الفهرس 
The adipose tissueOnly 14 pages are availabe for public view
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Abstract
T2DM is the major cause of diabetes worldwide. People with type 2 DM are more vulnerable to various forms
of both short and long-term complications, which often lead to their premature death .
Increase weight is an established risk factor for type 2 DM, recent studies have identified links between
obesity and type 2 DM involving pro inflammatory cytokines, insulin resistance, deranged fatty acid
metabolism and mitochondrial dysfunction , this risk determined not only by degree of obesity but also by
where fat accumulate . Increased visceral adiposity is usually associated with a clustering of atherogenic risk
factors, such as insulin resistance, hypertension, dyslipidemia, alterations in coagulation and inflammatory
cytokine profiles .
Visceral adipose tissue derived serpin (Vaspin) is a noval adipokine with insulin sensitizing effect , p lasma
Vaspin concentration is markedly elevated in humans with high body mass index (BMI) , t he increase in vaspin
may be a compensatory response to antagonize the action of other unknown proteases that are up-regulated
in obesity and in states of insulin resistance; hence this regulation may be defensive mechanism against
insulin resistance .
The aim of this study is t o evaluate serum Vaspin level in relation to atherogenic risk factors such as insulin
resistance, dyslipidemia, hypertension , inflammation in type 2 obese diabetic subjects and obese non
diabetic subjects.
The study was conducted on 80 subjects with age ranging from 30-60 years, BMI ranging from 27-39
selected from outpatient clinic of Internal medicine and Endocrinology of Ain shams University Hospit al, and
informed consent was obtained from each subject. They were divided into 2 groups 40 obese type 2 diabetic
subjects divided into 20 male and 20 female and 40 obese non diabetic subjects divided into 20 male and 20
female .
All subjects were submitted for f ull medical history , t horough clinical examination , f asting blood sugar (FBS)
, 2-h post prandial blood glucose level (2hpp) , g lycated hemoglobin (HBA1C) , l ipid profile (cholesterol,
triglycerides, HDL and LDL) , HOMA/IR , Serum Vaspin level (by ELISA) and Highly sensitive CRP
The results were statistically analyzed and the following was observed :
On co mparing the two studied groups as whole and after correction of gender:
There was statistical significant difference between the studied groups be ing higher in group I than group II
as regarding age (m= 52.30 ± 5.788 years vs m = 45.45 ± 7.815 years ), SBP (m= 138.88 ± 18.134 md/dl vs
m= 130.50 ± 15.925 md/dl ) ; and after correction of gender there was also a significant difference between
male case and control only with age (m= 5 3 ± 6 years vs m = 4 2 ± 8 years ) and SBP (m= 1 43 ± 16 md/dl vs
m= 1 28 ± 16 md/dl ) , but there were no significant difference as regarding female gender.
Regarding BMI , Waist/hip ratio and dia stolic blood pressure there was no statistical significant difference
between both groups with BMI (m=32.98 ± 3.086 vs 32.77 ± 2.95), WHR (m=0.937 ± 0.086 vs 0.937 ± 0.088),
DBP (m=82.88 ± 13.29 vs 80.63 ± 11.27) or even after correction of the gender, being in females BMI
(m=33.7 ± 3.5 vs 33.4 ± 2.4), WHR (m=0.91 ± 0.08 vs 0.91 ± 0.07), DBP (m=81 ± 13 vs 82 ± 11), and in males
BMI (m=32.3 ± 2.6 vs 32.2 ± 3.4), WHR (m=0.97 ± 0.09 vs 0.97 ± 0.09), DBP (m=84 ± 14 vs 79 ± 11).
As regarding lipid profile there was a high statistical significant difference between the studied groups be ing
higher in group I than group II in TAG only (m=161.15±41.323 mg/dl vs m=137.80±40.345 mg/dl ) ; and after
correction of gender there was also a significant difference between female case and control regarding TC
only with ( m=180±34 mg/dl vs m=±36 mg/dl ) , and a high significant difference between male case and
control regarding TAG (m=170±31 mg/dl vs m=133±38 mg/dl ) and LDL (m=161±23 mg/dl vs m=139±36
mg/dl ).
As regarding serum Vaspin there was a very high statistical significant difference between the studied groups
being higher in group II than group I (m=26.047±22.5044 ng/ml vs m=9.085±4.2863 ng/ml ) ; and after
correction of gender there was also a significant difference between female case and control with
(m=16.4±13 ng/ml vs m=8.5±2.4 ng/ml ) , and a high significant difference between male case and control
with (m=35.7±26 ng/ml vs m=9.7±5.6 ng/ml ) .
As regarding HOMA-IR there was a statistical significant difference between the studied groups being higher
in group I than group II (m=10.3497±9.23193 vs m=6.5972 ±6.97682 ) , after correction of gender there was a
significant difference between female case and control groups only with (m=11.01±9.27 vs m=5.34 ±3.59 )
and there was no significant difference between male case and control groups.
Regarding hs-CRP there was no statistical significant difference between both groups with (8.51 ± 1.47 vs
8.34 ± 2.09) or even after correction of the gender, being in females (8.9 ± 1.2 vs 9 ± 1.1) and in males (8.1 ±
1.6 vs 7.7 ± 2.6).
On comparing between females and males in each of case and control groups :
• Comparison between females and males in the case group:
A s regards hs-CRP there was a significant difference between both of them being higher in the female case
subjects with (m=8.9 ± 1.2 vs m= 8.1 ± 1.6), while there was no significant difference between both of them
regarding serum vaspin being slightly higher in male case subjects with ( m=9.7±5.6 vs m=8.5 ±2.4) , also no
statistical difference between both of them regarding HOMA-IR being slightly higher in female case subjects
with (m=11.01 ± 9.27 vs m=9.69 ± 9.39). .
• Comparison betwe en females and males in the control group:
A s regards serum vaspin there was a significant difference between both of them being high er in the male
control subjects with ( m= 35.7 ± 26 vs m= 16.4 ± 13 ) . Also there was a significant difference between both of
them as regards hs -CRP being higher in female control subjects than male control subjects with ( m= 9 ± 1.1
vs m= 7.7 ± 2.6 ) . W hile there was no significant difference between the two groups regarding HOMA-IR
being slightly higher in male control subjects with (m=7.92 ± 9.25 vs m=5.34 ± 3.59).
C orrelation between serum vaspin and other parameters in female case subjects
T here was a st atistical significant negative correlation a s re garding diabetic duration (p-value=0.008) and hs-
CRP (p-value=0.047).
There was a statistical significant positive correlation as regarding BMI (p-value=0.034), Waist/Hip ratio (pvalue=
0.039), HBA1c (p-value=0.049), LDL (p-value=0.02and HOMA-IR (p-value=0.008) .
T here was no statistical significant correlation regarding age, systolic blood pressure, dia stolic blood
pressure, fasting blood glucose, 2 hr post prandial, total cholesterol, triglycerides , high density lipoprotein (pvalue
.
C orrelation between serum vaspin and other parameters in male case subjects:
T here was a st atistical significant negative correlation a s re garding age (p-value=0.024)
T here was no statistical significant correlation regarding the remaining parameters.
C orrelation between serum vaspin and other parameters in the whole case group:
T here was a st atistical significant negative correlation a s re garding age (p-value=0.010) , diabetic duration
(p-value=0.015),
There was a statistical significant positive correlation as regarding Waist/Hip ratio (p-value=0.047), and LDL
(p-value=0.034) .
T here was no statistical significant correlation regarding BMI, systolic blood pressure, dia stolic blood
pressure, HA1c, fasting blood glucose, 2 hr post prandial, total cholesterol, triglycerides , high density
lipoprotein, hs-CRP and HOMA-IR (p- value .
C orrelation between serum vaspin and other parameters in female control subjects:
There was a statistical significant negative correlation as re garding age (p-value=0.004) .
There was no statistical significant correlation regarding remaining of the parameters (p-value .
C orrelation between serum vaspin and other parameters in male control subjects:
There was a statistical significant positive correlation as re garding LDL (p-value=0.0146),and hs-CRP (pvalue=
0.0146).
There was no statistical significant correlation regarding the remaining parameters (p-value
C orrelation between serum vaspin and other parameters in the whole control group:
There was no statistical significant correlation found between Vaspin and any of the other varients (p-value
Multivariate linear regression analysis of predictors of serum Vaspin level:
Vaspin level was found to be independently correlated with male gender and younger age with (pvalue=
0.031).
In conclusion the results of this study showed that obese type 2 diabetic subjects have more atherogenic risk
profile than obese non diabetic subjects as regarding hypertension, dyslipidemia, HOMA-IR which indicates
that poor glycemic profile has an additive role in making obese type 2 diabetic more prone to vascular
complication .
Also Vaspin level was found to be lower in type 2 diabetic subjects than obese non diabetic which may be
attributed to their older age, long diabetic duration , treatment taken for diabetes and worsening of the
metabolic parameters in them.
Regarding diabetic group there was no significant difference in serum vaspin, between males and females
although it is slightly lower in females.
There was positive correlation between serum vaspin and WHR, LDL, HBA1c in the diabetic group which
augment the concept that vaspin increases with presence of metabolic abnormalities. Female diabetic group
was found to have higher level of hs-CRP than male diabetic subjects, also there was negative correlation
between hs-CRP and serum vaspin level that may indicates development of vascular complications in them.
As regard obese non diabetics: male subjects were younger than female subjects and the serum Vaspin level
was found to be higher in male obese than female obese non diabetic subjects, also there was significant
positive correlation found between vaspin and LDL, hs-CRP in the male subjects which indicates that male
obese non diabetic subjects may have more metabolic risk than females.
Finally it was found that vaspin is linked to atherogenic risk factors of diabetes being increased during early
metabolic disturbances to fight against it but later on with worsening of the metabolic profile, longer duration of
diabetes and increasing age , vaspin starts to decrease. And that male gender and age are strong
independent predictors of serum vaspin level. Vaspin may be an important adepokine that may play important
protective role in the pathogeneses of obesity and type 2 diabetes and its role must be investigated more for
the possibility to guard against metabolic disturbance and cardiovascular risk.