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Adipose Tissue and Endocrine Function in Critical Care

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Diet and Nutrition in Critical Care

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Abstract

In addition to energy storage and insulation, the white adipose tissue is a complex endocrine organ responsible for the secretion of a high number of adipocyte-originated signaling molecules. These so-called adipokines are involved in the control of metabolism, linking the nutrient status to the tissues involved in energy intake and expenditure and affecting insulin sensitivity. Additionally, resident and recruited macrophages constitute an important part of the adipose tissue, responsible for the secretion of inflammatory and anti-inflammatory cytokines. Up until now, more than 40 different adipokines have been described. From these, leptin and adiponectin are the most studied during critical illness.

Although knowledge is still limited, current available literature suggests that the endocrine functions of adipose tissue might play an adaptive role during critical illness. In the acute phase of illness, the anti-inflammatory and insulin-sensitizing adiponectin is reduced, while pro-inflammatory cytokine expression in adipose tissue is upregulated. In the prolonged phase of critical illness, both adiponectin and anti-inflammatory cytokine production are increasing. Reports on the pro-inflammatory leptin during critical illness are controversial in both humans and animal investigations, possibly due to confounders such as gender, body mass index, and nutritional strategy.

Observational studies report lower mortality in obese than in lean critically ill patients, an association referred to as the “obesity paradox.” Potentially, the altered adipokine secretion profile observed in obesity plays a protective role during critical illness.

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Abbreviations

AdipoR:

Adiponectin receptor

ARDS:

Acute respiratory distress syndrome

CXCL10:

C-X-C motif chemokine 10

EMR1:

EGF-like module-containing mucin-like hormone receptor

HMW:

High molecular weight

IL:

Interleukin

kDa:

Kilodalton

LMW:

Low molecular weight

LPS:

Lipopolysaccharide

MCP-1:

Monocyte chemoattractant protein-1

MMW:

Medium molecular weight

PAI-1:

Plasminogen activator inhibitor-1

PPARγ:

Peroxisome proliferator-activated receptor γ

RBP4:

Retinol-binding protein 4

ROS:

Reactive oxygen species

TNF-α:

Tumor necrosis factor-alpha

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Authors and Affiliations

  1. Department of Cellular and Molecular Medicine, University of Leuven (KU Leuven), Laboratory of Intensive Care Medicine, Herestraat 49, bus 503, Leuven, Belgium

    Mirna Marques & Lies Langouche

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  1. Mirna Marques
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  2. Lies Langouche
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Correspondence to Lies Langouche .

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Editors and Affiliations

  1. Department of Nutrition, King's College London, London, United Kingdom

    Rajkumar Rajendram

  2. School of Medicine, King's College London, London, United Kingdom

    Victor R. Preedy

  3. Department of Biomedical Sciences, University of Westminster, London, United Kingdom

    Vinood B. Patel

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Marques, M., Langouche, L. (2014). Adipose Tissue and Endocrine Function in Critical Care. In: Rajendram, R., Preedy, V., Patel, V. (eds) Diet and Nutrition in Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8503-2_28-1

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