The adiponectin/leptin ratio as a biomarker of adiposopathy and visceral adipose tissue accumulation: sex-specific mechanisms

Adipose tissue (AT) dysfunction can lead to increased visceral AT (VAT) and metabolic damage. The adiponectin/leptin ratio (ALR) has been proposed as a biomarker of AT functionality. However, its participation in VAT accumulation and the impact of sex on these associations have not been evaluated. In an analytical cross-sectional study, 54 adults (29 male, 25 postmenopausal females, aged 30-70 years, BMI 19-31 kg/m2) were analysed. Anthropometric data, fasting serum samples, and subcutaneous AT (SAT) biopsies were obtained. Morpho-functional AT characteristics included ALR, adipocyte size, macrophage content and AT insulin resistance (ADIPO-IR). Using multivariate and mediation models, we evaluated the associations of SAT characteristics with systemic IR (TyG index), systemic inflammation (C-reactive protein), and VAT area. In postmenopausal females, ALR was inversely associated with adipocyte size, macrophage number, TyG index, CRP, and VAT area. SAT inflammation and ADIPO-IR were independently associated with VAT, and a mediation model suggested ALR as a possible precursor of VAT. Among males, ADIPO-IR and ALR were independently associated with VAT. These findings emphasize the importance of considering sex differences in the prevention and treatment strategies for metabolic diseases among Mexican-Mestizo populations, although these results should be confirmed by prospective studies.