Skip to main content

Comparison of urinary adiponectin in the presence of metabolic syndrome in peri- and postmenopausal women

Abstract

Objectives

To find the association between urinary adiponectin and metabolic syndrome (MetS) in peri- and postmenopausal women and its potential application as a noninvasive screening for MetS.

Methods

A cross-sectional study was conducted in healthy peri- and postmenopausal women (defined by STRAW + 10 staging) aged at least 40 years who attended annual check-ups or menopause clinics were recruited. Baseline demographic data, MENQOL, anthropometric measurements, blood pressure, laboratory (FBS, total cholesterol, HDL-C, LDL-C, TG), and urinary adiponectin were collected. The MetS was diagnosed according to JIS 2009.

Results

290 peri- and postmenopausal women had participated. The prevalence of Mets among our participants was 18%. Urinary adiponectin levels were similar in peri- and postmenopausal women with and without MetS (2.6 ± 2.2 vs. 2.3 ± 1.9 ng/mL, respectively, P = 0.55). Urinary adiponectin provides no diagnostic value for MetS (AUC = 0.516).

Conclusions

Urinary adiponectin has no role in screening and diagnosing MetS in peri- and postmenopausal women. The quest toward noninvasive screening for MetS is still going on.

Peer Review reports

Introduction

Women around the world increase their life expectancy [1]. With the finite fertile years, they have spent at least one-third of their life in menopause [2]. The incidence of metabolic syndrome (MetS) and cardiovascular disease (CVD) rise steeply during the menopausal transition [3]. MetS is a combination of multiple metabolic disorders such as visceral adipose tissue accumulation, abnormal fasting plasma glucose, abnormal lipid metabolism, and blood pressure regulation [4]. The menopause-induced estrogen deficiency contributes to body fat pattern redistribution toward visceral fat accumulation [5], insulin resistance, and chronic inflammation [6,7,8] which contribute to the occurrence of MetS [9].

MetS is considered as the sentinel event before CVD. Many clinical and biochemical markers correlated with MetS and CVD in menopausal women such as premature (age < 40 years) or early (age 40–45 years) at the onset of menopause [10,11,12], type of menopause (natural, surgical) [13], frequent hot flushes [14,15,16,17], early onset of hot flushes (age < 42 years) [15,16,17,18], inflammatory biomarkers [CRP, IL-6, and homocysteine-like Lp(a)] [8, 19], and visceral fat biomarkers (adiponectin, leptin, ghrelin) [20].

The visceral fat secretes many hormones involved in MetS such as adiponectin, leptin, and ghrelin [21]. Adiponectin consists of 244-amino acid, and secretes exclusively by adipocytes. Adiponectin is inversely correlated with visceral fat [22]. It exerts its affect through transmembrane receptors AdipoR1, AdipoR2 [23], and a surface membrane receptor T-cadherin (T-Cad) [24]. Adiponectin is a vasoactive peptide that exerts anti-diabetic, anti-atherosclerotic, anti-obesity, and anti-inflammatory effects [25]. It prevents metabolic deterioration toward MetS and expresses cardioprotection. Serum adiponectin is negatively correlated with MetS and could be used as a biomarker for MetS [20]. In our previous study, we reported the diagnostic performance of serum adiponectin for screening of MetS in peri- and postmenopausal women and found that serum adiponectin performs moderately well in the screening of MetS [20]. Adiponectin can be filtered out into the glomerular basement membrane in kidneys and excreted into urine [25, 26].

To the best of our knowledge, there has not been any validation study of urinary adiponectin for screening of MetS. We would like to find the association between urinary adiponectin and MetS in peri- and postmenopausal women and explore its potential application as a noninvasive, in-home screening for MetS.

Methods

Study design and participants

Healthy peri- and postmenopausal women (defined by STRAW + 10 stage of reproductive aging [27], which is the international standard to define reproductive aging into 10 stages) aged at least 40 years old (the age that defined premature menopause [28]) who attended an annual health check-up at check-up clinic, or a visit at menopause clinic at a university hospital, were recruited during January–December 2020. We excluded the participants who had a history of stroke, cardiovascular disease, cancer, polycystic ovary syndrome, diagnosed with any inflammatory diseases (SLE, autoimmune disease, rheumatoid arthritis, etc.), on immunosuppressive therapy, steroid or NSAIDs, and chronic kidney disease. The study was conducted following the Declaration of Helsinki, and the study protocol was approved by the Vajira Institutional Review Board. Informed consent was obtained from all participants.

Outcome measures

All participants have undergone a clinical and biochemical evaluation. The anthropometric measurements (waist circumference, hip circumference, and height) were carried out according to the World Health Organization recommendations [29]. Weight was measured in kilograms. The waist-hip ratio (WHR) was calculated and stratified into android (WHR ≥ 0.85) and gynoid (WHR < 0.85) body fat distribution pattern. The body mass index (BMI) was calculated and stratified into normal (BMI < 23.0 kg/m2), overweight (BMI 23.0–29.9 kg/m2), and obese (BMI ≥ 30.0 kg/m2) [30]. Height was measured while standing in light clothes without footwear. The standard sphygmomanometer was placed at the same level as the participants’ chest for blood pressure measurement.

Afterward, a two-part questionnaire was self-administered. The first part comprised demographic data including age, lifestyle (alcohol consumption, eating habits, and smoking), menstrual history, marital status, parity, education, occupation, and family history of metabolic diseases. The second part was the Thai version of MENQOL questionnaire. The MENQOL was translated and validated at our institution, with Cronbach’s alpha = 0.8940 [31]. The MENQOL questionnaire consists of 29 items within four domains, vasomotor (3 items), psychosocial (7 items), physical (16 items), and sexual (3 items). The participants were demanded to rate their experience of each of the items within the previous month and to score the bothersome of each symptom on a Likert scale ranging from 0 (not disturbed at all) to 6 (extremely disturbed). The investigators supervised the self-administered questionnaire or interviewed and completed the questionnaire for illiterate participants.

After an overnight fast, the blood specimen was drawn for bio-chemical evaluations including complete blood count (CBC), fasting blood glucose (FBG), triglyceride (TG), total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). The biochemical assays were conducted in an ISO 15189 certified biochemical laboratory at the department of clinical pathology. The FBG, total cholesterol, HDL-C, and TG were analyzed with an auto-analyzer (SIEMENS Dimension® EXL™ 200, USA) and reported as mg/dL. LDL-C was calculated using the Friedewald equation and reported as mg/dL.

Urine adiponectin was measured by an ultrasensitive human adiponectin ELISA kit (Invitrogen, Thermo Fisher Scientific, Austria) [32] with an auto-analyzer (TECAN® SUNRISE, Austria). Urine samples were collected and transferred to pyrogen/endotoxin-free tubes, and then snap-frozen at – 20 °C for further analysis according to the manufacturer’s recommendation. Each sample was assayed in duplicate with tenfold dilution using the quantitative sandwich enzyme immunoassay technique. The range of measured concentrations is 0–32 ng/mL using diluted reconstituted standard human adiponectin according to the manufacturer protocol. The coefficient variation (%CV) of intra- and inter-assay were less than 8.31% and 9.69%, respectively.

Criteria for diagnosis of MetS

The diagnosis of MetS was made following the Joint Interim Statement 2009 (JIS 2009) criteria [33], where the participants presented at least three of the following: (1) abdominal obesity defined as waist circumference ≥ 80 cm for Asian women; (2) elevated TG ≥ 150 mg/dl or drug treatment for elevated triglycerides; (3) reduced HDL-C < 50 mg/dl or drug treatment for reduced HDL-C; (4) elevated blood pressure defined as systolic ≥ 130 mmHg and/or diastolic ≥ 85 mmHg or antihypertensive drug treatment; and (5) elevated fasting glucose ≥ 100 mg/dl or drug treatment of elevated glucose.

Statistical analysis

We applied the formulae for sample size estimation in diagnostic test studies of biomedical informatics for adequate sensitivity/specificity [34] i.e. urinary adiponectin for diagnosis of MetS. From our previous study [8], we found that the prevalence of metabolic syndrome in peri- and postmenopausal women was 21.4%. With α = 0.05, and 80% power, two hundred and ninety participants were required for this study.

All data were analyzed using IBM SPSS statistics version 22.0 (SPSS Inc., USA). Data were presented as mean ± SD, number (%), or percentage (95% confidence interval—CI), as appropriate. Urinary adiponectin was analyzed and compared among participants with and without MetS using independent sample t-test or one-way ANOVA as appropriate. Pearson’s correlation coefficient was determined for the correlation between urinary adiponectin and MetS components. The area under the curve (AUC) of receiver operating characteristic (ROC) curve analysis for diagnosing MetS was performed to obtain the diagnostic performance and cutoff of urinary adiponectin for diagnosis of MetS by Yuden index. The P value of < 0.05 was considered statistically significant.

Results

290 peri- and postmenopausal women aged 57.2 ± 8.2 years were recruited. The prevalence of MetS among our participants was 18% (55 in 290 participants). Baseline characteristics and demographic information of participants were presented in Table 1. The participants with MetS were slightly older age and more into their menopausal years; moreover, they had worse health habits (alcohol drinking, fatty food, less exercise).

Table 1 Baseline characteristics of the participants (N = 290)

Urinary adiponectin level in participants with MetS group was slightly higher than participants without Mets but did not reach statistical significance (2.6 ± 2.2 vs 2.3 ± 1.9 ng/mL, respectively, P = 0.55). Urinary adiponectin also stabled with the increment of component of MetS in our participants (Fig. 1). Urinary adiponectin had negative correlations with waist circumference, body weight, BMI, FBG, TG, total cholesterol LDL-C, and HDL-C. The comparison of anthropometric measurements and metabolic profiles was presented in Table 2. Urinary adiponectin could not discriminate peri- and postmenopausal with and without MetS. The ROC curve of urinary adiponectin was presented in Fig. 2.

Fig. 1
figure 1

The mean urinary adiponectin (ng/mL) among participants without any components of MetS and those with 1–5 components of diagnostic criteria were statistically similar (P = 0.535)

Table 2 Anthropometric measurements and metabolic profile of the participants (N = 290)
Fig. 2
figure 2

ROC curve of urinary adiponectin in the diagnosis of MetS. The area under the curve is 0.516 which represents no diagnostic value of urinary adiponectin for MetS

Urinary adiponectin increased slowly with age after the late postmenopause period (Table 3) but did not change during the menopausal transition (Fig. 3). However, the urinary adiponectin did not significantly correlate with age, R2 = 0.006, P = 0.174 (Fig. 3).

Table 3 Urinary adiponectin stratified by age group (N = 290)
Fig. 3
figure 3

Scattered plot showing urinary adiponectin level slowly increased with the age of participants but not significantly correlated (R2 = 0.006, P = 0.174)

The quality of life in peri- and postmenopausal women with and without Mets were similar across each domain (Table 4). However, the global quality of life was better in participants without MetS than those with MetS.

Table 4 MENQOL among participants (N = 290)

Discussion

Although the urinary adiponectin increased with age, our study failed to find its association with MetS in peri- and postmenopausal women. To the best of our knowledge, this is the first study to explore the potential use of ultrasensitive urinary adiponectin for MetS.

Previous studies explored the use of urinary adiponectin for the screening or early detection of microvascular injury in diabetes mellitus [26, 35], and SLE [36], glomerular injury, and proteinuria in IgA nephropathy [37]. Furthermore, another study found that high urinary adiponectin levels were associated with the severity of arterial stiffness and have a positive correlation with FBG, TG, and blood pressure [38]. In those studies, urinary adiponectin performed quite well to detect the injury of microvasculature or glomerular unit. The advanced progression of the disease and a higher degree of microvascular injury increase the excretion of urinary adiponectin [26, 35,36,37]. The microvascular injury in our cohort (peri- and postmenopausal women with MetS) might be minimal because of the early detection and treatment of MetS before the occurrence of metabolic diseases, and CVD might delay the microvascular injury [39]. Monitoring the changes of urinary adiponectin over the menopausal transition or during the development of MetS until cardiovascular event might help us confirm our hypothesis in the future.

In our participants, urinary adiponectin was not different in the early stage of metabolic disease compared to healthy participants. However, the urinary adiponectin in women with and without MetS might be different in other races where lifestyle, body habitus, and gene expression profile, which need to evaluate in further investigation.

The quality of life in peri- and postmenopausal women with and without MetS in this study were similar in every domain unlike our previous survey [5], where those women with MetS or android body fat distribution pattern performed poorer in the vasomotor and psychological domain. This finding is explained by the age of participants. In this study, women with MetS were significantly older than women without MetS this study while the average age between the two groups was similar in our previous study. The severity of vasomotor symptoms can relieve spontaneously over time without any treatment [40]. In other words, our participants with MetS might pass the early postmenopausal years for a while so they had fewer vasomotor symptoms.

Conclusions

Urinary adiponectin level is not different in the presence of MetS in peri- and postmenopausal women. Further investigation should focus on the other marker that can potentially use as a noninvasive screening test for MetS. The study of urinary adiponectin in peri- and postmenopausal women is still warrant further investigation to see its changes during menopausal transition or the progression of metabolic diseases toward cardiovascular events.

Availability of data and materials

The datasets generated during and/or analyzed during the current study are not publicly available due to informed consent and confidentiality but are available from the corresponding author on reasonable request.

References

  1. Life expectancy at birth, female (years)|Data. https://data.worldbank.org/indicator/SP.DYN.LE00.FE.IN.

  2. Atisook R. Median age of postmenopausal women at out patient unit of Siriraj Hospital. Siriraj Med J. 1995;47:5.

    Google Scholar 

  3. Stachowiak G, Pertynski T, Pertynska-Marczewska M. Metabolic disorders in menopause. Przeglad menopauzalny Menopause Rev. 2015;14(1):59–64.

    Article  Google Scholar 

  4. Cornier MA, Dabelea D, Hernandez TL, Lindstrom RC, Steig AJ, Stob NR, Van Pelt RE, Wang H, Eckel RH. The metabolic syndrome. Endocr Rev. 2008;29(7):777–822.

    Article  CAS  Google Scholar 

  5. Kutheerawong L, Vichinsartvichai P. The influence of body fat distribution patterns and body mass index on MENQOL in women living in an urban area. Climacteric J Int Menopause Soc. 2016;19(1):66–70.

    Article  CAS  Google Scholar 

  6. Heilbronn LK, Campbell LV. Adipose tissue macrophages, low grade inflammation and insulin resistance in human obesity. Curr Pharm Des. 2008;14(12):1225–30.

    Article  CAS  Google Scholar 

  7. Sun S, Ji Y, Kersten S, Qi L. Mechanisms of inflammatory responses in obese adipose tissue. Annu Rev Nutr. 2012;32:261–86.

    Article  CAS  Google Scholar 

  8. Vichinsartvichai P, Sirirat S. Hematologic parameters as the predictors for metabolic syndrome in perimenopausal and postmenopausal women living in urban area: a preliminary report. Przeglad menopauzalny Menopause Rev. 2016;15(2):90–5.

    Article  Google Scholar 

  9. Gordon T, Kannel WB, Hjortland MC, McNamara PM. Menopause and coronary heart disease. The Framingham Study. Ann Intern Med. 1978;89(2):157–61.

    Article  CAS  Google Scholar 

  10. Shuster LT, Rhodes DJ, Gostout BS, Grossardt BR, Rocca WA. Premature menopause or early menopause: long-term health consequences. Maturitas. 2010;65(2):161–6.

    Article  Google Scholar 

  11. Ossewaarde ME, Bots ML, Verbeek AL, Peeters PH, van der Graaf Y, Grobbee DE, van der Schouw YT. Age at menopause, cause-specific mortality and total life expectancy. Epidemiology. 2005;16(4):556–62.

    Article  Google Scholar 

  12. Muka T, Oliver-Williams C, Kunutsor S, Laven JS, Fauser BC, Chowdhury R, Kavousi M, Franco OH. Association of age at onset of menopause and time since onset of menopause with cardiovascular outcomes, intermediate vascular traits, and all-cause mortality: a systematic review and meta-analysis. JAMA Cardiol. 2016;1(7):767–76.

    Article  Google Scholar 

  13. Honigberg MC, Zekavat SM, Aragam K, Finneran P, Klarin D, Bhatt DL, Januzzi JL Jr, Scott NS, Natarajan P. Association of premature natural and surgical menopause with incident cardiovascular disease. JAMA. 2019;322(24):2411–21.

    Article  Google Scholar 

  14. Thurston RC, El Khoudary SR, Sutton-Tyrrell K, Crandall CJ, Gold E, Sternfeld B, Selzer F, Matthews KA. Are vasomotor symptoms associated with alterations in hemostatic and inflammatory markers? Findings from the study of women’s health across the nation. Menopause (New York, NY). 2011;18(10):1044–51.

    Article  Google Scholar 

  15. Franco OH, Muka T, Colpani V, Kunutsor S, Chowdhury S, Chowdhury R, Kavousi M. Vasomotor symptoms in women and cardiovascular risk markers: Systematic review and meta-analysis. Maturitas. 2015;81(3):353–61.

    Article  Google Scholar 

  16. Muka T, Oliver-Williams C, Colpani V, Kunutsor S, Chowdhury S, Chowdhury R, Kavousi M, Franco OH. Association of vasomotor and other menopausal symptoms with risk of cardiovascular disease: a systematic review and meta-analysis. PLoS ONE. 2016;11(6):e0157417.

    Article  Google Scholar 

  17. Biglia N, Cagnacci A, Gambacciani M, Lello S, Maffei S, Nappi RE. Vasomotor symptoms in menopause: a biomarker of cardiovascular disease risk and other chronic diseases? Climacteric J Int Menopause Soc. 2017;20(4):306–12.

    Article  CAS  Google Scholar 

  18. Thurston R, Johnson B, Pepine C, Shufelt C, Reis S, Kelsey S, Bittner V, Stanczyk F, Braunstein G, Berga S, et al. Early-onset menopausal vasomotor symptoms are associated with endothelial dysfunction: the National Heart Lung And Blood Institute-sponsored women’s ischemia syndrome evaluation (wise) study. J Am Coll Cardiol. 2015;65:A1512.

    Article  Google Scholar 

  19. Davison S, Davis SR. New markers for cardiovascular disease risk in women: impact of endogenous estrogen status and exogenous postmenopausal hormone therapy. J Clin Endocrinol Metab. 2003;88(6):2470–8.

    Article  CAS  Google Scholar 

  20. Wattanapol P, Vichinsartvichai P, Sakoonwatanyoo P. Serum adiponectin is a potential biomarker for metabolic syndrome in peri-and postmenopausal women. Gynecol Endocrinol. 2020;36(7):620–5.

    Article  CAS  Google Scholar 

  21. Pulkkinen L, Ukkola O, Kolehmainen M, Uusitupa M. Ghrelin in diabetes and metabolic syndrome. Int J Peptides. 2010;2010:1–11.

    Article  Google Scholar 

  22. Ryo M, Nakamura T, Kihara S, Kumada M, Shibazaki S, Takahashi M, Nagai M, Matsuzawa Y, Funahashi T. Adiponectin as a biomarker of the metabolic syndrome. Circ J. 2004;68(11):975–81.

    Article  CAS  Google Scholar 

  23. Yamauchi T, Kamon J, Ito Y, Tsuchida A, Yokomizo T, Kita S, Sugiyama T, Miyagishi M, Hara K, Tsunoda M, et al. Cloning of adiponectin receptors that mediate antidiabetic metabolic effects. Nature. 2003;423(6941):762–9.

    Article  CAS  Google Scholar 

  24. Hug C, Wang J, Ahmad NS, Bogan JS, Tsao TS, Lodish HF. T-cadherin is a receptor for hexameric and high-molecular-weight forms of Acrp30/adiponectin. Proc Natl Acad Sci USA. 2004;101(28):10308–13.

    Article  CAS  Google Scholar 

  25. Morikawa M, Naito R, Mita K, Watabe S, Nakaishi K, Yoshimura T, Miura T, Hashida S, Ito E. Subattomole detection of adiponectin in urine by ultrasensitive ELISA coupled with thio-NAD cycling. Biophys Physicobiol. 2015;12:79–86.

    Article  CAS  Google Scholar 

  26. von Eynatten M, Liu D, Hock C, Oikonomou D, Baumann M, Allolio B, Korosoglou G, Morcos M, Campean V, Amann K, et al. Urinary adiponectin excretion: a novel marker for vascular damage in type 2 diabetes. Diabetes. 2009;58(9):2093–9.

    Article  Google Scholar 

  27. Harlow SD, Gass M, Hall JE, Lobo R, Maki P, Rebar RW, Sherman S, Sluss PM, de Villiers TJ. Executive summary of the stages of reproductive aging workshop + 10: addressing the unfinished agenda of staging reproductive aging. J Clin Endocrinol Metab. 2012;97(4):1159–68.

    Article  CAS  Google Scholar 

  28. Vichinsartvichai P. Primary ovarian insufficiency associated with autosomal abnormalities: from chromosome to genome-wide and beyond. Menopause (New York, NY). 2016;23(7):806–15.

    Article  Google Scholar 

  29. World Health Organization. Waist circumference and waist–hip ratio. Report of a WHO expert consultation. Geneva: World Health Organization; 2008. p. 5–7.

  30. Thai Health Promotion Foundation. Overweight and obesity patients guideline. Bangkok: Thai Health Promotion Foundation Information Center; 2015.

  31. Pongpatiroj A, Sripramote M, Wanitwanathong K. Effect of hormone replacement therapy on the quality of life in postmenopausal women. Vajira Med J. 2001;45:1–11.

    Google Scholar 

  32. Thermo Fisher Scientific I. Human adiponectin ELISA kit enzyme-linked immunosorbent assay for quantitative detection of human adiponectin. In.

  33. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC Jr. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120(16):1640–5.

    Article  CAS  Google Scholar 

  34. Hajian-Tilaki K. Sample size estimation in diagnostic test studies of biomedical informatics. J Biomed Inform. 2014;48:193–204.

    Article  Google Scholar 

  35. Yamakado S, Cho H, Inada M, Morikawa M, Jiang YH, Saito K, Nakaishi K, Watabe S, Takagi H, Kaneda M, et al. Urinary adiponectin as a new diagnostic index for chronic kidney disease due to diabetic nephropathy. BMJ Open Diabetes Res Care. 2019;7(1):e000661.

    Article  Google Scholar 

  36. Rovin BH, Song H, Hebert LA, Nadasdy T, Nadasdy G, Birmingham DJ, Yung YuC, Nagaraja HN. Plasma, urine, and renal expression of adiponectin in human systemic lupus erythematosus. Kidney Int. 2005;68(4):1825–33.

    Article  CAS  Google Scholar 

  37. Shimotomai T, Kakei M, Narita T, Koshimura J, Hosoba M, Kato M, Komatsuda A, Ito S. Enhanced urinary adiponectin excretion in IgA-nephropathy patients with proteinuria. Ren Fail. 2005;27(3):323–8.

    Article  CAS  Google Scholar 

  38. Jeon WS, Park JW, Lee N, Park SE, Rhee EJ, Lee WY, Oh KW, Park SW, Park CY, Youn BS. Urinary adiponectin concentration is positively associated with micro- and macro-vascular complications. Cardiovasc Diabetol. 2013;12:137.

    Article  Google Scholar 

  39. Czernichow S, Greenfield JR, Galan P, Jellouli F, Safar ME, Blacher J, Hercberg S, Levy BI. Macrovascular and microvascular dysfunction in the metabolic syndrome. Hypertens Res. 2010;33(4):293–7.

    Article  CAS  Google Scholar 

  40. North American Menopause Society. Treatment of menopause-associated vasomotor symptoms: position statement of The North American Menopause Society. Menopause. 2004;11(1):11–33.

Download references

Acknowledgements

The authors would like to thank all lab scientists who work tirelessly until this project is finished, and all the participants who cordially participated in this project even during the peak of the COVID-19 pandemic.

Funding

This study was supported by Navamindradhiraj University Research Fund. The funding source has not been involved in study design, data collection, analysis, interpretation, writing reports, and submission.

Author information

Authors and Affiliations

Authors

Contributions

P.V. designed, analyzed, interpreted data, and contributed to writing the manuscript. R.T. designed, associated with lab results, interpreted data, and contributed to writing manuscript. T.J. designed, interpreted data. P.S. designed, analyzed, interpreted data, and was a major contributor to the laboratory testing. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Patsama Vichinsartvichai.

Ethics declarations

Ethics approval and consent to participate

The study was conducted under the ethical principles of the Declaration of Helsinki, and the study protocol was approved by the Vajira Institutional Review Board. The informed consent was obtained from all subjects.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vichinsartvichai, P., Teeramara, R., Jirasawas, T. et al. Comparison of urinary adiponectin in the presence of metabolic syndrome in peri- and postmenopausal women. BMC Women's Health 22, 70 (2022). https://doi.org/10.1186/s12905-022-01655-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12905-022-01655-8

Keywords