Association of serum zinc levels with the atherogenic index in obese adults
DOI:
https://doi.org/10.18203/2320-6012.ijrms20260219Keywords:
Obesity, BMI, Serum zinc, AIP, Triglycerides, HDL cholesterol, Cardiovascular riskAbstract
Background: Obesity is associated with dyslipidemia and micronutrient imbalances, including altered serum zinc levels. The atherogenic index of plasma (AIP) is an emerging biomarker of cardiovascular risk. This study evaluated the association between serum zinc and AIP in obese adults.
Methods: In this comparative cross-sectional study at Sylhet MAG Osmani Medical College, Bangladesh (July 2022–June 2023), 60 participants were enrolled and divided by body mass index (BMI) according to WHO Asian guidelines: group A (obese, BMI ≥25 kg/m², n=30) and group B (healthy, BMI 18.5–24.9 kg/m², n=30). Serum zinc, triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C) were measured, and AIP was calculated as log₁₀ (TG/HDL-C).
Results: The mean BMI was significantly higher in group A compared to group B (30.13±2.39 versus 21.88±1.87 kg/m²; p<0.001), while age and gender distribution were similar. Group A exhibited higher TG (188.53±36.93 versus 145.30±32.22 mg/dl; p<0.001) and lower HDL-C (39.43±5.93 versus 47.43±7.93 mg/dl; p=0.001). Serum zinc was significantly reduced (10.15±1.03 versus 13.13±1.34 µmol/l; p<0.001), and AIP was higher (0.32 versus 0.12; p<0.001) in obese participants compared to healthy subjects. Regression analyses showed a strong negative correlation between BMI and serum zinc (r=−0.797, p<0.001), a moderate negative correlation with TG (r=−0.591, p<0.001), and a moderate positive correlation with HDL-C (r=0.616, p<0.001).
Conclusion: Obese adults exhibited lower serum zinc levels and elevated AIP. BMI and lipid parameters, particularly TG and HDL-C, significantly predicted serum zinc status, highlighting the interrelationship between obesity, dyslipidemia, and micronutrient deficiency.
Metrics
References
Caruso A, Gelsomino L, Panza S, Accattatis FM, Naimo GD, Barone I, et al. Leptin: a heavyweight player in obesity-related cancers. Biomolecules. 2023;13(7):1084. DOI: https://doi.org/10.3390/biom13071084
NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: pooled analysis of 2416 population-based studies in 128.9 million participants. Lancet. 2017;390(10113):2627-42.
Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults 1980–2013: systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9945):766-81. DOI: https://doi.org/10.1016/S0140-6736(14)60460-8
Wang LY, Denniston M, Lee S, Galuska D, Lowry R. Long-term health and economic impact of preventing and reducing overweight and obesity in adolescence. J Adolesc Health. 2010;46(5):467-73. DOI: https://doi.org/10.1016/j.jadohealth.2009.11.204
Itoh M, Suganami T, Satoh N, Tanimoto-Koyama K, Yuan X, Tanaka M, et al. Increased adiponectin secretion by eicosapentaenoic acid in rodent models of obesity and human obese subjects. Arterioscler Thromb Vasc Biol. 2007;27:1918-25. DOI: https://doi.org/10.1161/ATVBAHA.106.136853
Yamaguchi K, Yang L, McCall S, Huang J, Yu XX, Pandey SK, et al. Inhibiting triglyceride synthesis improves hepatic steatosis but worsens liver damage and fibrosis in obese mice with NASH. Hepatology. 2007;45:1366-74. DOI: https://doi.org/10.1002/hep.21655
Lonardo A, Ballestri S, Marchesini G, Angulo P, Loria P. Nonalcoholic fatty liver disease: a precursor of metabolic syndrome. Dig Liver Dis. 2015;47:181-90. DOI: https://doi.org/10.1016/j.dld.2014.09.020
Ferraro F, Martín M, Verona J, Gilligan L, Verona MF, Botta E, et al. Increased CETP and Lp-PLA2 activities in youth with high TG/HDL-C ratio. Indian J Pediatr. 2021;88(12):1180-6. DOI: https://doi.org/10.1007/s12098-021-03806-5
Dağ H, İncirkuş F, Dikker O. Atherogenic index of plasma and its association with fatty liver in obese adolescents. Children (Basel). 2023;10(4):641. DOI: https://doi.org/10.3390/children10040641
Sapunar J, Aguilar-Farías N, Navarro J, Araneda G, Chandía-Poblete D, Manríquez V, et al. High prevalence of dyslipidemia and atherogenic risk in children and adolescents. Rev Med Chil. 2018;146(10):1112-22. DOI: https://doi.org/10.4067/S0034-98872018001001112
Hussain A, Ali I, Kaleem WA, Yasmeen F. Correlation between BMI and lipid profile in type 2 diabetics. Pak J Med Sci. 2019;35:591-7. DOI: https://doi.org/10.12669/pjms.35.3.7
Niroumand S, Khajedaluee M, Khadem-Rezaiyan M, Abrishami M, Juya M, Khodaee G, et al. Atherogenic index of plasma (AIP): a marker of cardiovascular disease. Med J Islam Repub Iran. 2015;29:627-35.
Millán J, Pintó X, Muñoz A, Zúñiga M, Rubiés-Prat J, Pallardo LF, et al. Lipoprotein ratios: physiological significance and clinical usefulness. Vasc Health Risk Manag. 2009;5:757-65. DOI: https://doi.org/10.2147/VHRM.S6269
Dobiášová M, Frohlich J. The log (TG/HDL-C) index as an atherogenic marker. Clin Biochem. 2001;34:583-8. DOI: https://doi.org/10.1016/S0009-9120(01)00263-6
Yang SH, Du Y, Li XL, Zhang Y, Li S, Xu RX, et al. TG/HDL-C ratio and cardiovascular events in diabetics with CAD. Am J Med Sci. 2017;354:117-24. DOI: https://doi.org/10.1016/j.amjms.2017.03.032
Bora K, Pathak M, Borah P, Hussain MI, Das D. APOA-I polymorphisms and atherogenic indices. Balk J Med Genet. 2017;20:59-69. DOI: https://doi.org/10.1515/bjmg-2017-0002
Afshin A, Forouzanfar MH, Reitsma MB, Sur P, Estep K, Lee A, et al. Health effects of overweight and obesity in 195 countries. N Engl J Med. 2017;377:13-27. DOI: https://doi.org/10.1056/NEJMoa1614362
Nowicki GJ, Cybulska AM, Polak M, Grochans E, Bohatyrewicz R, Blicharska E, et al. Association between anthropometric indices and trace elements. Nutrients. 2025;17(19):3141. DOI: https://doi.org/10.3390/nu17193141
Arbi S, Oberholzer HM, Van Rooy MJ, Venter C, Bester MJ. Effects of mercury and cadmium exposure on coagulation in rats. Ultrastruct Pathol. 2017;41:275-83. DOI: https://doi.org/10.1080/01913123.2017.1327909
Moussavi Javardi MS, Madani Z, Movahedi A, Karandish M, Abbasi B. Dietary fat quality, lipid profile, and AIP in obese and non-obese adults. Lipids Health Dis. 2020;19:213. DOI: https://doi.org/10.1186/s12944-020-01387-4
Wang ZL, Li J, Sun CH, Yin X, Zhi XY, Liu YT, et al. Strong association between AIP and obesity in college students. BMC Endocr Disord. 2025;25:80. DOI: https://doi.org/10.1186/s12902-024-01807-x
Rios-Lugo MJ, Madrigal-Arellano C, Gaytán-Hernández D, Hernández-Mendoza H, Romero-Guzmán ET. Association of serum zinc levels in overweight and obesity. Biol Trace Elem Res. 2020;198(1):51-7. DOI: https://doi.org/10.1007/s12011-020-02060-8
Soskic S, Gluvic Z, Obradovic M, Ilincic B, Cabarkapa V, Stokic E, Isenovic ER. A pilot study on the relationship between zinc deficiency and anthropometric and metabolic parameters in obese adults in Serbia. Scand J Clin Lab Invest. 2025;85(1):51-7. DOI: https://doi.org/10.1080/00365513.2025.2460034
Abdel Gawad MM, Omar OM, Abo Elwafa RA, Mohamed EM. Serum zinc level and its relation to insulin resistance and lipid profile in childhood and adolescent obesity. Egypt J Obes Diabetes Endocrinol. 2017;3(2). DOI: https://doi.org/10.4103/ejode.ejode_6_17
Zaky DSE, Sultan EA, Salim MF, et al. Zinc level and obesity. Egypt J Intern Med. 2013;25:209-12. DOI: https://doi.org/10.4103/1110-7782.124985
Karadağ MK, Yıldırım E. AIP and mean platelet volume in ischemic and nonischemic heart failure. Biomark Med. 2019;13(3):175-83. DOI: https://doi.org/10.2217/bmm-2018-0196
Cure E, Icli A, Uslu AU, Sakiz D, Cure MC, Baykara RA, et al. AIP as a marker of subclinical atherosclerosis in ankylosing spondylitis. Clin Rheumatol. 2018;37(5):1273-80. DOI: https://doi.org/10.1007/s10067-018-4027-0
Won KB, Heo R, Park HB, Lee BK, Lin FY, Hadamitzky M, et al. AIP and progression of coronary atherosclerosis. Atherosclerosis. 2021;324:46-51. DOI: https://doi.org/10.1016/j.atherosclerosis.2021.03.009
Khosravi A, Sadeghi M, Farsani ES, Danesh M, Heshmat-Ghahdarijani K, Roohafza H, et al. AIP as a novel index for unstable coronary plaques. J Res Med Sci. 2022;27:45. DOI: https://doi.org/10.4103/jrms.jrms_590_21
Zhang JS, Yeh WC, Tsai YW, Chen JY. AIP and obesity among adults in Taiwan. Int J Environ Res Public Health. 2022;19(22):14864. DOI: https://doi.org/10.3390/ijerph192214864
Zhu X, Yu L, Zhou H, Ma Q, Zhou X, Lei T, et al. AIP as a better biomarker associated with obesity in China. Lipids Health Dis. 2018;17(1):37. DOI: https://doi.org/10.1186/s12944-018-0686-8
Vekic J, Zeljkovic A, Stefanovic A, Jelic-Ivanovic Z, Spasojevic-Kalimanovska V. Obesity and dyslipidemia. Metabolism. 2019;92:71-81. DOI: https://doi.org/10.1016/j.metabol.2018.11.005
Zeljkovic A, Vekic J, Mihajlovic M, Gojkovic T, Vladimirov S, Zeljkovic D, et al. Role of HDL in colorectal cancer. Int J Mol Sci. 2021;22(7):3352. DOI: https://doi.org/10.3390/ijms22073352
Eslami O, Shahraki M, Shahraki T. Obesity indices and lipid abnormalities among university students. Int J Prev Med. 2019;10:15. DOI: https://doi.org/10.4103/ijpvm.IJPVM_177_17
Amini S, Shirali S, Jafarirad S, Ehsani H, Mohseni H, Bargard M. Lipids, BMI, waist circumference, BP in depressed elderly vs. healthy subjects. Int J Prev Med. 2019;10:185. DOI: https://doi.org/10.4103/ijpvm.IJPVM_372_17
Cui R, Qi Z, Zhou L, Li Z, Li Q, Zhang J. Lipid profile and BMI in type 2 diabetes patients in China. Clin Interv Aging. 2016;11:445-52.
Ezeukwu AO, Agwubike EO. Anthropometric adiposity measures and AIP in non-obese Nigerian males. Libyan J Med. 2014;9. DOI: https://doi.org/10.3402/ljm.v9.23798
Wu TT, Gao Y, Zheng YY, Ma YT, Xie X. AIP as a predictor of CAD in postmenopausal women. Lipids Health Dis. 2018;17:197. DOI: https://doi.org/10.1186/s12944-018-0828-z
Bo MS, Cheah WL, Lwin S, Moe Nwe T, Win TT, Aung M. Relationship between AIP and CVD risk factors in Malaysian university staff. J Nutr Metab. 2018;2018:7027624. DOI: https://doi.org/10.1155/2018/7027624
Downloads
Published
How to Cite
Issue
Section
