Serum Adipsin as a Steatosis Marker and Its Correlation with Metabolic Abnormalities in Metabolic-Associated Fatty Liver Disease of Iraqi Patients
A Cross-Sectional Study at a Teaching Hospital in Baghdad, Iraq
DOI:
https://doi.org/10.47419/bjbabs.v7i3.476Keywords:
Adipokine, adipsin, diabetes, MAFLD, NAFLDAbstract
Background: One of the most common chronic liver diseases in the world is nonalcoholic fatty liver disease (NAFLD), which is the main cause of liver-related morbidity and death, becoming metabolic-associated fatty liver disease (MAFLD) in 2020 instead of NAFLD.
Objective: To assess serum adipsin levels and their association with severity of steatosis and metabolic abnormalities in Iraqi patients with MAFLD, and to explore its potential as a steatosis-related biomarker requiring further validation.
Methods: This cross-sectional study included 138 patients, aged ≥18 years, enrolled during the study period and subsequently categorized into three groups according to the predefined study design. Patients with viral hepatitis, significant alcohol consumption, type 1 diabetes mellitus (DM), polycystic ovary syndrome, active smoking status, malignancies, and having medications were excluded. Blood samples were collected to measure liver function test, lipid profile, renal function, fasting blood glucose, hemoglobin A1c (HbA1c), and adipsin.
Results: The findings revealed that the patient group of MAFLD with DM had lower serum adipsin levels but higher fasting blood glucose and HbA1c than the patients with MAFLD without DM and non-MAFLD; also, the MAFLD groups had lower serum adipsin levels than the patients of non-MAFLD group.
Conclusion: The study reveals a correlation between steatosis stages and serum adipsin levels in MAFLD patients, suggesting that its levels may be used as a biomarker for the prediction of steatosis.
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[1] Francque SM, Marchesini G, Kautz A, Walmsley M, Dorner R, Lazarus JV, et al. Non-alcoholic fatty liver disease: A patient guideline. JHEP Reports. 2021;3(5):100322. doi:10.1016/j.jhepr.2021.100322
[2] Abdulhakeem ZR, Odda AH, Abdulsattar SA. Relationship of serum ghrelin, amylase and lipase with insulin level in type 2 diabetes mellitus patients. Medical Journal of Babylon. 2023;20(1):71–76. doi:10.4103/mjb.mjb_20_23
[3] Pan J, Li Q, Sun Y, Gu Y, Ding Y, Pang N, et al. Increased serum adipsin correlates with MAFLD and metabolic risk abnormalities. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2023;16:187–200. doi:10.2147/ DMSO.S397654
[4] Gallo G, Nalli G, Baratta F, Desideri G, Savoia C, et al. Metabolic Dysfunction-Associated Steatotic Liver Disease: A Silent Driver of Cardiovascular Risk and a New Target for Intervention. International Journal of Molecular Sciences. 2025;26(16):8081. doi:10.3390/ijms26168081
[5] Eslam M, Newsome PN, Sarin SK, Anstee QM, Targher G, Romero-Gomez M, et al. A new definition for metabolic dysfunction-associated fatty liver disease: an international expert consensus statement. Journal of Hepatology. 2020;73(1):202–209. doi:10.1016/j.jhep.2020.03.039
[6] Elfors M, El Sayed R, Mohamed AA, et al. Serum Adipsin as a Marker of MAFLD and Its Relation with Metabolic Abnormalities. Archives of Medical Research. 2025;76(1):160–170. doi:10.1016/j.arcmed.2025.01.005
[7] Abdulsattar SA, Nahi WM, Mohammed EA. Biomarker-Guided Prediction of Pregnancy Viability: Current Evidence and Emerging Insights—A Narrative Review. Al-Rafidain Journal of Medical Sciences. 2025;9:246–254. doi:10.54133/ajms.v9i1.246
[8] Maity SK, et al. Adipose tissue-derived adipsin marks human aging in non-type 2 diabetes population. Clinical and Translational Medicine. 2024;12(4):e004179. doi:10.1002/ctm2.4179
[9] G Gómez-Banoy N, Guseh JS, Li G, Rubio-Navarro A, Chen T, Poirier B, et al. Adipsin preserves beta cells in diabetic mice and associates with protection from type 2 diabe-tes in humans. Nature Medicine. 2019;25(11):1739–1747. doi:10.1038/s41591-019-0593-5
[10] Shrestha R, et al. Estimation of liver fat by FibroScan in patients with nonalcoholic fatty liver disease. Cureus. 2021;13(7):e16414. doi:10.7759/cureus.16414
[11] Z Zhang J, et al. Association of circulating adipsin with nonalcoholic fatty liver disease in obese adults: a cross-sectional study. BMC Endocrine Disorders. 2021;21(1):131. doi:10.1186/s12902-021-00811-7
[12] Yilmaz Y, et al. Serum levels of omentin, chemerin and adipsin in patients with biopsy-proven nonalcoholic fatty liver disease. Scandinavian Journal of Gastroenterology. 2011;46(1):91–97. doi:10.3109/00365521.2010.516452
[13] Fitzpatrick E, et al. Analysis of adipokine concentrations in pediatric non-alcoholic fatty liver disease. Pediatric Obesity. 2012;7(6):471–479. doi:10.1111/ j.2047-6310.2012.00072.x
[14] C Cao L, et al. Global epidemiology of type 2 diabetes in patients with NAFLD or MAFLD: a systematic review and meta-analysis. Diabetology and Metabolic Syndrome. 2024;22(1):101. doi:10.1186/s13098-024-0101-2
[15] Mantovani A, et al. Non-alcoholic fatty liver disease and risk of incident diabetes mellitus: an updated meta-analysis of 501 022 adult individuals. Gut. 2021;70(5):962–969. doi:10.1136/gutjnl-2020-322572
[16] Chang Y, et al. Cohort study of non-alcoholic fatty liver disease, NAFLD fibrosis score, and the risk of incident diabetes in a Korean population. American Journal of Gastroenterology. 2013;108(12):1861–1868. doi:10.1038/ajg.2013.349
[17] Flier JS, Cook KS, Usher P, Spiegelman BM. Severely impaired adipsin expression in genetic and acquired obesity. Science. 1987;237(4813):405–408. doi:10.1126/ science.237.4813.405
[18] Chedraui P, et al. Circulating leptin, resistin, adiponectin, visfatin, adipsin and ghrelin levels and insulin resistance in postmenopausal women with and without the metabolic syndrome. Maturitas. 2014;79(1):86–90. doi:10.1016/j.maturitas.2014.06.003
[19] Derosa G, et al. Adipocytokine levels in obese and non-obese subjects: an observational study. Inflammation. 2013;36(4):914–920. doi:10.1007/s10753-013-9626-5
[20] Azizi M, Tadibi V, Behpour N. The effect of aerobic exercise training on β-cell function and circulating levels of adipsin in community of obese women with type 2 diabetes mellitus. International Journal of Diabetes in Developing Countries. 2017;37(3):298–304. doi:10.1007/ s13410-016-0517-3
[21] Pomeroy C, et al. Effect of body weight and caloric restriction on serum complement proteins, including Factor D/ adipsin: studies in anorexia nervosa and obesity. Clinical and Experimental Immunology. 1997;108(3):507–515. doi:10.1046/j.1365-2249.1997.1080307.x
[22] Milek M, et al. Adipsin serum concentrations and adipose tissue expression in people with obesity and type 2 diabetes. International Journal of Molecular Sciences. 2022;23(4):2222. doi:10.3390/ijms23042222
[23] Zhou Q, et al. Relationship between serum adipsin and the first phase of glucose-stimulated insulin secretion in individuals with different glucose tolerance. Journal of Diabetes Investigation. 2018;9(5):1128–1134. doi:10.1111/jdi.12800
[24] Lo JC, Ljubicic S, Leibiger B, Kern M, Leibiger IB, Moede T, et al. Adipsin is an adipokine that improves β cell function in diabetes. Cell. 2014;158(1):41–53. doi:10.1016/j. cell.2014.06.022
[25] Ma L, et al. Adipsin and adipocyte-derived C3aR1 regulate thermogenic fat in a sex-dependent fashion. Cell Reports. 2024;43(11):e178925. doi:10.1016/j.celrep.2024.178925
[26] Gilani A, et al. Adipose signals regulating distal organ health and disease. Trends in Endocrinology and Metabolism. 2024;73(2):169–177.
[27] Dalmas E. Adipose tissue inflammation in obesity and during surgery-induced weight loss: emerging paracrine dialogue between macrophages and lymphocytes [dissertation]. Paris, France: Université Pierre et Marie Curie-Paris VI; 2012.
[28] Rabiee A, Hossain MA, Poojari A. Adipose tissue insulin resistance: A key driver of metabolic syndrome pathogenesis. Biomedicines. 2025;13(10):2376. doi:10.3390/ biomedicines13102376
[29] Bou Matar D, et al. Adipose tissue dysfunction disrupts metabolic homeostasis: mechanisms linking fat dysregulation to disease. Frontiers in Endocrinology. 2025;16:1592683. doi:10.3389/fendo.2025.1592683
[30] Platt KA, et al. Independent regulation of adipose tissue-specificity and obesity response of the adipsin promoter in transgenic mice. Journal of Biological Chemistry. 1994;269(46):28558–28562. doi:10.1016/j.jbc.1994.28558
[31] Guo Y, et al. Validation of non-invasive indicators in the screening of metabolic dysfunction-associated fatty liver disease: a cross-sectional study among Uighurs in rural Xinjiang. BMC Gastroenterology. 2023;28(1):555. doi:10.1186/s12876-023-0555-7
[32] Taheri E, et al. Predictors of metabolic-associated fatty liver disease (MAFLD) in adults: a population-based study in Northeastern Iran. Diabetology and Metabolic Syndrome. 2021;14(Suppl 1):S102. doi:10.1186/s13098-021-S102
[33] Pan J, et al. Associations between adipokines and metabolic dysfunction-associated fatty liver disease using three different diagnostic criteria. Biomedicines. 2023;12(6):2126. doi:10.3390/biomedicines12062126
[34] Liang Z, Huang R, Zhang L. Correlation between hepatic steatosis severity diagnosed by ultrasound and metabolic indexes in elderly patients with MAFLD. Frontiers in Medicine. 2025;11:1467773. doi:10.3389/ fmed.2025.1467773
[35] Huh JH, et al. Obesity is an important determinant of severity in newly defined metabolic dysfunction-associated fatty liver disease. Liver International. 2022;42(3): 241–247. doi:10.1111/liv.15123
[36] Zhu C, et al. J-shaped relationship between serum prolactin and metabolic-associated fatty liver disease in female patients with type 2 diabetes. Frontiers in Endocrinology. 2022;13:815995. doi:10.3389/fendo.2022.815995
[37] Mohiuddin MS, et al. Metabolic dysfunction-associated fatty liver disease and type 2 diabetes: pathophysiological links, epidemiological trends, and clinical implications. Frontiers in Endocrinology. 2025;16:1669478. doi:10.3389/fendo.2025.1669478
[38] Akkız H, Gieseler RK, Canbay A. Liver fibrosis: from basic science towards clinical progress, focusing on the central role of hepatic stellate cells. International Journal of Molecular Sciences. 2024;25(14):7873. doi:10.3390/ijms25147873
[39] Koky T, Drazilova S, Komarova S, Macej M, Toporcerova D, Janicko M, et al. Adipokine profiles reflect metabolic dysfunction but not fibrosis in patients with primary biliary cholangitis. World Journal of Hepatology. 2026;18(2):113685. doi:10.4254/wjh.v18.i2.113685
[40] Gu Y, Luo J, Chen Q, Qiu Y, Zhou Y, Wang X, et al. Inverse association of serum adipsin with the remission of non-alcoholic fatty-liver disease: A 3-year community-based cohort study. Annals of Nutrition and Metabolism. 2022;78(1):21–32. doi:10.1159/000521234
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