Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Reviews
Year : 2022 | Month : February | Volume : 16 | Issue : 2 | Page : ZE06 - ZE11 Full Version

Obesity: Overview of a Universal Health Conundrum


Published: February 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/51930.15973
Aparna Pandey, Krishnan Viswanathan, Prabhu Manickam Natrajan, Jayadevan Sreedharan

1. PhD Scholar, Department of Dental, Thumbay Dental Hospital, Ajman, United Arab Emirates. 2. Professor, Department of Periodontology, Rajah Muthiah Dental College and Hospital, Annamalai University, Annamalai Nagar, Tamil Nadu, India. 3. Associate Professor, Department of Periodontology, College of Dentistry, University of Science and Technology of Fujairah, Fujairah, United Arab Emirates. 4. Program Director, Department of Periodontology, Gulf Medical University, Ajman, United Arab Emirates.

Correspondence Address :
Dr. Aparna Pandey,
PhD Scholar, Department of Dental, Thumbay Dental Hospital, Ajman, United Arab Emirates.
E-mail: dr_aparna4@yahoo.co.in

Abstract

Obesity is a worldwide health issue which is displaying increasing prevalence trend. World Health Organisation (WHO) has already given it as epidemic status. Many physiological parameters such as Body Mass Index (BMI), Waist Circumference (WC), Waist to Hip Ratio (WHR) are used for measurement of obesity. This review was written with the aim to give an inclusive picture of current prevalence of obesity along with discussing the physiology and function of different adipocytes and the numerous chemical messengers released by them. The manifold impact of obesity on various body systems can be elucidated by exploring the adipocytes, adipokines, its functions and signalling mechanism. The adipokines enlist as key players in numerous systemic diseases. Obesity has a significant pathophysiological role in morbidity and mortality causing conditions globally. Obesity can potentially be the leading reason of economic burden on global healthcare, adversely impacting the comprehensive quality of life. This review is an effort to provide a better understanding of the current obesity status and emphasise further researches on its diverse aspects.

Keywords

Adipocyte, Adipokines, Body mass index, Morbidity, Mortality

The idea of excessive body fat has been in human evolution since centuries, but paradoxically it was considered to be a criterion for a healthy body, which can survive numerous diseases compared to slimmer counterparts (1). It was only in the last century, that excessive body fat raised a serious health concern among medical fraternity. The etymology of the word obese was from Latin word ‘obedere’ means ‘over eat’ and ‘obesitas’ means ‘being very fat’ (2).

Obesity is defined as an accumulation of excessive body fat and is closely related to ill health and several major diseases. Obesity remains a highly enigmatic, multifaceted, complex conditions which is accepted as an extreme of health rather than a disease.

PREVALENCE

Obesity is an ignored health condition, non communicable and multifactorial. The increasing number of obese individuals in all age groups as well as in different strata of society is alarming. The prevalence of obesity is tripled from 1975 to 2016 (3). The World Health Organization (WHO) published latest reports in which the most obese country in the world is “The island of Nauru”, where 61.0% of its adult population is obese (3). By 2030, USA can reach disturbing number of over 85% of population being overweight or obese (4). In 1997 WHO consultation officially recognised the global nature of obesity as an epidemic (5). The overweight or obese individuals outnumbered the percentage of underweight individuals by 2000 (6). The recent fact about obesity from WHO as published in 2021 states that 39% of adults aged 18 years and above were overweight in 2016, and 13% were obese. In 2019 under the age of 5 years an approximately 38.2 million children were overweight or obese. Over 340 million children and adolescents aged 5-19 were overweight or obese in 2016 (7).

However, the obesity prevalence variation is based on modifiable and non modifiable factors. The non modifiable and modifiable factors affecting the obesity prevalence, data are discussed later in the article. Ashraf Hassan Humaidan Al Zaabi from Zayed Military Hospital in Abu Dhabi conducted one of the largest population studies on young Emirati population in the age of 18-20 years. The research pointed towards a high incidence of cardio-metabolic disorders such as high triglycerides, obesity, impaired fasting glucose, hypertension and high cholesterol in the subjects. It showed that over 70% population under 30 years of age were obese (8).

PARAMETERS FOR OBESITY

Body Mass Index (BMI)

BMI is the most common tool to measure weight element of body. It is measured by body weight in kilogram divided by square of the height in meters hence expressed as kg/m2. Eknoyan G, a Belgian astronomer and statistician was working extensively on concept of “Social averages” to define normal average for a person (9). In an attempt to reach the Gaussian or normal distribution expressed as Bell curve, Quetelet concluded that ratio of weight to the height square followed the Bell curve better when compared with weight to height or weight to third power of height (10). Hence, BMI is also called Quetelet Index, the squaring of the height for the weight lead to a more uniform weight distribution over the height of the person. However, the limitation to measure BMI is that, it expresses weight distribution uniformly over the height, which is not the actual finding as the truncal adiposity is more than the extremities (10). BMI has been classified by numerous authors under different categories and ranges. A report, BMI: Considerations for Practitioners, published by the Department of health and human service of the Centers for Disease Control and Prevention (CDC), mentioned details of BMI into four categories, as presented in (Table/Fig 1) (11).

In 1981 Garrow, had presented a similar classification with different terminology (Table/Fig 2) [12,13].

The International Obesity Task Force (IOTF) in 1997 added to the number of BMI categories to include different degrees of obesity and changed the terms (Table/Fig 3) (14).

Nevertheless, the BMI assessment has its innate limitations like the interpretation varies based on region and ethnicity. The BMI measures excess body weight with the square of height ratio, considering that the excess weight is all due to fat, which is interpreted as obesity (15). Nevertheless, the additional weight can be due to muscle mass as in BMI of a sports person, which is frequently miscalculated as increased fat mass and thereby giving increased BMI (16).

Waist Circumference (WC)

The body fat is not uniformly distributed all over the height. The visceral or abdominal fat is prominent area for fat deposition. Hence, measurements like WC and Waist Hip Ratio (WHR) become significant indicators of body fat or obesity. WC is a routine and simple method to measure visceral adiposity. Abdominal obesity however, fluctuates based on gender, body type and race.

Waist to Hip Ratio (WHR)

WHR is another parameter to assess obesity. It is computed by taking the measurement around the waist at its slimmest point and by dividing the width around the hips and buttocks at their broadest positions (17).

Measurement protocol: The measurement of WC can be done in many ways given by different authors such as exact measurement at the umbilicus (18) or 2.5 cm above the umbilicus (19).

Diverse factors influence the measurement of WC. The subject related factors are the posture, the phase of respiration, the stomach content and the abdominal tension. As per WHO, the posture of the subject should be standing with arms at the sides, feet positioned close together, and weight evenly distributed across the feet. The measurement should be done with overnight fasting by the subject at the end of normal expiration with no tension on the stomach wall (20). The measurement tape should be non stretchable and snug fit to the measurement site and parallel to the floor (21). The International Diabetes Federation (IDF) 2006 suggested WC as a measurement for central obesity and cut off marks calibrated at >94 and >80 cm for European men and women, respectively, and >90 and >80 cm for the South Asian, and South and Central American ethnic groups. The obesity cut-off for WHR as given by WHO is 0.90 for males and 0.85 for females with BMI over 30 kg/m2 (22).

PHYSIOLOGY OF ADIPOCYTES

Adipocytes are the primary cells for storage of excess fat in the form of triglycerols. It reflects the positive energy balance of the body, which is utilised during negative energy state of the body as during starvation (23).

There are three known types of adipocytes: White Adipose Tissue (WAT), Brown Adipose Tissue (BAT) and Biege Adipose Tissue. White adipocytes are also called ‘unilocular’ and portrayed by the presence of a single large lipid droplet. It typically serves as an “Energy Bank” (24). WAT regulates energy homeostasis it senses the demand for the energy based on the complex coordination of internal and external messengers and release or uptake energy, accordingly. Nevertheless, in obesity when it becomes functionally impaired and cannot store excess energy, it gets deposited in ectopic sites and interferes with glucose metabolism, leading to a phenomenon called lipotoxicity. An increase in insulin resistance occurs as a result of lipotoxicity (25).

Besides the WAT another type of adipocytes is BAT, its primary function is to protect the body from cold by acting like padding, hence called Hibernating organ (24). It develops during embryonic development and is mostly concentrated in the interscapular region of small mammals and infants. The main structural difference between the two adipocytes is related to cellular contents and vascularity.

In WAT, 90% of the cell is filled with lipid or triglycerol, with few scattered mitochondria and meagre blood supply. In BAT there is multilocular arrangement of triglycerides with abundance of mitochondria. It has higher neural and vascular supply. The brown colour is due to mitochondria and vascularisation (26).

Recent developments show the presence of adipocytes with features of both white and brown hence called Beige Adipocytes, which are present in significant number contrary to previous conclusions (27). The genetic information for the beige (brite) adipocytes is different than both white and brown types. Interestingly, it has a reversible thermogenic profile wherein, in warm conditions it undergoes a morphological transformation into white adipocytes [27-29]. The presence of a distinct type of adipocytes called bone marrow adipose tissue has been recorded (30).

ADIPOKINES

Unlike the previous theories where adipocytes were believed to be only a source of energy storage along with insulation and lining tissue, these are now proved to be active cells. These are now considered as endocrine organs which release plentiful of chemical mediators or “adipocytokines” (31). The adipokines mediate role in insulin resistance, glucose metabolism besides playing role in inflammatory conditions along with other pro and anti-inflammatory cytokines. Adipokines are categorised as hormones, growth factors, angiogenic factors, and cytokines. The prominent adipokines discussed here are adiponectin, resistin, leptin and visfatin.

Adiponectin

A plasmatic protein expressed mostly in subcutaneous tissues and one of the few, which is inversely related to obesity [32,33]. The plasma level of adiponectin in a healthy individual is in a range of 1.9 to 17.0 mg/mL (34). Adiponectin exerts its effect through the receptors AdipoR1, AdipoR2 and T cadherins due to its structural homology to complement factor C1q. Through various signalling pathways it shows effect on adipose tissues, endothelial, macrophages and skeletal cells. The key signalling mechanism of adiponectin is primarily based on receptor-ligand interaction wherein adiponectin binds to its receptors and brings about the signalling cascades through different pathways. Binding of adiponectin to its receptors AdipoR1, AdipoR2 and T cadherins, activates adaptor protein containing a pleckstrin homology domain, adaptor protein, phosphotyrosine interacting with pH domain and leucine zipper 1 (APPL1). APPL1 is the first directly interacting protein which then mediates several signalling cascades pathways. The main pathways are Adenosine Monophosphate-activated Protein Kinase (AMPK), mammalian Target of Rapamycin (mTOR), Nuclear Factor-kappa B (NF-κB) and c-Jun N-Terminal Kinase (JNK) (35).

Activated APPL1 initiates complex signal transduction by activating Peroxisome Proliferator-Activated Receptor-α (PPAR-α) and phosphorylating AMPK and p38 Mitogen-Activated Protein Kinase (p38-MAPK) and therefore APPL1-AMPK signalling that translocate transcription factors into the nucleus (36). Phosphorylation of the above key signalling proteins showed enhanced adipocyte differentiation, glucose uptake, and lipid metabolism (37).

Due to its wide scope of action, it becomes a target messenger for management of metabolic syndrome. The adiponectin has positive effect on insulin sensitivity, fatty acid oxidation and glucose uptake. It increases adipogenesis, enhances glucose metabolism and free fatty acid metabolism in muscles (38).

The anti-inflammatory functions of adiponectin on monocytes are by subduing its migration and suppressing the differentiation of foam cells. Through inhibition of Tumour Necrosis Factor-alpha (TNF-α) induced NF-κB activation it suppresses the inflammatory response of endothelial cells (39). The skeletal muscle, liver, and adipose tissue exhibit the adiponectin receptor AdipoR1 and AdipoR2, via these receptors adiponectin expresses its anti-inflammatory and metabolic activities leading to anti-atherogenic and antidiabetic action (39).

Resistin

Resistin an adipokine, is a member of cysteine rich secretory family, known as Resistin Like Molecule (RELM) (40). It is secreted by adipocytes and triggers Insulin resistance {in (insulin) + resisit (resistance)}, hence the name. This is studied as a pivotal hormone causing obesity mediated insulin resistance. Nevertheless, the hormone possesses variable structural expression in different species, its role and behaviour in animals cannot be interpolated directly in human beings. Primarily secretion of resistin in humans is from monocytes in contrast to mice where it is secreted from white adipocyte cells (41). Some studies reported significant increase in the levels of resistin in obesity related Type 2 Diabetes Mellitus (Type 2 DM) [42,43], whereas some of them showed no strong correlation between the two hence, its role remains controversial (44). The resistin functions in autocrine, paracrine and endocrine pathways through vast range of cell receptors and signalling molecules [45,46].

The atherogenic action of resistin is exerted by an increase in the expression of endothelin 1, the Intercellular Adhesion Molecule (ICAM) and the Vascular Cell Adhesion Molecule (VCAM) by activating endothelial cell. The other studies showed the systemic effect of resistin is in gastric cancer (47), breast cancer (48), colorectal cancer (49), and endometrium cancer (50), and oesophageal squamous cell cancer (51). Numerous autoimmune conditions have also been linked to levels of resistin such as rheumatoid arthritis, and systemic lupus erythematosus (52).

The pleiotropic role and different fate of secretory resistin implicates its role in various diseases besides obesity and diabetes; with respect to Cardiovascular Diseases (CVD) and atherosclerosis, resistin has been found to have possible roles in the development of endothelial dysfunction, thrombosis, angiogenesis, inflammation and smooth muscle cell dysfunction (53).

Leptin

It is a non glycosylated peptide hormone of 167 amino acids discovered in1994 serendipitously (54). It is secreted by WAT and shows diurnal variation with higher levels in the evening and early morning hours. Leptin exerts its effect through various receptors, which are extensively present in hypothalamus. Hypothalamus gauges the nutritional state of the body through signalling from leptin. It then modulates the levels of anorexigenic (appetite-diminishing) neuropeptides such as α-Melanocyte Stimulating Hormone (MSH) and orexigenic (i.e., appetite stimulating) neuropeptides such as neuropeptide Y to control food intake (55).

Genetic defects in these signalling mechanisms at different levels can lead to obesity. As opposed to Leptin ghrelin hormone secreted by gastric lining works to increase the appetite. A higher ghrelin to leptin ratio reflects increased hunger sensation (56).

Numerous studies showed that increase in the fat diet can lead to Leptin resistance hence, in obese people the high levels of leptin may be recorded [57,58]. This is the result of reduced central leptin sensitivity (59). The raised levels of leptin have been linked to atherosclerosis; serum leptin levels are positively related to intima media thickness, thus having role in atherosclerosis (60). Leptin deficiency and resistance are also associated with Type 2 DM, therefore Leptin can be therapeutically used in its treatment specifically for Lipoatrophic diabetes [61,62]. Research on female athletes inferred that leptin is a probable metabolic messenger that establishes connection between fat tissues, present energy and the reproductive axis [63]. Leptin is known to mediate inflammatory response through expression of proinfammatory cytokines in macrophages and T-cells via numerous signalling pathways (38).

Visfatin

The adipokine is a relatively new addition to the list of hormones secreted primarily by white fat cells. It was secreted by human peripheral blood lymphocyte as Pre B-cell colony Enhancing Factor (PBEF) [64]. Fukuhara A et al., identified it as a protein mediator secreted by fat cells, the amino acid sequence of which was similar to PBEF and Nampt (Nicotinamide phosphoribosyl transferase). Nampt is an enzyme involved in NAD+ salvage pathway [65]. An interesting fact about visfatin is that it mostly remained unchanged over the evolutionary chart the canine visfatin protein sequence is 96% and 94% identical to human and rodent visfatin, respectively [66]. It is secreted in wide range of tissues like bone marrow, liver, muscles, brain, kidney, spleen, testis, lungs, foetal membranes but predominantly expressed in tissue. It has antiapoptotic and proinflammatory roles in numerous pathophysiological visceral adipose conditions [67]. As for its wide array of functions and tissues which express it, necessitates further researches on it.

FACTORS AFFECTING OBESITY

The excessive consumption of calorie than utilisation leads to overweight and obesity. Several factors influence this equilibrium of total consumption and the utilisation of the calories. The non modifiable factors are gender, ethnicity or race, cultural background and genetics. The few modifiable factors affecting the obesity prevalence data are lifestyle, dietary habits and socio-economic status.

Gender

Kroll DS et al., gave an interesting insight about the gender difference of obesity based on neuroimaging. The authors discussed how taste perception, taste response, the choice of food, preference for comfort food varies with gender due to micro difference in brain structure [68]. The neurotransmitters like dopamine, opioid and serotonin signalling has gender based variation, which affects the BMI [68].

Genetics

Genes have direct influence on body characteristics and body metabolism hence, the body weight and circumference exhibit genetic predilection. Therefore, a person with familial trait of obesity is at a higher risk of being obese, the condition gets aggravated if other systemic factors like hormonal imbalance exist simultaneously. The genetic predisposition to obesity can be polygenic, monogenic or syndromic [69]. More than 100 syndromes have been related to obesity, other co-existing clinical presentations are mental challenge, dysmorphic facies, or organ-system specific abnormalities. The most common syndromic obesity is Bardet Biedl and Prader Willi syndrome [70]. O’Rahilly S and Farooqi IS in 2006 stated that a child with both obese parents have 80% chances of being obese and a child with normal weight parents has only 15 % risk of being obese [71].

Racial/Ethnicity

Racial and ethnic variations influence the onset, pattern and rapidity of weight gain and response to obesity management. Women in Africa, America and Hispanic women tend to experience weight gain earlier in life than Caucasians and Asians, and age-adjusted obesity rates are higher in these groups. Non Hispanic black men and Hispanic men have a higher obesity rate then non Hispanic white men, but the difference in prevalence is significantly less than in women [72].

Few of the modifiable factors are dietary habit, socio-economic status and lifestyle. People having higher consumption of carbohydrates, processed food and sugary drinks are at a higher risk of becoming obese with time. People belonging to more affluent class have easy accessibility to more processed and higher calorie food with less physically exerting daily routine, therefore causing increased tendency of weight gain. Other environmental and lifestyle factors such as sleep deprivation, psychological stress, depression, anxiety and certain medications such as antipsychotics, antidepressants, antidiabetic, antihypertensives and steroids all these can lead to increased BMI [73]. Physical inactivity and sedentary lifestyle and with most tasks being limited to onscreen involvement have presented some association with increased BMI, especially in adolescence life.

OBESITY AS A HEALTH CHALLENGE

The excessive body fat accumulation possesses serious threat to individual’s physical and psychological health and growth. For decades, the role of obesity as a major health concern had been understated. However, recent developments have consolidated the role of obesity as the prime health concerns and linked it to various health maladies. The various co-morbidities related to obesity are type 2 diabetes, hypertension, stroke, coronary artery disease, congestive heart failure, asthma, chronic back pain, osteoarthritis, pulmonary embolism, gallbladder disease, and also an increased risk of disability. All this leads to more than three million deaths worldwide annually [74]. Obesity has been widely related to unfavourable lipid levels and cholesterol values. The BMI values have been used as a predictor for overall mortality. At the range of 30-35 kg/m2, mostly median survival is reduced by 2-4 years; whereas at 40-45 kg/m2, it is reduced by 8-10 years [75]. Obesity related sleep apnoea and shortness of breath have also impacted the quality of life, as the hypoventilation during sleep leads to interrupted sleep in the night thereby causing fatigue and exhaustion throughout the day [76]. The puzzling correlation of breast, colon, and gastric malignancy to obesity has been highlighted in the discussion of the adipokines. Both high and low BMI has been linked to cancer incidences.

Obesity has been for long considered as a social stigma leading to discrimination, mockery and rejection. All these have made a considerable bearing on mental health of overweight or obese people. The health complications as a consequence of these co-morbidities further add on to the inferior life quality and life expectancy. These health issues put sizable economic burden on the health system of the global community.

PREVENTION AND MANAGEMENT OF OBESITY

In near future, the obesity epidemic will be a worse health crisis than many other chronic diseases. Prevention of the condition still is a superior choice than its management. Preventive approaches include healthy lifestyle, reduced intake of high calorie and processed food. Incorporating better sleep hours, reduced anxiety and depression, following a structured life under a trained staff can play critical role in weight management [77]. Psychological intervention like Cognitive Behavioural Therapy (CBT) emphasises on altering unhealthy cognitions, emotions, and/or behaviours and promoting physical activities with better food choices and shown appreciable outcomes in children and adolescence [78]. Besides this the surgical and pharmacological intervention has also given noticeable results in management of obesity. Nevertheless, these management modalities have some potential side-effects [79]. The management of obesity has better and more sustainable results with a holistic approach, where physical, mental and psychological health is in harmony with each other.

WHO has laid Global action plan on physical activity 2018-2030 with a motto of “More active people for a healthier world”. This global action plan sets out four strategic objectives achievable through 20 policy actions that are universally applicable to all countries, recognising that each country is at a different starting point in their efforts to reduce levels of physical inactivity and sedentary behaviour. This system based approach guides each country to implement over the short term (2-3 years), medium term (3-6 years), and longer-term (7-12 years) based on its subpopulation. This includes monitoring and data reporting of inadequate physical activity among persons aged 18 years and over, and among adolescents (aged 11-17 years) [80].

Sedentary behaviour is defined as any waking behaviour characterised by an energy expenditure ≤1.5 metabolic equivalents, such as sitting, reclining or lying down [81]. Globally, 23% of adults and 81% of adolescents (aged 11-17 years) do not meet the WHO global recommendations on physical activity for health [82]. The sustainable development goals 2030 include increasing physical activity, which directly contributes to good health, ending all forms of malnutrition, quality education, gender equality, decent work and economic growth, industry, innovation and infrastructure, reduced inequalities, sustainable cities and communities, responsible production and consumption [80].

Conclusion

It can be concluded that obesity adversely impacts the quality of life. The white fat cells were considered only as a passive store house of energy and not much was known about the cytokinetic activity of these cells. It’s only of late that a medical science have explored the overwhelming functions, complex pathways, and profound effects of adiposity and related adipokines and its role in numerous pathophysiological functions. Nevertheless, much has to be investigated because of the magnanimous domain of obesity. In a world, where food scarcity is possessing a challenge to humankind at social, economic, and humanitarian levels having rising figures of obesity prevalence presents an equivalent thwarting situation.

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DOI and Others

DOI: 10.7860/JCDR/2022/51930.15973

Date of Submission: Aug 19, 2021
Date of Peer Review: Nov 11, 2021
Date of Acceptance: Jan 12, 2022
Date of Publishing: Feb 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? NA
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA

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