**Author details**

able side effects. Still, the effect of long‐term maintenance of metformin on adiponectin levels in children and adolescents is still unknown, particularly in children; thus, its use should be

In conclusion, adiponectin association with obesity‐related cardiometabolic risk factors, such as IR, dyslipidaemia, atherosclerosis and NAFLD, have been well demonstrated. Interventional studies are good options to tackle obesity and the referred co‐morbidities, pharmacological adjuvants being an option to be considered. The variety of interventional approaches, with different study designs, populations and PE protocol makes the impact of these interventions on inflammatory mediators, and particularly on adiponectin, less clear;

The relation between adiponectin and cardiometabolic risk in children and adolescents is still

Considering the different adiponectin multimers, HMW adiponectin has been associated with a better metabolic control, improving IR, while the LMW multimer presents an opposite effect. The concentrations and the relative percentage of the multimers should be considered

Obesity, and particularly abdominal obesity, is closely associated with lower adiponectin values in paediatric ages. Adiponectin acts as an insulin sensitiser, decreasing as the IR rises. Nevertheless, there might be a negative feedback mechanism, causing a relative decrease in adiponectin as insulin sensitivity improves. Higher adiponectin levels are associated with an improvement in lipid profile, with decreased TG and increased HDLc, being the influence on LDLc more limited. Besides the contribution to a less atherogenic lipid profile, adiponectin further prevents atherosclerosis by a direct positive effect on blood vessels. It reduces the formation of foam cells, macrophage infiltration and activation, and the vascular wall remodelling. Adiponectin is also associated with smaller arterial IMT and increased vessel elasticity, in children. Likewise,

Combining the specific effects of adiponectin in lipid profile, BP and IR, a decrease in this adipokine will induce clustering of several cardiovascular risk factors in OB children and

HMW adiponectin seems to be a better predictor of cardiometabolic risk factors than total adiponectin. An increase in total and HMW adiponectin is achieved following interventional programmes, particularly those involving exercise and diet interventions. Changes in body composition, with reduction of total and central body fat, more than changes in body weight,

The positive effects of adiponectin on general metabolism are not so clear in PP individuals, particularly the improvement in IR. No significant differences are usually observed between

carefully considered [126, 127].

98 Adiposity - Omics and Molecular Understanding

however, a positive effect is almost consistently found.

increased adiponectin is linked to reduced, healthier, BP.

appear to be the key for therapeutic success.

adolescents that predicts cardiometabolic diseases in the future.

**5. Conclusions and final remarks**

as potential markers of CVD risk.

under research.

Henrique Nascimento1 , Susana Coimbra1, 2\*, Carla Rêgo3 , Alice Santos‐Silva1 and Luís Belo1

\*Address all correspondence to: ssn.coimbra@gmail.com

1 UCIBIO\REQUIMTE, Department of Biological Sciences, Laboratory of Biochemistry, Faculty of Pharmacy, University of Porto, Porto, Portugal

2 CESPU, Institute of Research and Advanced Training in Health Sciences and Technologies (IINFACTS), Gandra‐PRD, Portugal

3 Children and Adolescent Centre, CUF Hospital, Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
