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(Circulation. 2007;115:1537-1543.)
© 2007 American Heart Association, Inc.

Epidemiology

Circulating Adipocyte–Fatty Acid Binding Protein Levels Predict the Development of the Metabolic Syndrome

A 5-Year Prospective Study

Aimin Xu, PhD^*; Annette W.K. Tso, MD^*; Bernard M.Y. Cheung, MD, PhD; Yu Wang, PhD; Nelson M.S. Wat, MD; Carol H.Y. Fong, BSc; Dennis C.Y. Yeung, BSc; Edward D. Janus, MD, PhD; Pak C. Sham, MD, PhD; Karen S.L. Lam, MD

From the Department of Medicine (A.X., A.W.K.T., B.M.Y.C., N.M.S.W., C.H.Y.F., D.C.Y.Y., K.S.L.L.), Research Centre of Heart, Brain, Hormone, and Healthy Aging (A.X., B.M.Y.C., Y.W., K.S.L.L.), and Genome Research Centre (Y.W., P.C.S.), University of Hong Kong, and Department of Clinical Biochemistry (E.D.J.), Queen Mary Hospital, Hong Kong, China. Dr Janus is now with the Department of Medicine, University of Melbourne, Western Hospital, Footscray, Australia.

Correspondence to Dr Karen Lam, Department of Medicine, University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong, China. E-mail ksllam{at}hkucc.hku.hk

Received June 22, 2006; accepted January 9, 2007.

Background— Adipocyte–fatty acid binding protein (A-FABP), a major cytoplasmic protein in adipocytes, plays a central role in the development of diabetes and atherosclerotic cardiovascular disease in experimental animals. We have previously shown that A-FABP is present in the bloodstream and that its circulating levels correlate with metabolic risk factors in a cross-sectional study. In the present study, we further evaluated the prospective association of A-FABP with the metabolic syndrome (MetS) as defined by the updated National Cholesterol Education Program criteria.

Methods and Results— In the present study, 495 nondiabetic adults from the population-based Hong Kong Cardiovascular Risk Factor Prevalence Study were prospectively followed up for 5 years. The relationship of serum A-FABP with the MetS and its components was investigated. At baseline, high A-FABP levels were associated with the MetS (odds ratio, 4.0; 95% CI, 1.5 to 10.4; highest versus lowest sex-specific tertile, adjusted for age, body mass index, the homeostasis model assessment index for insulin resistance, C-reactive protein, and adiponectin, P=0.005). On long-term follow-up, subjects with higher baseline A-FABP levels had progressively worse cardiometabolic risk profile and increasing risk of the MetS. Among 376 subjects without the MetS at baseline, 50 had developed it at 5 years. Apart from the homeostasis model assessment index for insulin resistance (P=0.001), baseline A-FABP was the only independent predictor of the development of the MetS during the 5-year follow-up (odds ratio, 4.7; 95% CI, 1.8 to 11.9; highest versus lowest sex-specific tertile, P=0.001, adjusted for the homeostasis model assessment index for insulin resistance and body mass index). A-FABP was predictive of the MetS even after adjustment for each of its individual components.

Conclusions— Circulating A-FABP predicts the development of the MetS independently of adiposity and insulin resistance.

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