based on recent basic and clinical studies , it has been shown that adipocytokines may contribute to the induction of carcinogens and progression of tumors ( 1 ) . 
 

visfatin was initially recognized as a growth factor for proliferation of b - cell lymphocyte , called the pre - b cell colony - enhancing factor .
subsequently , it was found as a cytokine present in a variety of cells and tissues with metabolic and inflammatory effect .
visfatin have also been shown to correlate with pro - inflammatory cytokines such as il-1 , il-6 , and tnf . it stimulates il-6 and il-8 and may be associated with oxidative stress parameters .
modulation of insulin by binding to the insulin receptor is another recognized function for visfatin ( 2,3 ) . 
 

previously , we reported the levels of various adipocytokines in patients with colorectal cancer and we found a significant increase in the visfatin serum level in colorectal cancer patients comparing to controls ( 4 ) .
therefore , we examined if this cytokine increases in patients with colorectal adenoma as a precursor of colorectal cancer .
to the best of our knowledge , in addition to a previous study done by nakajima et al .
( 1 ) , the present study is among the first reports to evaluate the visfatin level in patients with colorectal adenoma comparing to healthy controls . 


 this case - control study was conducted at the department of surgery of imam medical complex affiliated to tehran university of medical sciences . between january 2014 and june 2015
, a total of 34 patients diagnosed with colorectal adenoma and 35 disease - free controls were included in case and control groups , respectively .
patients with a previous history of any colorectal disease including polyps , adenoma , irritable bowel disease or cancerous lesion were excluded from the study .
disease - free controls were selected from participants in the persian gulf healthy heart study ( 5 ) .
this study was carried out between march 2013 and march 2015 in colorectal surgery department of tehran university of medical sciences .
all the patients were informed about the study and written informed consent was taken from each patient . 
 
 for each patient , systolic and
body mass index ( bmi ) and waist - to - hip ratio ( whr ) were calculated after measuring height , weight , waist circumference ( midway level between the costal margins and the iliac crests ) and hip circumference ( at the level of the greater trochanters ) . in order to measure serum markers ,
fasting venous blood samples were obtained from all patients and the disease - free controls .
serum biochemical parameters including blood glucose , triglyceride , and cholesterol levels were measured on the day of sampling using selectra 2 autoanalyzer ( vital scientific , spankeren , netherlands ) .
serum cholesterol ( hdl and total ) and triglyceride levels were measured using cholesterol oxidase / phenol aminoantipyrine and glycerol-3-phosphate oxidase phenol aminoantipyrine enzymatic methods , respectively . in cases with triglycerides level of less than 400 mg / dl , serum ldl was calculated using the friedewald formula .
enzyme - linked immunosorbent assay kits ( adipogen , seoul , korea ) were utilized in order to measure visfatin levels .
the assay sensitivity for visfatin was 0.10 ng / ml ; the intra- and inter - assay coefficients of variance were 3.85.5% and 6.49.5% , respectively . 
 

descriptive values were expressed as the mean  sd . in order to compare visfatin levels between groups a two - tailed t - test was considered .
pearson s correlation was also used to assess the relationship between visfatin levels and other measured variables .

 this case - control study was conducted at the department of surgery of imam medical complex affiliated to tehran university of medical sciences . between january 2014 and june 2015
, a total of 34 patients diagnosed with colorectal adenoma and 35 disease - free controls were included in case and control groups , respectively .
patients with a previous history of any colorectal disease including polyps , adenoma , irritable bowel disease or cancerous lesion were excluded from the study .
disease - free controls were selected from participants in the persian gulf healthy heart study ( 5 ) .
this study was carried out between march 2013 and march 2015 in colorectal surgery department of tehran university of medical sciences .
all the patients were informed about the study and written informed consent was taken from each patient . 
 
 for each patient , systolic and
body mass index ( bmi ) and waist - to - hip ratio ( whr ) were calculated after measuring height , weight , waist circumference ( midway level between the costal margins and the iliac crests ) and hip circumference ( at the level of the greater trochanters ) . in order to measure serum markers ,
fasting venous blood samples were obtained from all patients and the disease - free controls .
serum biochemical parameters including blood glucose , triglyceride , and cholesterol levels were measured on the day of sampling using selectra 2 autoanalyzer ( vital scientific , spankeren , netherlands ) .
serum cholesterol ( hdl and total ) and triglyceride levels were measured using cholesterol oxidase / phenol aminoantipyrine and glycerol-3-phosphate oxidase phenol aminoantipyrine enzymatic methods , respectively . in cases with triglycerides level of less than 400 mg / dl , serum ldl was calculated using the friedewald formula .
enzyme - linked immunosorbent assay kits ( adipogen , seoul , korea ) were utilized in order to measure visfatin levels .
the assay sensitivity for visfatin was 0.10 ng / ml ; the intra- and inter - assay coefficients of variance were 3.85.5% and 6.49.5% , respectively . 

descriptive values were expressed as the mean  sd . in order to compare visfatin levels between groups a two - tailed t - test was considered .
pearson s correlation was also used to assess the relationship between visfatin levels and other measured variables .

 in this study a total of 69 cases including 34 patients with colorectal adenoma and 35 disease - free controls were enrolled .
patients included 18 males ( 53% ) and 16 females ( 47% ) and controls were 18 male ( 51% ) and 17 female ( 49% ) . patients and controls were also matched regarding their age as well .
demographic information of both groups and other studied variables including systolic and diastolic blood pressures , body mass index ( bmi ) , waist to hip ratio and lipid profile of patients have been summarized in table 1 . as can be seen in table 1
, there was no significant statistical difference among the patients and the controls in terms of these variables ( p>0.05 in all comparisons ) . 
 

* p < 0.05 were considered significant . 
 
 * * two - tailed t - test was used to compare visfatin levels between groups .
pearson s correlation was used to evaluate the relationship between visfatin levels and other measured variables . 
 

meansd of visfatin levels in male and female patients were 6.33.01ng / ml and 7.13.05ng / ml , respectively . the visfatin level in the control group was 7.22.41ng / ml and 6.42.59ng / ml for males and females , respectively
. moreover , there was no significant difference in terms of the visfatin level between both gender in each group ( p=0.482 for patients and p=0.375 for controls ) .
we also tried to analyze any possible correlation between the visfatin levels and each of the mentioned studied variables . except for a significant correlation between the bmi value and visfatin level ( p=0.041 ) ,
visfatin levels were analyzed separately based on the location of the adenoma within the large intestine in the patient group ( table 2 ) .
we found no significant difference between the levels of visfatin in each location comparing the healthy controls ( p>0.05 in all comparisons ) .
there was no statistical difference between the locations groups in terms of visfatin level as well ( p=0.068 ) . 
 

* values show possible differences between visfatin levels of patients suffering from adenoma in each part of colon or rectum comparing to the control levels . 


 visfatin can be found in significant amounts in adipose tissue and it is produced primarily by visceral adipose tissue .
therefore , visfatin serum levels may be affected by a change in body weight and relationship between obesity , bmi and serum levels of visfatin has also been documented ( 2,6 ) .
although the visfatin level had a significant relation with the bmi value in our adenoma patients , we found no statistical significant relation in the healthy controls . 
 

metabolic syndrome is a group of harmful metabolic abnormalities , including visceral obesity , hyperglycemia , dyslipidemia , and hypertension .
increased circulating visfatin levels have also been found in patients with metabolic syndrome ( 7,8 ) .
therefore , we tried to depict any relation between visfatin level and metabolic abnormalities involved in metabolic syndrome in patients with colorectal adenoma .
although we found a significant relation between the visfatin level and bmi of patients , we did not detect any relation for hyperglycemia , hypertension ( systolic and diastolic ) and dyslipidemia ( hyper cholesterolemia or hypertriglyceridemia ) . 
 

sigmoid ( 13 patients , 38.2% ) and rectum ( 13 patients , 38.2% ) were the most common site followed by ascending colon ( 6 patients , 17.6% ) . ascending ( 3.923.25 ng / ml ) and transverse colon ( 8.551.34 ng / ml ) had the lowest and highest mean serum levels of visfatin , respectively .
nevertheless , our analysis revealed no significant difference between these levels and the value for the visfatin level in normal controls .
nakajima et al . ( 1 ) analyzed the possible relations between the size and number of colorectal adenomas and some adipocytokines including the visfatin .
they found that except for adiponection , other cytokines including the visfatin has no relation with these two factors .
consequently , according to this study and our findings , it seems that size , number and location of colorectal adenoma are not influential factors affects the adipocytokine levels . 
 

low number of cases was the major limitation in our study . designing another study with higher number of patients

 although visfatin level has been shown to be increased in serums of patients with colorectal cancer , it does not significantly increase in cases with colorectal adenoma .
site of adenoma within the colon or rectum does not seem to play an important role in this regard as well . 

 
 background : visfatin is an adipocytokine secreted by visceral adipose tissue . it has been shown 
 that adipocytokines may contribute to the induction of carcinogens and progression of tumors . previously , 
 we found a significant increase in the visfatin serum level in colorectal cancer patients . 
 herein , 
 we investigated if this cytokine increases in patients with colorectal adenoma as a precursor of 
 colorectal cancer . 

 
 methods : in this case - control analytic study , a total of 34 patients diagnosed with colorectal adenoma 
 and 35 disease - free controls were included . 
 adenomas were also categorized based on their 
 location within the colon . 
 visfatin serum levels were measured in all cases and controls using enzyme- 
 linked immunosorbent assay kits . in order to compare visfatin levels between groups a twotailed 
 t - test was considered . 
 pearson correlation was also used to assess the relationship between 
 visfatin levels and other measured variables . 

 
 results : patients included 18 male ( 53% ) and 16 female ( 47% ) with a meansd age of 48.310.96 
 years and controls were 18 male ( 51% ) and 17 female ( 49% ) with a meansd age of 51.612.52 
 years . there were no significant difference in terms of the visfatin level between the two groups 
 ( 6.73.01 ng / ml for patients and 6.82.49 ng / ml for controls , p>0.05 ) . except for a significant correlation 
 between the bmi and visfatin level ( p=0.041 ) , no other correlation was detected . 
 we found no 
 significant difference between the levels of visfatin in each location of adenoma comparing the 
 healthy controls ( p>0.05 in all comparisons ) . 
 there was no statistical difference between the locations 
 groups in terms of visfatin level as well ( p>0.05 ) . 

 
 conclusion : visfatin serum level does not significantly increase in patients with colorectal adenoma . 
 site of adenoma within the colon or rectum does not seem to play an important role in this regard 
 as well . 
 