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In Reply: I agree with Dr Stefan and colleagues that the study in the EPIC-Potsdam cohort provides additional evidence supporting an association of higher serum fetuin-A level and diabetes risk and extends the observation over a broader age range.¹

Emerging evidence suggests that fetuin-A might also regulate adipogenesis,² and in our study in the Health ABC cohort, higher fetuin-A levels were associated with increased visceral adiposity. Visceral adiposity is increased in older individuals³ and is strongly associated with diabetes risk.⁴ However, in the EPIC-Potsdam study and other studies, older age was associated with lower fetuin-A levels.^{1, 5} These observations lead to several important questions regarding aging and changes in body composition and glucose metabolism and how fetuin-A may be involved in these processes. For example, what promotes hepatic fetuin-A production and secretion into serum, and what factors lead to maintenance of higher fetuin-A levels throughout an individual's life? Do individuals with . . . [Full Text of this Article]

Joachim H. Ix, MD, MAS
joeix@ucsd.edu
Division of Nephrology
Department of Medicine
University of California, San Diego

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