatic Insulin Sensitivity and Reduced Responsiveness to Peroxisome Proliferator-activated Receptor {gamma} Agonists
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R. Furuya, M. Odamaki, H. Kumagai, and A. Hishida
Beneficial effects of icodextrin on plasma level of adipocytokines in peritoneal dialysis patients
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P. F. Bodary and D. T. Eitzman
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Genetic Architecture of the APM1 Gene and Its Influence on Adiponectin Plasma Levels and Parameters of the Metabolic Syndrome in 1,727 Healthy Caucasians
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S. Lee, F. Bacha, N. Gungor, and S. A. Arslanian
Racial Differences in Adiponectin in Youth: Relationship to visceral fat and insulin sensitivityv
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J. Spranger, S. Verma, I. Gohring, T. Bobbert, J. Seifert, A. L. Sindler, A. Pfeiffer, S. M. Hileman, M. Tschop, and W. A. Banks
Adiponectin Does Not Cross the Blood-Brain Barrier but Modifies Cytokine Expression of Brain Endothelial Cells
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Improvements in insulin resistance with weight loss, in contrast to rosiglitazone, are not associated with changes in plasma adiponectin or adiponectin multimeric complexes
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X Fang, R Palanivel, X Zhou, Y Liu, A Xu, Y Wang, and G Sweeney
Hyperglycemia- and hyperinsulinemia-induced alteration of adiponectin receptor expression and adiponectin effects in L6 myoblasts
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E. Isganaitis and R. H. Lustig
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Plasma Adiponectin Levels and Sonographic Phenotypes of Subclinical Carotid Artery Atherosclerosis: Data From the SAPHIR Study
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M. Galisteo, M. Sanchez, R. Vera, M. Gonzalez, A. Anguera, J. Duarte, and A. Zarzuelo
A Diet Supplemented with Husks of Plantago ovata Reduces the Development of Endothelial Dysfunction, Hypertension, and Obesity by Affecting Adiponectin and TNF-{alpha} in Obese Zucker Rats
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C. Kistorp, J. Faber, S. Galatius, F. Gustafsson, J. Frystyk, A. Flyvbjerg, and P. Hildebrandt
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Dietary fish oil positively regulates plasma leptin and adiponectin levels in sucrose-fed, insulin-resistant rats
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R. Clasen, M. Schupp, A. Foryst-Ludwig, C. Sprang, M. Clemenz, M. Krikov, C. Thone-Reineke, T. Unger, and U. Kintscher
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Exogenous Testosterone (T) Alone or with Finasteride Increases Physical Performance, Grip Strength, and Lean Body Mass in Older Men with Low Serum T
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Adiponectinemia in Visceral Obesity: Impact on Glucose Tolerance and Plasma Lipoprotein and Lipid Levels in Men
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Biethnic Comparisons of Autosomal Genomic Scan for Loci Linked to Plasma Adiponectin in Populations of Chinese and Japanese Origin
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