Download PDF
Exp Clin Endocrinol Diabetes 2017; 125(03): 191-195
DOI: 10.1055/s-0042-123035
Article
© Georg Thieme Verlag KG Stuttgart · New York

The Clinical Characteristics of Obese Patients with Acanthosis Nigricans and Its Independent Risk Factors

Yueye Huang
1   Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
,
Jiaqi Chen
1   Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
,
Xingchun Wang
1   Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
,
Yan Li
1   Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
,
Shezhen Yang
2   Department of Endocrinology, Haimen People’s Hospital, Jiangsu, China
,
Shen Qu
1   Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
› Author Affiliations
Further Information

Publication History

received   01 July 2016
first decision 10 November 2016

accepted     05 December 2016

Publication Date:
12 January 2017 (online)

Also available at
   Permissions and Reprints

Abstract

Objective: This study aimed to investigate the clinical characteristics and risk factors for acanthosis nigricans (AN) in obese patients.

Methods: 80 obese patients without AN (OB group) and 128 obese patients with AN (AN group) were included in this study. Clinical data for each patients were collected. Serum levels of leptin were measured by ELISA.

Results: Body mass index (BMI), uric acid (UA) levels, fasting insulin, and HOMA-IR were higher in AN than OB (P<0.05). The levels of leptin were significantly higher in AN than OB (P<0.001) after adjustment for BMI and gender. In male patients, AN showed lower serum levels of testosterone than OB (P<0.001). Multiple Logistic-regression analysis demonstrated that UA (OR 4.627, 95%CI 2.443–8.762, P<0.001) and Leptin (OR 4.098, 95%CI 1.237–13.581, P=0.021) were independent risk factors for AN. In addition, low testosterone level was an independent risk factor for AN in male obese patients (OR 39.062, 95%CI 5.523–283.808, P<0.001).

Conclusions: AN is associated with more severe hyperinsulinemia and hyperuricemia in obese patients, as well as lower serum testosterone levels in male patients. UA and Leptin were independent risk factors for AN in obese patients. Low testosterone may be a valuable predictor of AN in male obese patients.

Key words

obesity - acanthosis nigricans - insulin resistance - leptin - testosterone
 

  • References

  • 1 Ng M, Fleming T, Robinson M et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384: 766-781
    CrossrefPubMedGoogle Scholar
  • 2 Jones LH, Ficca M. Is Acanthosis Nigricans a reliable indicator for risk of type 2 diabetes?. J Sch Nurs 2007; 23: 247-251
    CrossrefPubMedGoogle Scholar
  • 3 Sinha S, Schwartz RA. Juvenile acanthosis nigricans. J Am Acad Dermatol 2007; 57: 502-508
    CrossrefPubMedGoogle Scholar
  • 4 Kobaissi HA, Weigensberg MJ, Ball GD et al. Relation between acanthosis nigricans and insulin sensitivity in overweight Hispanic children at risk for type 2 diabetes. Diabetes Care 2004; 27: 1412-1416
    CrossrefPubMedGoogle Scholar
  • 5 Atwa M, Emara A, Balata M et al. Serum leptin, adiponectin, and resistin among adult patients with acanthosis nigricans: correlations with insulin resistance and risk factors for cardiovascular disease. Int J Dermatol 2014; 53: e410-e420
    CrossrefPubMedGoogle Scholar
  • 6 Koerner A, Kratzsch J, Kiess W. Adipocytokines: leptin – the classical, resistin – the controversical, adiponectin – the promising, and more to come. Best Pract Res Clin Endocrinol Metab 2005; 19: 525-546
    CrossrefPubMedGoogle Scholar
  • 7 Zhang F, Chen Y, Heiman M et al. Leptin: structure, function and biology. Vitam Horm 2005; 71: 345-372
    PubMedGoogle Scholar
  • 8 Polyzos SA, Kountouras J, Mantzoros CS. Leptin in nonalcoholic fatty liver disease: a narrative review. Metabolism 2015; 64: 60-78
    CrossrefPubMedGoogle Scholar
  • 9 Zhou Y, Rui L. Leptin signaling and leptin resistance. Front Med 2013; 7: 207-222
    CrossrefPubMedGoogle Scholar
  • 10 Allison MA, Lx JH, Morgan C et al. Higher leptin is associated with hypertension: the Multi-Ethnic Study of Atherosclerosis. J Hum Hypertens 2013; 27: 617-622
    CrossrefPubMedGoogle Scholar
  • 11 Ames BN, Cathcart R, Schwiers E et al. Uric acid provides an antioxidant defense in humans against oxidant- and radical-caused aging and cancer: a hypothesis. Proc Natl Acad Sci U S A 1981; 78: 6858-6862
    CrossrefPubMedGoogle Scholar
  • 12 Sautin YY, Johnson RJ. Uric acid: the oxidant-antioxidant paradox. Nucleosides Nucleotides Nucleic Acids 2008; 27: 608-619
    CrossrefPubMedGoogle Scholar
  • 13 Kodama S, Saito K, Yachi Y et al. Association between serum uric acid and development of type 2 diabetes. Diabetes Care 2009; 32: 1737-1742
    CrossrefPubMedGoogle Scholar
  • 14 Khosla UM, Zharikov S, Finch JL et al. Hyperuricemia induces endothelial dysfunction. Kidney Int 2005; 67: 1739-1742
    CrossrefPubMedGoogle Scholar
  • 15 Chuengsamarn S, Rattanamongkolgul S, Jirawatnotai S. Association between serum uric acid level and microalbuminuria to chronic vascular complications in Thai patients with type 2 diabetes. J Diabetes Complications 2014; 28: 124-129
    CrossrefPubMedGoogle Scholar
  • 16 Xia J, Wang Z, Zhang F. Association between Related Purine Metabolites and Diabetic Retinopathy in Type 2 Diabetic Patients. Int J Endocrinol 2014; 2014 651050
    PubMedGoogle Scholar
  • 17 Li L, Yang C, Zhao Y et al. Is hyperuricemia an independent risk factor for new-onset chronic kidney disease?: A systematic review and meta-analysis based on observational cohort studies. BMC Nephrol 2014; 15: 122
    CrossrefPubMedGoogle Scholar
  • 18 Feig DI, Kang DH, Johnson RJ. Uric acid and cardiovascular risk. N Engl J Med 2008; 359: 1811-1821
    CrossrefPubMedGoogle Scholar
  • 19 Daskalopoulou SS, Athyros VG, Elisaf M et al. The impact of serum uric acid on cardiovascular outcomes in the LIFE study. Kidney Int 2004; 66: 1714-1715
    PubMedGoogle Scholar
  • 20 Burke JP, Hale DE, Hazuda HP et al. A quantitative scale of acanthosis nigricans. Diabetes Care 1999; 22: 1655-1659
    CrossrefPubMedGoogle Scholar
  • 21 Bonora E, Targher G, Alberiche M et al. Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity: studies in subjects with various degrees of glucose tolerance and insulin sensitivity. Diabetes Care 2000; 23: 57-63
    CrossrefPubMedGoogle Scholar
  • 22 Hermanns-Le T, Scheen A, Pierard GE. Acanthosis nigricans associated with insulin resistance: pathophysiology and management. Am J Clin Dermatol 2004; 5: 199-203
    CrossrefPubMedGoogle Scholar
  • 23 Groschl M, Topf HG, Kratzsch J et al. Salivary leptin induces increased expression of growth factors in oral keratinocytes. J Mol Endocrinol 2005; 34: 353-366
    CrossrefPubMedGoogle Scholar
  • 24 Stallmeyer B, Kampfer H, Podda M et al. A novel keratinocyte mitogen: regulation of leptin and its functional receptor in skin repair. J Invest Dermatol 2001; 117: 98-105
    CrossrefPubMedGoogle Scholar
  • 25 Takahashi H, Honma M, Ishida-Yamamoto A et al. Adiponectin and leptin modulate cell proliferation and cytokine secretion of normal human keratinocytes and T lymphocytes. J Dermatol Sci 2010; 59: 143-145
    CrossrefPubMedGoogle Scholar
  • 26 Wei CY, Sun CC, Wei JC et al. Association between Hyperuricemia and Metabolic Syndrome: An Epidemiological Study of a Labor Force Population in Taiwan. Biomed Res Int 2015; 2015 369179
    PubMedGoogle Scholar
  • 27 Johnson RJ. Why focus on uric acid?. Curr Med Res Opin 2015; 31 (Suppl. 02) 3-7
    CrossrefPubMedGoogle Scholar
  • 28 Su P, Hong L, Zhao Y et al. Relationship Between Hyperuricemia and Cardiovascular Disease Risk Factors in a Chinese Population: A Cross-Sectional Study. Med Sci Monit 2015; 21: 2707-2717
    CrossrefPubMedGoogle Scholar
  • 29 Lima WG, Martins-Santos ME, Chaves VE. Uric acid as a modulator of glucose and lipid metabolism. Biochimie 2015; 116: 17-23
    CrossrefPubMedGoogle Scholar
  • 30 Liu P, Chen Y, Wang B et al. Allopurinol treatment improves renal function in patients with type 2 diabetes and asymptomatic hyperuricemia: 3-year randomized parallel-controlled study. Clin Endocrinol (Oxf) 2015; 83: 475-482
    CrossrefPubMedGoogle Scholar
  • 31 Kleikamp S, Bohm M, Frosch P et al. Acanthosis nigricans, papillomatosis mucosae and “tripe palms” in a patient with metastasized gastric carcinoma. Dtsch Med Wochenschr 2006; 131: 1209-1213
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Bo S, Cavallo-Perin P, Gentile L et al. Hypouricemia and hyperuricemia in type 2 diabetes: two different phenotypes. Eur J Clin Invest 2001; 31: 318-321
    CrossrefPubMedGoogle Scholar
  • 33 Rotter I, Kosik-Bogacka D, Dolegowska B et al. Analysis of relationships between the concentrations of total testosterone and dehydroepiandrosterone sulfate and the occurrence of selected metabolic disorders in aging men. Aging Male 2015; 18: 249-255
    CrossrefPubMedGoogle Scholar
  • 34 Wickramatilake CM, Mohideen MR, Pathirana C. Association of metabolic syndrome with testosterone and inflammation in men. Ann Endocrinol (Paris) 2015; 76: 260-263
    CrossrefPubMedGoogle Scholar
  • 35 Dhindsa S, Ghanim H, Batra M et al. Insulin Resistance and inflammation in hypogonadotropic hypogonadism and their reduction after testosterone replacement in men with type 2 diabetes. Diabetes Care 2016; 39: 82-91
    CrossrefPubMedGoogle Scholar
  • 36 De Pergola G, Pannacciulli N, Ciccone M et al. Free testosterone plasma levels are negatively associated with the intima-media thickness of the common carotid artery in overweight and obese glucose-tolerant young adult men. Int J Obes Relat Metab Disord 2003; 27: 803-807
    CrossrefPubMedGoogle Scholar
  • 37 Cooper LA, Page ST, Amory JK et al. The association of obesity with sex hormone-binding globulin is stronger than the association with ageing – implications for the interpretation of total testosterone measurements. Clin Endocrinol (Oxf) 2015; 83: 828-833
    CrossrefPubMedGoogle Scholar
  • 38 Peter A, Kantartzis K, Machann J et al. Relationships of circulating sex hormone-binding globulin with metabolic traits in humans. Diabetes 2010; 59: 3167-3173
    CrossrefPubMedGoogle Scholar