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Retinoic acid (RA) was demonstrated to exert protective effect on obesity and the metabolic syndrome in animal studies.The present study was designed to examine the associations of circulating RA with metabolic syndrome (MetS) among a middle-aged and elderly Chinese population.We measured serum RA concentrations in a cross-sectional sample of 2280 Chinese men and women aged from 50 to 75 years in Guangzhou city.MetS was defined according to the updated National Cholesterol Education Program Adult Treatment Panel III criteria for Asian Americans.Serum RA levels were inversely associated with adipocyte fatty acid-binding protein (A-FABP,r=-0.087,P=0.001),8-iso-prostaglandin F2α (8-iso PGF2α,r=–0.248,P<0.001),13-S-hydroxyoctadecadienoic acid (13-HODE,r=–0.175,P<0.001),high sensitivity C-reactive protein (hsCRP,r=-0.104,P=0.015),and interleukin-6 (IL-6,r=–0.093,P=0.020) and positively correlated with HDL cholesterol (r=0.067,P=0.038).Compared with the highest RA quartile (2.87±0.64 ng/mL),the odds ratio for MetS in the lowest quartile (1.21±0.46 ng/mL) was 2.58 (95%CI 2.04-3.72) after multiple adjustments.The ORs (95%CIs) for comparisons of extreme quartiles of RA levels were 3.52 (2.73,4.44) for MetS,1.87 (1.50,2.38) for central obesity,2.95 (1.68,4.38) for hypertriglyceridemia,1.60 (1.19,2.01) for reduced HDL cholesterol,and 2.14 (1.65,2.69) for hyperglycemia.Further adjustment of adipokines,oxidative stress index and inflammatory markers did not affect these associations.Serum RA levels are inversely associated with adipokines,oxidative stress and inflammatory markers and an increased risk of MetS in middle-aged and elderly Chinese subjects.