https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Regensburg Universitäres Herzzentrum Regensburg Regensburg, Deutschland; 2Klinik für Psychosomatische Medizin und Psychotherapie Freiburg im Breisgau, Deutschland; 3Caritas Krankenhaus St. Lukas Kelheim GmbH Klinik für Kardiologie, Angiologie, Pneumologie und internistische Intensivmedizin Kelheim, Deutschland; 4Institut für Klinische Chemie und Laboratoriumsmedizin Regensburg, Deutschland
Introduction:
Chronic adipose tissue inflammation plays a significant role in the development of cardiometabolic diseases. We investigated the relationship between the proinflammatory marker lipocalin-2, resistin and hsCRP, and body composition in male and female patients with morbid obesity.
Methods:
In this prospective cohort study, we included 209 obese women (mean BMI 40.0±7.4 kg/m², mean age 44±12 years) and 143 obese men (mean BMI 41.7±8.2 kg/m², mean age 46±12 years) participating in a medical weight reduction program. A control group of 76 individuals (mean BMI 24.7±3.3 kg/m², mean age 41±13 years) was also included. Lipocalin-2 levels were measured by ELISA in serum from 249 obese participants and 52 lean controls. Participants were stratified by BMI into non-obese (BMI <30 kg/m²) and obesity grades I-III (obese I: 30≤BMI<35 kg/m², obese II: 35≤BMI<40 kg/m², and obese III: BMI ≥40 kg/m²).
Results:
Patients with morbid obesity (obese III) showed higher lipocalin-2 levels (90.0±46.3 ng/mL) than non-obese (75.8±32.2 ng/mL, p=0.035) or obese I individuals (77.8±35.0 ng/mL, p=0.041). Lipocalin-2 levels increased with rising BMI (r=0.140; p=0.015) and correlated with measures of subcutaneous and visceral fat, displaying sex-specific differences. In men, lipocalin-2 correlated with % body fat (r=0.205, p=0.029) and epicardial fat (r=0.215, p=0.023). In women, lipocalin-2 correlated with parameters for subcutaneous fat, such as hip circumference (r=0.152, p=0.040), total body fat (r=0.152, p=0.043), and % body fat (r=0.155, p=0.038). Although women displayed higher hsCRP levels across obesity grades (data not shown), only men showed an association between hsCRP and lipocalin-2 (r=0.206, p=0.026). Levels of the proinflammatory and cardiometabolic resistin were associated with lipocalin-2 in both sexes (men: r=0.301, p=0.005; women: r=0.397, p<0.001.
Conclusion:
Lipocalin-2 levels increase with higher obesity grades, with sex-specific patterns in body composition. The association between lipocalin-2 and resistin may contribute to the development of insulin resistance and cardiometabolic diseases. These findings underscore the complex interplay between inflammatory markers, adiposity, and sex-specific differences in cardiometabolic risk, highlighting the potential of lipocalin-2 as a biomarker for obesity-related inflammation and metabolic dysfunction. Further research is needed to explore its utility in predicting cardiometabolic outcomes and guiding therapeutic strategies.