ORIGINAL ARTICLE Year : 2022  |  Volume : 42  |  Issue : 1  |  Page : 21-26

Association of serum adiponectin, lipid profile, and food quality with acne vulgaris severity

Tozhar A Ismael1, Abeer M Abdel-Aziz1, Mostafa Mansour2, Marwa Zohdy1
1 Department of Dermatology, Andrology & STDs, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
2 Department of Clinical Pathology. Faculty of Medicine, Mansoura University, Mansoura, Egypt

Date of Submission14-Jul-2020Date of Acceptance19-Nov-2020Date of Web Publication18-Dec-2021

Correspondence Address:
PhD Marwa Zohdy
Lecturer of Dermatology, Department of Dermatology, Faculty of Medicine, Mansoura University, Mansoura 5516
Egypt

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/ejdv.ejdv_43_20

Background Acne vulgaris (AV) is a chronic inflammatory disease of the pilosebaceous unit characterized by increased sebum production in response to androgens. Adiponectin is a protein expressed in human adipocytes that reduces tissue triglyceride (TG) content. A contradictory relationship was detected between lipid profile and AV. Moreover, dietary glycemic index and glycemic load have been shown to be inversely associated with adiponectin concentrations.
Objective We aimed to investigate the relationship between blood lipid profile, serum adiponectin, and quality of food in adolescent patients with AV and its correlation with AV severity.
Patients and methods A total of 45 Egyptian adolescent male and female patients with AV were recruited from the Outpatient Clinics of Dermatology of Mansoura University Hospitals (with mean age 19.9 years); moreover, 35 apparently healthy individuals of matched age, sex, and BMI were selected as a control group. Serum adiponectin, total cholesterol (TC), TGs, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) were assessed by appropriate kits.
Results TC, TG, and LDL were significantly higher and HDL was significantly lower in AV cases when compared with control groups. AV cases showed significantly higher adiponectin concentration when compared with the control group. Adiponectin showed significant positive correlations with female sex, disease grade, TC, LDL, dairy+hyperglycemic food, hyperglycemic+fatty food, and dairy+hyperglycemic+fatty food and a significant negative correlation with HDL. Smoking, dairy+hyperglycemic food, hyperglycemic+fatty food, dairy+hyperglycemic+fatty food, high TC, LDL, and adiponectin were significantly associated with more severe AV.
Conclusion Adiponectin and quality of food may play a role in the pathogenesis of AV and may affect its severity.

Keywords: acne vulgaris, adiponectin, diet, food, lipid profile

How to cite this article:
Ismael TA, Abdel-Aziz AM, Mansour M, Zohdy M. Association of serum adiponectin, lipid profile, and food quality with acne vulgaris severity. Egypt J Dermatol Venerol 2022;42:21-6
How to cite this URL:
Ismael TA, Abdel-Aziz AM, Mansour M, Zohdy M. Association of serum adiponectin, lipid profile, and food quality with acne vulgaris severity. Egypt J Dermatol Venerol [serial online] 2022 [cited 2021 Dec 18];42:21-6. Available from: http://www.ejdv.eg.net/text.asp?2022/42/1/21/332674   Introduction 

Acne vulgaris (AV) is a common skin disease that affects more than 85% of adolescents [1]. It is a multifactorial process in which several factors have been implicated, including hormonal effects, follicular hyperkeratinization, proliferation of Propionibacterium acne, as well as inflammatory, environmental, and genetic factors [2].

Diet is also a risk factor of AV. The western diet is implicated in rising rates of obesity and insulin resistance among the younger populations [3]. Obesity may be correlated with increased sebum production and development of severe acne [4].

Adiponectin is a polypeptide protein hormone produced and secreted exclusively by adipocytes. It is the protein product of an adipose tissue specific factor adipose most abundant gene transcript 1 [5]. Adiponectin reduces tissue triglyceride (TG) content and upregulates insulin signaling [6]. Serum adiponectin correlates positively with high-density lipoprotein (HDL) and negatively with TGs [7].

A relation was detected between lipid profile and AV. Human sebum comprises mainly of TGs (40–60%), wax esters (19–26%), and squalene (11–15%), with some cholesterol and cholesterol esters. Total cholesterol (TC) levels may affect the development of AV, because both adrenal and gonadal androgens are synthesized from cholesterol derived from the plasma [8].

We aimed to study the relationship between serum adiponectin, blood lipid profile, and quality of food in AV in adolescent patients for better understanding of acne pathogenesis.

  Patients and methods 

This study was conducted as a case–control study on 45 Egyptian adolescent male and female patients with AV (group A) and 35 apparently healthy individuals of matched age, sex, and BMI as a control group (group B). Patients were recruited from the Outpatient Clinics of Dermatology of Mansoura University Hospitals. AV diagnosis was based on clinical examination. Patients with AV were classified into three subgroups, that is, group 1 (mild), group 2 (moderate), and group 3 (severe and very severe), according to acne scoring system of Hayashi et al. [9]. The study was ethicaly approved By IRB of Mansoura Faculty of Medicine (MS/17.12.72).

Patient selection

Adolescent male and female patients between 15 and 25 years of age, with any stage of AV were included in our study. On the contrary, we excluded the following patients: those on systemic antibiotics to treat acne at least 1 month before the study and topical therapy for 1 week; patients on present or past medical history of isotretinoin or hormonal therapy for at least 3 months; patients with occupational acne, tar acne, and acneiform eruptions; pregnant and lactating women; female patients with clinical evidence of hirsutism; patients with known history of lipid metabolic disorder or intake of drugs that affect lipid metabolism (statins); patients with history of diabetes mellitus, rheumatoid arthritis, other autoimmune diseases, polycystic ovary syndrome, hyperthyroidism, or hypothyroidism; and patients with BMI more than 30. A written informed consent was taken from all patients before participation in the study.

Clinical assessment

Full history taking included personal history such as name, age, sex, occupation, residence, special habits of medical importance, and marital status; present history such as onset, course, and duration of AV, relation to diet, relation to stress, relation to sun exposure, previous treatment, as well as history of other skin diseases; family history of AV and postacne scars; past history of medications (type, dose, and duration) or systemic diseases such as cardiovascular diseases; and full dietary history according to the dietary assessment scoring system [10] adopted by Food and Agriculture Organization in 2018 ([Table 1]).

Table 1 Food history assessment according to Food and Agriculture Organization of the United Nations [11]

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Full general examination was done to exclude associated systemic diseases, together with detailed dermatological examination to evaluate clinical variant, severity of AV, and presence of acne scars. Diagnosis of AV was made on the basis of the patient’s history and the typical clinical features of noninflammatory lesions form, including closed (whiteheads) and open (blackheads) comedones, and inflammatory lesions including papules, pustules, nodules, and/or cysts on the face, chest, and upper back.

Laboratory investigations

Patients should be fasting for at least 12 h before the blood sampling. All studied participants were tested for serum levels of adiponectin and lipid profile. Overall, 5 ml of venous blood sample was collected from each participant after 12–14 h fasting, and the samples were evaluated for lipid profile and serum adiponectin. The resultant serum was aliquoted and stored at −20°C.

Serum levels of TC, TG, and HDL cholesterol were assessed using Biosystem A15 auto-analyzer by appropriate kits (Biosystems S.A., Barcelona, Spain). The low-density lipoprotein cholesterol (LDL-C) was calculated according by ‘Friedwald’s equation’:

LDL -c = Total cholesterol - (HDL -c + TG/5).

Enzyme-linked immunosorbent assay kit was used to measure the serum level of adiponectin.

Statistical analysis

The collected data were revised, coded, tabulated, and introduced to a PC using Statistical package for Social Science (IBM Corp. Released 2011, IBM SPSS Statistics for Windows, Version 20.0.; IBM Corp., Armonk, New York, USA). Data were presented, and suitable analysis was done according to the type of data obtained for each parameter. Shapiro test was done to test the normality of data distribution. Significant data were considered to be nonparametric. Mean and SD were used for parametric numerical data, whereas median and range for nonparametric numerical data. Frequency and percentage were used for nonnumerical data. Student t test was used to assess the statistical significance of the difference between two study group means. Mann–Whitney test (U test) was used to assess the statistical significance of the difference of a nonparametric variable between two study groups. χ2 test was used to examine the relationship between two qualitative variables. Fisher’s exact test was used to examine the relationship between two qualitative variables when the expected count is less than 5 in more than 20% of cells. Correlation analysis was used to assess the strength of association between two quantitative variables. The correlation coefficient defines the strength and direction of the linear relationship between two variables. Logistic and ordinal regression analyses were used for prediction of risk factors. P is significant if less than 0.05 at confidence interval 95%.

  Results 

Sociodemographic data

The present study was conducted on 45 cases with AV. Their mean age was 19.9 years. There were 21 (46.7%) males and 24 (53.3%) females. For comparison, 35 age-matched and sex-matched healthy individuals as a control group were included. In our cases, there were 18 patients with family history of AV (40%) and five (11.1%) patients had history of smoking, with BMI of 22.1±2.1, which are not significantly different from the control group. There was no significant difference between control group and AV group regarding occupation (data not shown).

Clinical data

Median duration for AV cases was 9 months, ranged from 0.1 to 72 months. The onset was sudden in 35.6%, whereas most of cases had gradual disease (64.4%). Grades differed between cases: 46.7% were mild, 28.9% were moderate, and 24.4% were severe. Stress aggravated the disease in 51.5% of cases; 13.3% received previous treatment for AV (data not shown).

Comparison of dietary history between the studied groups

Regression analysis was conducted for assessment of dietary risk on prediction of acne development within healthy controls. Although single dietary component did not revealed significant association with acne development, combination of dietary components revealed increased risk of acne development within healthy controls ([Table 2]).

Comparison of lipid profile and adiponectin concentration between all studied groups

The mean values of TC, TG, and LDL were significantly higher in patients with AV than control group, whereas the mean value of HDL was significantly lower in case than control groups (P<0.001). AV cases showed significantly higher adiponectin concentration when compared with the control group ([Table 3]).

Table 3 Comparison of lipid profile and adiponectin concentration between all studied groups

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Comparison of clinical and laboratory data between high and low adiponectin subgroups in all studied cases

Higher grades of AV were significantly associated with high adiponectin. Otherwise, no significant differences were found in clinical data between high and low adiponectin subgroups. TC and LDL were significantly associated with high adiponectin. No significant differences were found in TG and HDL between high and low adiponectin subgroups ([Table 4]).

Table 4 Comparison of clinical and laboratory data between high and low adiponectin subgroups in all studied cases

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Correlation of adiponectin level with other studied parameters in studied acne vulgaris cases

Adiponectin showed significant positive correlations with female sex, disease grade severity, TC, LDL, dairy+hyperglycemic, hyperglycemic+fats, and dairy+hyperglycemic+fats and significant negative correlation with HDL. Otherwise, no significant correlations were found between adiponectin levels with other studied parameters in studied AV cases ([Table 5]).

Table 5 Correlation of adiponectin level with other studied parameters in studied acne vulgaris cases

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  Discussion 

Although the process of pathogenesis of AV has been thoroughly studied [12], the association between diet and acne has been yielding conflicting results. Some authors proved that diets high in carbohydrates and fat worsen or associated with severe AV [13],[14], whereas others [15],[16] did not find such a relationship. In addition, it was suggested that insulin resistance may play a major role in the pathogenesis of postadolescent acne. Hyperinsulinemic diets were also thought to be an environmental factor in the development of acne as they influence follicular epithelial growth, keratinization, and androgen-mediated sebum secretion [11].

Adiponectin is an adipocyte-derived hormone that is produced mainly by subcutaneous fat; it exhibits important anti-inflammatory, antioxidant, and antidiabetic effects. Dietary glycemic index and glycemic load have been shown to be inversely associated with adiponectin concentrations [17]. Adiponectin is thought to be a probable pathogenetic cofactor contributing to the development of AV through the possible associations among dietary glycemic index, glycemic load, milk consumption, insulin resistance, and low adiponectin levels in patients with AV [18].

Thus, in view of the lack of studies and consensus on the relationship between dyslipidemia and adiponectin with acne, we aimed to study the relationship between serum adiponectin, blood lipid profile, and quality of food in AV in adolescent patients for better understanding of acne pathogenesis. To the best of our knowledge, the present study is one of the first studies to evaluate the relationship between serum adiponectin, blood lipid profile, and quality of food in AV. No significant differences were found in family history, smoking, BMI, dietary history, and occupation between the studied cases and controls.

By regression analysis, single dietary component did not reveal significant association with acne development; combination of dietary components revealed increased risk of acne development within healthy controls. Cordain et al. [18] reported that the Kitavan Islanders of Papua, New Guinea, and the Ache hunter-gatherers of Paraguay never develop acne and they have markedly lower rates of obesity, diabetes mellitus, hyperlipidemia, and cardiovascular diseases. They suggested that the absence of acne in these societies might be a direct consequence of their low glycemic-load diets.

In our study, TC, TG, and LDL were significantly higher and HDL was significantly lower in cases when compared with control groups. Vergani et al. [19] also found low levels of HDL in severe cystic acne. Meas [20] reported that the serum lipid profile of patients with acne differs significantly from that in healthy controls. Male and female patients with acne have significantly low plasma HDL cholesterol, elevated TC, and LDL-C levels. Moreover, Jiang et al. [21] found that the constituent ratios of patients with acne with TC, TG, and LDL-C levels above normal range were significantly higher than in the healthy control group; this goes hand in hand with our results.

In this study, AV cases showed significantly higher adiponectin concentration when compared with control group (P=0.013). Karadag et al. [22] also reported that basal adiponectin levels in the acne group were significantly higher compared with the control group. On the contrary, Çerman et al. [18] found that serum adiponectin concentration was significantly lower in the patients with AV than in the healthy controls. We can suggest that the elevated level of adiponectin in patients with acne is mainly owing to its anti-inflammatory action, so it can act as an endogenous protective mechanism; thus, its level correlates with the severity of acne. Tilg and Wolf [5] support a strong anti-inflammatory function of adiponectin; it suppresses the production of the potent proinflammatory cytokine TNF-alpha.

Izadi et al. [23] in their study review on 25 articles found an inverse relationship between plasma TGs, LDL, and serum adiponectin, whereas a positive correlation between adiponectin and HDL was detected.

However, in our study, higher TC and LDL were significantly associated with high adiponectin, and this may be owing to the significantly higher TC and LDL and also adiponectin in acne cases than in control group. Moreover, higher grades of AV were significantly associated with high adiponectin; this may be explained by the anti-inflammatory defense in the more inflammatory acne. The controversy between our results in this point and with other studies may be owing to that their studies were done on healthy patients do not have acne, but our cases were patients with acne, which showed elevated adiponectin and also showed above than normal combination of dairy, hyperglycemic, and fat diet consumptions.

In our cases, adiponectin showed significant positive correlations with female sex, grade of acne, TC, LDL, dairy+hyperglycemic, hyperglycemic+fats, and dairy+hyperglycemic+fats, and a significant negative correlation with HDL. In the study of Çerman et al. [18], glycemic index and glycemic load values were significantly higher in the AV group than in the healthy controls, with inverse correlations with serum adiponectin.

  Conclusion 

Adiponectin may play a role in the pathogenesis of AV and may affect its severity. Combination of more than one of the western diets, dairy, saturated fatty acids, and/or hyperglycemic carbohydrate may aggravate the acne in acne-susceptible patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]