title: Association between prehypertension, metabolic and inflammatory markers, decreased adiponectin and enhanced insulinemia in obese subjects.
abstract: BACKGROUND
  Obesity is associated with development of the cardiorenal metabolic syndrome, which is a constellation of risk factors, such as insulin resistance, inflammatory response, dyslipidemia, and high blood pressure that predispose affected individuals to well-characterized medical conditions such as diabetes, cardiovascular and kidney chronic disease. The study was designed to establish relationship between metabolic and inflammatory disorder, renal sodium retention and enhanced blood pressure in a group of obese subjects compared with age-matched, lean volunteers.
  
  
  METHODS
  The study was performed after 14 h overnight fast after and before OGTT in 13 lean (BMI 22.92 ± 2.03 kg/m(2)) and, 27 obese (BMI 36.15 ± 3.84 kg/m(2)) volunteers. Assessment of HOMA-IR and QUICKI index were calculated and circulating concentrations of TNF-α, IL-6 and C-reactive protein, measured by immunoassay.
  
  
  RESULTS
  THE STUDY SHOWS THAT A HYPERINSULINEMIC (HI: 10.85 ± 4.09 μg/ml) subgroup of well-characterized metabolic syndrome bearers-obese subjects show higher glycemic and elevated blood pressure levels when compared to lean and normoinsulinemic (NI: 5.51 ± 1.18 μg/ml, P < 0.027) subjects. Here, the combination of hyperinsulinemia, higher HOMA-IR (HI: 2.19 ± 0.70 (n = 12) vs. LS: 0.83 ± 0.23 (n = 12) and NI: 0.98 ± 0.22 (n = 15), P < 0.0001) associated with lower QUICKI in HI obese when compared with LS and NI volunteers (P < 0.0001), suggests the occurrence of insulin resistance and a defect in insulin-stimulated peripheral action. Otherwise, the adiponectin measured in basal period was significantly enhanced in NI subjects when compared to HI groups (P < 0.04). The report also showed a similar insulin-mediated reduction of post-proximal urinary sodium excretion in lean (LS: 9.41 ± 0.68% vs. 6.38 ± 0.92%, P = 0.086), and normoinsulinemic (NI: 8.41 ± 0.72% vs. 5.66 ± 0.53%, P = 0.0025) and hyperinsulinemic obese subjects (HI: 8.82 ± 0.98% vs. 6.32 ± 0.67%, P = 0.0264), after oral glucose load, despite elevated insulinemic levels in hyperinsulinemic obeses.
  
  
  CONCLUSIONS
  In conclusion, this study highlights the importance of adiponectin levels and dysfunctional inflammatory modulation associated with hyperinsulinemia and peripheral insulin resistance, high blood pressure, and renal dysfunction in a particular subgroup of obeses.
authors: Disciplina de Medicina Interna, Laboratório de Metabolismo Hidrossalino, Universidade Estadual de Campinas, 13083-592 Campinas, SP, Brasil ; Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, 13083-592 Campinas, SP, Brasil.
authors: Amanda Roberta
authors: AR
authors: de Almeida
authors: Disciplina de Medicina Interna, Laboratório de Metabolismo Hidrossalino, Universidade Estadual de Campinas, 13083-592 Campinas, SP, Brasil ; Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, 13083-592 Campinas, SP, Brasil.
authors: Sarah
authors: S
authors: Monte-Alegre
authors: Disciplina de Medicina Interna, Laboratório de Metabolismo Hidrossalino, Universidade Estadual de Campinas, 13083-592 Campinas, SP, Brasil ; Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, 13083-592 Campinas, SP, Brasil.
authors: Michele Bianca
authors: MB
authors: Zanini
authors: Disciplina de Medicina Interna, Laboratório de Metabolismo Hidrossalino, Universidade Estadual de Campinas, 13083-592 Campinas, SP, Brasil ; Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, 13083-592 Campinas, SP, Brasil.
authors: Aglécio Luiz
authors: AL
authors: Souza
authors: Disciplina de Medicina Interna, Laboratório de Metabolismo Hidrossalino, Universidade Estadual de Campinas, 13083-592 Campinas, SP, Brasil ; Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, 13083-592 Campinas, SP, Brasil.
authors: Maurício
authors: M
authors: Etchebehere
authors: Disciplina de Medicina Interna, Laboratório de Metabolismo Hidrossalino, Universidade Estadual de Campinas, 13083-592 Campinas, SP, Brasil ; Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, 13083-592 Campinas, SP, Brasil.
authors: José Antonio Rocha
authors: JA
authors: Gontijo
keywords: Adiponectin; Blood pressure; Inflammation; Metabolic syndrome; Obesity; Renal function