256 © 2025 The Author(s). Published by College of Education for Pure Science (Ibn Al-Haitham), University of Baghdad. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License Measurement of Some Biochemical Parameters in Metabolic Syndrome Suhair Abdul-Raheem Ahmed 1 and Israa Fadhil Ascar 2* 1,2 Department of Chemistry, College of Science for Women, University of Baghdad, Baghdad, Iraq. *Corresponding Author. Received: 32 September 2023 Accepted : 2 January 2024 Published: 20 July 2025 doi.org/10.30526/38.3.3750 Abstract Patients with diabetes, high blood pressure (BP), and obesity have metabolic syndrome (MetS). The study aims to evaluate the levels of obestatin and osteopontin (OPN) as markers for detecting MetS and their relationship with other biomarker parameters at Al-Yarmuk Teaching Hospital in Baghdad. A total of 165 patients (125 with MetS and 40 healthy subjects as a control group) whose ages ranged from 20 to 80 years were examined and participated in this study. Body mass index (BMI), BP, fasting serum glucose (FSG), liver enzymes, total protein, and serum lipid profile were evaluated in each patient and control. In addition, obestatin and OPN were used with commercial ELISA kits according to the manufacturer's instructions. The study's results showed significant differences (p < 0.05) in BMI, BP, FSG, liver enzymes, and lipid profile between the MetS and control groups. The levels of obestatin were notably decreased in the MetS group compared to the control group (280.8 pg/mL vs. 1082.1 pg/mL). The level of OPN in patients was significantly higher than in controls (17.96 ng/mL vs. 5.47 ng/mL), respectively. The receiver operating characteristic (ROC) curve tests for obestatin and OPN are 0.981 and 0.999, respectively, which indicate that Obestatin and OPN are considered good diagnostic markers for subjects with MetS. It can be proposed that decreased levels of obestatin and increased levels of OPN in obese individuals may contribute to the onset of MetS and disrupted lipoprotein metabolism. Keywords: Lipid profile, Liver enzymes, Metabolic syndrome, Obestatin, Osteopontin. 1. Introduction Metabolic syndrome (MetS), also known as insulin resistance (IR) syndrome or syndrome X, is a group of characteristics that together increase the risk of type 2 diabetes mellitus (T2DM) and heart disease. These characteristics include obesity, high blood pressure (BP), elevated blood sugar levels, and high triglycerides (TG). Controlling weight, blood sugar levels, total cholesterol (TC), and TG levels can help extend life and reduce the risk of heart attacks and strokes (1). A significant waist circumference or an "apple-shaped" body, and elevated BP, they are diagnosed with hypertension. They are currently experiencing MetS (2). The underlying factors contributing to MetS include obesity, IR, physical inactivity, genetic predisposition, and advancing age (3,4). A peptide hormone called obestatin is a 23- amino acid peptide and is secreted from the stomach and acts in the spleen, intestine, breast https://orcid.org/0009-0001-4966-0160 mailto:Sohair.Abd2305m@csw.uobaghdad.edu.iq https://orcid.org/0000-0002-0793-6659 mailto:israafa_chem@csw.uobaghdad.edu.iq https://orcid.org/0009-0001-4966-0160 mailto:Sohair.Abd2305m@csw.uobaghdad.edu.iq https://orcid.org/0000-0002-0793-6659 mailto:israafa_chem@csw.uobaghdad.edu.iq https://orcid.org/0009-0001-4966-0160 mailto:Sohair.Abd2305m@csw.uobaghdad.edu.iq https://orcid.org/0000-0002-0793-6659 mailto:israafa_chem@csw.uobaghdad.edu.iq https://orcid.org/0009-0001-4966-0160 mailto:Sohair.Abd2305m@csw.uobaghdad.edu.iq https://orcid.org/0000-0002-0793-6659 mailto:israafa_chem@csw.uobaghdad.edu.iq https://orcid.org/0009-0001-4966-0160 mailto:Sohair.Abd2305m@csw.uobaghdad.edu.iq https://orcid.org/0000-0002-0793-6659 mailto:israafa_chem@csw.uobaghdad.edu.iq https://orcid.org/0009-0001-4966-0160 mailto:Sohair.Abd2305m@csw.uobaghdad.edu.iq https://orcid.org/0000-0002-0793-6659 mailto:israafa_chem@csw.uobaghdad.edu.iq IHJPAS. 2025, 38(3) 257 milk, mammary gland, as well as plasma (5). It was first discovered to interact with the orphan receptor GPR39, a receptor related to the ghrelin receptor subfamily, and is associated with weight gain, decreased food intake, gastric emptying, and reduced intestinal motility (6). It can be considered a significant indicator of an individual's nutritional status, providing insights into the presence of obesity and IR (7). Due to its considerable cardiovascular disease (CVD) as well as metabolic effects, obestatin is regarded as a promising therapeutic target for managing obesity in patients, particularly those with diabetes. Additionally, large amounts of these peptides are excreted in both fat- and lean-forms. Adipose tissue in overweight patients releases factors that promote angiogenesis (8). Furthermore, it has been demonstrated that obestatin not only upregulates genes related to β-cell regeneration, insulin production, and lipogenesis but also accelerates lipogenesis, increases β-cell mass, and improves lipid metabolism (9). Moreover, there is a frequent inverse correlation between circulating levels of obestatin in humans and the presence of obesity and DM. Additionally, studies have demonstrated that this peptide exhibits protective metabolic effects in diabetes models, indicating its potential therapeutic value in this context (10). Detailed analysis using NMR and circular dichroism spectroscopy revealed that human and mouse obestatin, as well as human obestatin fragments: (6-23), (11-23), and (16-23), all adopt α-helical secondary structure. Although their order is different, their structures are distinct (11). The human obestatin gene is located on chromosome 3 (3p25-26) and was initially thought to consist of four exons (12); however, further studies identified additional upstream exons (13). Osteopontin (OPN) is a glycosylated and hyperphosphorylated protein that was initially discovered in bone tissue and has also been identified in eggshells (14). The entity in question is a negatively charged structure, consisting of three hundred amino acids and featuring a cell-binding sequence composed of arginine, glycine, and aspartate. The specific location can be found on the long arm of chromosome 4, within the 4q13 region. The OPN protein is an acidic glycoprotein with a molecular weight of 34 kDa. Following its secretion from cells, it undergoes post-translational modifications, resulting in a molecular weight ranging from 44 to 75 kDa in various mammalian cells (15). The stromal cell protein serves as a mediator for various biological functions. It plays a role in regular physiological functions. It has been linked to the development of different disease conditions, such as atherosclerosis, cancer, glomerulonephritis, as well as several chronic inflammatory disorders (16). This study aims to examine the correlation between serum levels of obestatin and OPN in patients with MetS. 2. Materials and Methods This study recruited 125 patients with a clinical diagnosis of MetS and 40 healthy volunteers aged 20-80 years from December 2022 to May 2023 at Al-Yarmuk Teaching Hospital in Baghdad. Blood samples were collected from 40 healthy individuals and 125 patients with MetS. Blood samples were obtained in sterile gel tubes and centrifuged at 1000 x g for 15 minutes. A small aliquot of the obtained serum was then isolated and stored at - 20°C until the analysis time to measure biomarker parameters. The height and weight of each subject were measured, and then used to calculate the body mass index (BMI) in kilograms per square meter (kg/m²) according to the following equation: BMI = Mass / (Height)². Systolic and diastolic BP (SBP and DBP) respectively, fasting serum glucose (FSG), liver enzyme [alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) in U/L units], total protein in g/dL units, and lipid profile test including: IHJPAS. 2025, 38(3) 258 TC, TG, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), and very low density lipoprotein (VLDL) using (Linear, Spain) kits were measured for each patient and control. Determination of obestatin and OPN levels was performed using commercial ELISA kits according to the manufacturer's recommendations, USA. 2.1. Statistical analysis Data were expressed as median (25 th and 75 th percentiles) for irregularly distributed numerical variables. The Mann-Whitney test was used to describe numerical variables that were not normally distributed. The significance level was set at a p-value of 0.05, using receiver operating characteristic (ROC) curve analysis; obestatin and OPN cut-off values were assessed. 3. Results As shown in Table (1), there were no notable changes in age. However, significant differences in BMI were observed among the study groups. Table 1. The demographic characteristics of MetS and controls p-value Control (n= 40) MetS (n= 125) Variables N.S 49.5 (61-35.00) 53 (68-42.00) Age (Year) 0.001 20.00 (22 -19) 39.5 (44.50- 35.42) BMI (kg/m 2 ) 0.001 12.00 (12 -12) 16 (16-15) SBP (mmHg) 0.001 8 (8 -8) 9 (9.50-9.00) DBP (mmHg) *The collected data were analyzed by median (25 th and 75 th percentiles) via the man Whitney test at the 0.05 level. Findings showed a significant difference in BMI between the MetS group (39.5 kg/m²) and the control group (20 kg/m²), but not between the ages of the two groups (53 and 49.5 years, respectively). Also, SBP and DBP were 16 mmHg and 9 mmHg, respectively, for the MetS group (p = 0.001). The results in Table (2) show that the FSG for MetS was 117 mg/dL, which was significantly different (p= 0.001) from that of the control group, 99 mg/dL. There were significant differences (p= 0.001) in the levels of ALT, AST, and ALP in the MetS group, which were recorded as 38.6, 36.4, and 83.4 U/L, compared to 29.8, 28.9, and 70.6 U/L in the healthy control group. The exception was total protein, which was slightly higher in the healthy group (6.20 g/dL) than in the MetS group (5.89 g/dL). Table 2. Serum glucose, liver enzymes, and total proteins levels of MetS and control group Variables MetS (n= 125) Control (n= 40) p-value FSG (mg/dL) 117 (136-101) 99 (104-96) 0.001 ALT(U/L) 38.60 (42.38-32.55) 29.80 (39.55-22.65) 0.001 AST(U/L) 36.40(42.00-31.00) 28.90 (37.35-21.95) 0.001 ALP (U/L) 83.40(90.65-74.63) 70.60 (90.85-59.75) 0.001 Total protein (g/dL) 5.89(6.04-5.49) 6.20 (6.64-6.04) 0.001 FSG: Fasting serum glucose, ALT: Alanine aminotransferase, AST: Aspartate aminotransferase, ALP: alkaline phosphatase The serum lipid profile results for patients and healthy groups are shown in Table (3). There were significant differences (p= 0.001) between the MetS group and the control group regarding serum cholesterol, TG, LDL-C, and VLDL. While HDL-C was significantly IHJPAS. 2025, 38(3) 259 decreased (p=0.001) in the MetS group compared to the healthy group. Table 3. Serum lipid profile of MetS and control group p-value Control (n= 40) MetS (n= 125) Variables 0.001 151.00 (158-135) 237.00 (257.00-229.00) Cholesterol (mg/dL) 0.001 111.00 (145.00-97.00) 282.00 (304.00-265.50) TG (mg/dL) 0.001 47.5 (48.50-4600) 29 (30.50-27.50) HDL-C (mg/dL) 0.001 72.00 (86.00-64.00) 150.00(168.00-142.00) LDL-C (mg/dL) 0.001 23.50(31.50-20.00) 56.00(60.00-53.00) VLDL (mg/dL) *The collected data were analyzed by median at the p < 0.05 level. TG: Triglycerides: LDL-C: Low-density lipoprotein cholesterol, HDL-C: High-density lipoprotein cholesterol, VLDL: Very low-density lipoprotein. The results of Table (4) and Figure (1) showed a significant (p= 0.001) decrease in obestatin level in the MetS group (280.82 pg/mL) compared to the control group (1082.1 pg/mL). While the OPN level was significantly (p= 0.001) higher in the MetS group (17.96 ng/mL) as compared to the healthy control group (5.47 ng/mL), as shown in Figure (2). The ROC test results for the obestatin levels demonstrated ideal cut-off values, with a sensitivity of 97.58% and a specificity of 100.00%. The area under the curve (AUC) was calculated to be 0.981, indicating a high level of accuracy in diagnosing the condition (Figure 3). Similarly, the OPN levels exhibited a sensitivity of 98.39% and a specificity of 100.00%, with an AUC of 0.999 (Figure 4). These findings suggest that both obestatin and OPN are reliable diagnostic factors. The cut-off value for the obestatin level was determined to be ≤ 577.871, while for the OPN level it was > 6.974. Values below these thresholds are indicative of patients with the condition being tested. Table 4. Serum obestatin and OPN of MetS and control group p-value Control (n= 40) MetS (n= 125) Variables 0.001 1082.10 (1305.66-720.79) 280.82 (441.89-174.90) Obestatin (pg/mL) 0.001 5.47(5.68-5.15) 17.96 (20.74- 10.00) OPN (ng/mL) The collected data were analyzed by the median at the p < 0.05 level. OPN: Osteopontin. Figure 1. Median serum obestatin of MetS and control group IHJPAS. 2025, 38(3) 260 Figure 2. Median serum OPN of MetS and control group. Figure 3. The ROC curve of obestatin. Figure 4. The ROC curve of OPN 4. Discussion It has been proposed that MetS is a result of a complicated interplay between hereditary and environmental variables. Distress's pathophysiological causes important changes in metabolic processes. Numerous chronic disorders, including hypertension, chronic inflammation, oxidative stress, and hypertriglyceridemia, have been linked to these changes. Concern for T2DM risk factors ,i.e., obesity, IR, and fatty liver will arise from disruption of 0 20 40 60 80 100 Obestatin_pg_ml_ 0 20 40 60 80 100 100-Specificity Se ns itiv ity AUC = 0.981 P < 0.001 Sensitivity: 97.6 Specificity: 100.0 Criterion: ≤577.871 0 20 40 60 80 100 Osteopontin_ng_ml_ 0 20 40 60 80 100 100-Specificity Se ns iti vi ty AUC = 0.999 P < 0.001 Sensitivity: 98.4 Specificity: 100.0 Criterion: >6.974 IHJPAS. 2025, 38(3) 261 cellular metabolic pathways, commonly known as MetS, which is particularly caused by abnormalities in carbohydrate metabolism (17,18). A person's BMI, serves as a measure of overall health and is often associated with metabolic disease (19). This result is consistent with previous research (20), which found that the patient group had a BMI of 27.5 kg/m 2 , while the control group had a BMI of 22.6 kg/m 2 . The hypertension is a serious health risk factor with disproportionate prevalence in emerging countries, contributing to increased mortality in both developed and developing countries globally (21). Due to changed lipid excretion, metabolic illnesses, and disorders, BP is intimately related to metabolic alterations and occurs in obesity (22), which is in a greement with previous study (23). So, it found an association between MetS and hypertension. A straightforward equation may be used to determine how metabolism is directly impacted by IR and how much more VLDL is produced (24). The liver excretes VLDL, which prevents the apolipoprotein B protein from being broken down and raises TG levels. When lipoprotein lipase secretion is reduced due to a high proportion of VLDL, the ratio of TG is seen to rise as the body fills with these particles. Low-density lipoprotein cholesterol counts sharply increase, offsetting a startling decline in HDL-C values (25, 26). It has been confirmed that individuals with MetS exhibit significantly elevated liver enzyme levels compared to healthy individuals. This finding further strengthens the association between liver enzymes and the risk of developing MetS. This result is consistent with the results of the literature (27), which confirmed that the liver enzyme levels in patients with metabolic syndrome were much higher than those in healthy people, further confirming the link between liver enzymes and MetS risk.Patients with MetS are at high risk for CVD and have elevated TG levels in addition to elevated LDL-C. They also have low HDL-C levels and large numbers of small, dense LDL (sd-LDL) particles (28). The obestatin is an appetite-suppressing hormone that reduces food intake and delays gastrointestinal motility, thereby preventing weight gain (29). This result is agreed with results of (30), who found that the serum level of obestatin was lower significantly in Mets patients as compared to the controls. While OPN is a versatile protein that plays a crucial role in the regulation of inflammatory processes, which have been implicated in the pathogenesis of atherosclerosis and MetS (31). This result is consistent with that of (32), who found elevated expression of OPN in obese individuals compared with healthy controls.The OPN levels are thought to be elevated in obesity-related diseases, suggesting that OPN may affect lipid absorption and metabolism (33). The ROC analysis, is a curve showing the discriminative power of a dual classifier as a function of the discriminative threshold (34). Results obtained from the ROC analysis suggest that these parameters are considered good diagnostic markers for MetS. 5. Conclusion The results of this study indicate that alterations in metabolic status may impact the concentrations of serum obestatin and OPN. Hence, assessing this parameter can provide valuable insights into the diagnosis of MetS and the dysregulation of lipoprotein metabolism in individuals with obesity. Acknowledgment The authors thank the medical staff at Al-Yarmuk Teaching Hospital in Baghdad for their assistance in completing this work. IHJPAS. 2025, 38(3) 262 Conflict of Interest The authors declare that they have no conflicts of interest. Funding None. Ethical Clearance This research was approved by the Scientific Committee in College of Science for Women, and this is consistent with the instructions of the Iraqi Ministry of Health and Environment. A verbal agreement was obtained from each person included in the survey on December 13, 2022. References 1. Stetic L, Belcic I, Sporis G, Stetic L, Starcevic N. 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