"Deficiency in ELF4, X-Linked": a Monogenic Disease Entity Resembling Behçet's Syndrome and Inflammatory Bowel Disease.

Defining monogenic drivers of autoinflammatory syndromes elucidates mechanisms of disease in patients with these inborn errors of immunity and can facilitate targeted therapeutic interventions. Here, we describe a cohort of patients with a Behçet's- and inflammatory bowel disease (IBD)-like disorder termed "deficiency in ELF4, X-linked" (DEX) affecting males with loss-of-function variants in the ELF4 transcription factor gene located on the X chromosome. An international cohort of fourteen DEX patients was assessed to identify unifying clinical manifestations and diagnostic criteria as well as collate findings informing therapeutic responses. DEX patients exhibit a heterogeneous clinical phenotype including weight loss, oral and gastrointestinal aphthous ulcers, fevers, skin inflammation, gastrointestinal symptoms, arthritis, arthralgia, and myalgia, with findings of increased inflammatory markers, anemia, neutrophilic leukocytosis, thrombocytosis, intermittently low natural killer and class-switched memory B cells, and increased inflammatory cytokines in the serum. Patients have been predominantly treated with anti-inflammatory agents, with the majority of DEX patients treated with biologics targeting TNFα.

Examining measurement invariance of appetitive trait and ARFID symptom measures by food security status.

OBJECTIVE: Measures assessing appetitive traits (i.e., individual differences in the desire to consume food) and disordered eating have generally been developed in predominantly food-secure populations. The current study aims to test measurement invariance (MI) for a measure of appetitive traits and a measure of Avoidant Restrictive Food Intake Disorder (ARFID) symptomology across food security status. METHOD: Data from a sample of mothers (n = 634) and two undergraduate samples (n = 945 and n = 442) were used to assess MI for the Adult Eating Behavior Questionnaire (AEBQ), which measures appetitive traits, and the Nine Item ARFID Screen (NIAS), which measures ARFID symptomology. Current food security was assessed using the 18-item USDA Household Food Security Survey Module, which was dichotomized into two groups: 1) the 'food insecure' group included marginal, low, and very low food security and 2) the 'food secure' group included high food security. Overall and multi-group confirmatory factor analyses were conducted separately for each measure in each sample. RESULTS: Results demonstrated scalar (i.e., strong) MI for both measures across samples, indicating that these measures performed equivalently across food-secure and food-insecure individuals. CONCLUSION: Findings suggest that differences in appetitive traits by food security status observed in prior research are not artifacts of measurement differences, but instead reflect true differences. Additionally, past mixed results regarding the relationship between food insecurity (FI) and ARFID symptomology are not likely driven by measurement error when using the NIAS.

Food insecurity is associated with eating disorders independent of depression and anxiety: Findings from the 2020-2021 Healthy Minds Study.

OBJECTIVE: To examine the association between food insecurity and eating disorder (ED) risk independent of co-occurring anxiety/depression. METHOD: Data were provided by 121,627 undergraduate/graduate students who participated in the 2020-2021 Healthy Minds Study (HMS). Participants responded to questionnaire measures of food insecurity and risk for EDs, depression, and anxiety. Established cut-offs were used to identify students with food insecurity and probable psychopathology. Separate modified Poisson regressions adjusted for age, gender, race/ethnicity, and socioeconomic background examined the association between food insecurity and each form of psychopathology. The association between food insecurity and probable ED was then examined in a regression further adjusted for probable depression and anxiety. RESULTS: Food insecurity was significantly associated with all three forms of psychopathology when examined separately (prevalence ratios ranged from 1.41 to 1.54, all p's < .001). When accounting for probable depression/anxiety, food insecurity was significantly associated with 1.19 times greater prevalence of a probable ED (p < .001). DISCUSSION: The association between food insecurity and EDs was replicated in a large, national sample of university students. To our knowledge, this is the first study to examine the independence of this relationship after adjusting for depression/anxiety. This finding supports the hypothesis that specific mechanisms, rather than general psychological distress, likely underlie the food insecurity-ED relationship.

Exploring the possibility of parents' broad internalizing phenotype acting through passive gene-environment correlations on daughters' disordered eating.

Twin studies demonstrate significant environmental influences and a lack of genetic effects on disordered eating before puberty in girls. However, genetic factors could act indirectly through passive gene-environment correlations (rGE; correlations between parents' genes and an environment shaped by those genes) that inflate environmental (but not genetic) estimates. The only study to explore passive rGE did not find significant effects, but the full range of parental phenotypes (e.g., internalizing symptoms) that could impact daughters' disordered eating was not examined. We addressed this gap by exploring whether parents' internalizing symptoms (e.g., anxiety, depressive symptoms) contribute to daughters' eating pathology through passive rGE. Participants were female twin pairs (aged 8-14 years; M = 10.44) in pre-early puberty and their biological parents (n = 279 families) from the Michigan State University Twin Registry. Nuclear twin family models explored passive rGE for parents' internalizing traits/symptoms and twins' overall eating disorder symptoms. No evidence for passive rGE was found. Instead, environmental factors that create similarities between co-twins (but not with their parents) and unique environmental factors were important. In pre-early puberty, genetic factors do not influence daughters' disordered eating, even indirectly through passive rGE. Future research should explore sibling-specific and unique environmental factors during this critical developmental period.

Exploring differential item functioning on eating disorder measures by food security status.

PURPOSE: Food insecurity is associated with elevated eating disorder (ED) pathology, yet commonly used ED measures may not fully capture ED pathology in the context of food insecurity. The present study used differential item functioning (DIF) analyses to explore whether item endorsement on two commonly used ED questionnaires differed by food security status. METHODS: Participants were 634 cisgender women recruited through Amazon's Mechanical Turk. DIF was explored for items on the Short Eating Disorder Examination Questionnaire (S-EDE-Q) and the Eating Disorder Diagnostic Scale for DSM-5 (EDDS-5). DIF analyses used a hybrid ordinal logistic regression/item response theory approach, with the presence of both statistical (p < .01) and clinical significance (pseudo ΔR2 ≥ .035) indicating DIF. RESULTS: There was no evidence of clinically significant DIF within the S-EDE-Q. Two items on the EDDS-5 exhibited statistically and clinically significant DIF, with moderate effect sizes. Specifically, compared to food-secure participants, food-insecure participants were more likely to report (1) eating large amounts of food when not physically hungry and (2) feeling disgusted, depressed, or guilty about overeating at lower levels of overall ED pathology but less likely to report these experiences at higher levels of overall ED pathology. CONCLUSIONS: Findings highlight a potential need to adapt ED measures to fully capture ED pathology in food-insecure populations. LEVEL OF EVIDENCE: Level III, well-designed cohort study.

Bi-Directional Associations Between Real-Time Affect and Physical Activity in Weight-Discordant Siblings.

Pediatric obesity confers increased risk for a host of negative psychological and physical health consequences and is reliably linked to low levels of physical activity. Affective antecedents and consequences of physical activity are thought to be important for the development and maintenance of such behavior, though research examining these associations in youth across the weight spectrum remains limited. OBJECTIVE: This study examined bi-directional associations between affect and physical activity (i.e., moderate-to-vigorous physical activity [MVPA] and total activity counts), and the extent to which weight (body mass index z-score [z-BMI]) moderated these associations. METHODS: Participants were drawn from a prior study of siblings (N = 77; mean age = 15.4 ± 1.4 years) discordant for weight status (39 nonoverweight siblings, 38 siblings with overweight/obesity) who completed ecological momentary assessment (EMA) with accelerometer-assessed physical activity. RESULTS: Generalized linear mixed models indicated z-BMI moderated trait-level and momentary associations. When adolescents with higher z-BMI reported momentary negative affect, they evidenced less MVPA within the next hour. Across the sample, greater overall activity was associated with lower negative affect. However, at the momentary level, when adolescents with higher (but not lower) z-BMI evidenced greater activity, they reported decreases in negative affect. CONCLUSIONS: Findings indicate affective experiences surrounding physical activity differ according to z-BMI. Specifically, momentary negative affect may impede momentary MVPA among youth with higher z-BMI. Further research is warranted to elucidate factors influencing these momentary associations and the extent to which these momentary associations prospectively predict weight change.

Examining vegetarianism, weight motivations, and eating disorder psychopathology among college students.

OBJECTIVE: Previous research has suggested a link between vegetarianism, broadly defined, and symptoms of eating disorders (ED). However, the literature supporting this link is mixed and limited by possible measurement artifacts. Using data from a national sample of college students, the present study examines ED symptomatology among three groups: (a) vegetarians whose meat avoidance is motivated by weight concerns; (b) non-weight motivated vegetarians; and (c) nonvegetarians. METHOD: Participants include 9,910 students from 12 colleges and universities across the United States who participated in the web-based Healthy Bodies Study. ED symptomatology was measured using the Short-Eating Disorder Examination-Questionnaire (S-EDE-Q). First, multi-group confirmatory factor analysis was conducted to test measurement invariance (MI) of the S-EDE-Q across weight-motivated vegetarians, non-weight-motivated vegetarians, and nonvegetarians. Gender- and BMI-adjusted ANCOVA was used to compare S-EDE-Q scores across groups. RESULTS: 9.3% of participants were vegetarian. Cis-women and gender minority students were more likely to be vegetarian; those who became vegetarians after entering college were more likely to report weight-related motivations. Strict MI was supported for the S-EDE-Q global and subscale scores. Weight-motivated vegetarians reported higher levels of restraint, shape/weight overvaluation, body dissatisfaction, and global ED psychopathology relative to other participants. DISCUSSION: To our knowledge, this is the first to explicitly link weight motivations for vegetarianism to ED psychopathology in a large, representative sample of young adults. Results suggest that students presenting with ED symptoms should be assessed for their motivations for adopting a vegetarian diet, and this information should be considered in treatment decisions.

Gender-based differential item functioning in measures of eating pathology.

OBJECTIVE: Eating disorder (ED) symptoms are common and impairing in males, despite their perception as "female" disorders. As existing self-report symptom measures were developed and primarily validated in women, there is a need to establish the utility of these measures in men. The present study used differential item functioning (DIF) analyses to explore whether item endorsement differed by gender for three commonly used ED symptom measures. METHOD: Participants were undergraduate men (n = 1,083) and women (n = 2,424) from three universities in the United States. Global scores on the Eating Attitudes Test-26 (EAT-26), Eating Disorder Examination Questionnaire (EDEQ), and Eating Disorder Diagnostic Scale for DSM-IV (EDDS) were examined. Tests of DIF were conducted by regressing each item against its composite scale score, and then comparing fit and variance explained (R2 ) to a model with the interaction of item*gender. The clinical significance threshold for DIF is ΔR2 ≥ 0.13. RESULTS: There was no evidence of clinically significant DIF within the EAT-26, EDEQ, or EDDS. DISCUSSION: Findings suggest that the examined measures perform similarly for undergraduate men and women, supporting their use in nonclinical male samples. However, development and testing of items reflecting ED symptoms that more commonly occur in males (e.g., muscularity-oriented behaviors) is encouraged.

Opioid-Related Harms in Canada.

The rise in harms associated with opioids is an issue of increasing public health importance in Canada. The Government of Canada recently reported 2,816 apparent opioid-related deaths across the country in 2016. Recent 2017 data show that deaths involving fentanyl-related opioids have doubled from January to March as compared to the same time period in 2016 (Government of Canada 2017). Additional measures that provide a better understanding of opioid-related harms, such as hospitalizations and emergency department (ED) visits, are a high priority. The objective of this study is to present pan-Canadian data on hospitalizations and ED visits because of opioid poisoning.

The significant effects of puberty on the genetic diathesis of binge eating in girls.

OBJECTIVE: Recent data show significant phenotypic and genetic associations between ovarian hormones and binge eating in adulthood. Theories of hormonal risk focus on puberty and the possibility that hormone activation induces changes in genetic effects that then lead to differential risk for binge eating in postpuberty and adulthood. Although this theory is difficult to test in humans, an indirect test is to examine whether genetic influences on binge eating increase during the pubertal period in girls. Prior work has shown pubertal increases in genetic influences on overall disordered eating symptoms, but no study to date has examined binge eating. The present study was the first to examine these increases for binge eating. METHODS: Participants included 1,568 female twins (aged 8-25 years) from the Michigan State University Twin Registry. Binge eating and pubertal development were assessed with self-report questionnaires. RESULTS: Twin moderation models showed significant linear increases in genetic effects from prepuberty (5%) to postpuberty (42%), even after controlling for the effects of age and body mass index. DISCUSSION: Results provide critical support for increased genetic influences on binge eating during puberty. Additional studies are needed to identify hormonal mechanisms and fully test contemporary models of ovarian hormone risk.

Genetic and environmental associations between body dissatisfaction, weight preoccupation, and binge eating: Evidence for a common factor with differential loadings across symptom type.

OBJECTIVE: Prior twin studies provide support for a single "common factor" that contributes genetic and environmental risk to a range of disordered eating symptoms. However, the common factor may be indexed less well by binge eating (BE) than other symptoms of eating disorders [i.e., body dissatisfaction (BD) and weight preoccupation (WP)]. We sought to explore the presence of a common factor and test whether loadings differed across three key symptoms (i.e., BE, BD, WP). METHOD: Disordered eating was assessed via self-report in 631 female twin pairs from the Michigan State University Twin Registry. RESULTS: We detected a common disordered eating factor that was influenced primarily by additive genetic and nonshared environmental influences. However, we observed different loadings on this common factor by symptom type, as factor loadings for BD and WP were stronger than that for BE. Moreover, the residual environmental and/or genetic variances (i.e., those that are independent of the common factor) were larger in BE than those of BD or WP. DISCUSSION: Although all three symptoms share a common set of genetic and environmental influences, risk for BE may involve additional genetic, biological, and environmental factors that are not shared with other symptoms of eating pathology. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:157-161).

Does parental divorce moderate the heritability of body dissatisfaction? An extension of previous gene-environment interaction effects.

OBJECTIVE: Previous research suggests that parental divorce moderates genetic influences on body dissatisfaction. Specifically, the heritability of body dissatisfaction is higher in children of divorced versus intact families, suggesting possible gene-environment interaction effects. However, prior research is limited to a single, self-reported measure of body dissatisfaction. The primary aim of this study was to examine whether these findings extend to a different dimension of body dissatisfaction: body image perceptions. METHOD: Participants were 1,534 female twins from the Minnesota Twin Family Study, aged 16-20 years. The Body Rating Scale (BRS) was used to assess body image perceptions. RESULTS: Although BRS scores were heritable in twins from divorced and intact families, the heritability estimates in the divorced group were not significantly greater than estimates in the intact group. However, there were differences in nonshared environmental effects, where the magnitude of these environmental influences was larger in the divorced as compared with the intact families. DISCUSSION: Different dimensions of body dissatisfaction (i.e., negative self-evaluation versus body image perceptions) may interact with environmental risk, such as parental divorce, in discrete ways. Future research should examine this possibility and explore differential gene-environment interactions using diverse measures.

A comparison of scoring models for computerised mental health screening for federal prison inmates.

BACKGROUND: There are high rates of mental disorder in correctional environments, so effective mental health screening is needed. Implementation of the computerised mental health screen of the Correctional Service of Canada has led to improved identification of offenders with mental health needs but with high rates of false positives. AIMS: The goal of this study is to evaluate the use of an iterative classification tree (ICT) approach to mental health screening compared with a simple binary approach using cut-off scores on screening tools. METHODS: A total of 504 consecutive admissions to federal prison completed the screen and were also interviewed by a mental health professional. Relationships between screening results and more extended assessment and clinical team discussion were tested. RESULTS: The ICT was more parsimonious in identifying probable 'cases' than standard binary screening. ICT was also highly accurate at detecting mental health needs (AUC=0.87, 95% CI 0.84-0.90). The model identified 118 (23.4%) offenders as likely to need further assessment or treatment, 87% of whom were confirmed cases at clinical interview. Of the 244 (48.4%) offenders who were screened out, only 9% were clinically assessed as requiring further assessment or treatment. Standard binary screening was characterised by more false positives and a comparable false negative rate. CONCLUSIONS: The use of ICTs to interpret screening data on the mental health of prisoners needs further evaluation in independent samples in Canada and elsewhere. This first evaluation of the application of such an approach offers the prospect of more effective and efficient use of the scarce resource of mental health services in prisons. Although not required, the use of computers can increase the ease of implementing an ICT model.

The role of stress in the association among food insecurity, eating disorder pathology, and binge eating-related appetitive traits.

PURPOSE: Growing literature demonstrates a positive association between food insecurity (FI) and eating disorder pathology. Additionally, FI has been associated with two appetitive traits strongly linked to binge eating, food responsiveness and emotional overeating. However, little research has investigated factors that might help to explain these associations. One hypothesis is that experiencing FI may increase stress, and that eating disorder pathology, particularly binge eating-related phenotypes, may serve as a coping strategy. This study explores stress as a potential mechanism in the association between FI and general eating disorder pathology, as well as two appetitive traits strongly associated with binge eating (food responsiveness and emotional overeating). METHODS: Cis-gender women (N = 634) completed online questionnaires assessing FI, stress, eating disorder pathology (measured via the total score on the Short Eating Disorder Examination Questionnaire), and binge eating-related appetitive traits (measured via the Adult Eating Behavior Questionnaire). Cross-sectional indirect effects analyses with a 1000-sample bootstrap were used to test pathways among FI, stress, and eating-related constructs. RESULTS: FI was significantly associated with eating disorder pathology and associated appetitive traits (ps < 0.001). Stress explained a significant proportion of the correlation between FI and each eating-related construct. CONCLUSIONS: Our findings extend prior research on the relationships between FI, eating disorder pathology, and binge eating-related appetitive traits to provide preliminary evidence that stress may act as an underlying mechanism. Future studies should use longitudinal designs to assess the prospective relationships among these constructs.

Exploring differences in disordered eating and related appetitive traits among women based on childhood and current food security status.

Despite emerging evidence that food insecurity (FI) is associated with elevated rates of eating pathology, little is known about the lasting impact of FI on eating behaviors. Studies that have explored the association between FI during childhood and eating behavior in adulthood have not accounted for current FI. The present study explored differences in disordered eating (DE) and related appetitive traits among four groups of cisgender female mothers: individuals who (1) endorsed childhood FI only (n = 96), (2) endorsed current FI only (n = 134), (3) endorsed both childhood and current FI (n = 257), and (4) denied both childhood and current FI (n = 146). Participants responded to online questionnaires including items from the USDA Household Food Security Survey Module, the 7-item Eating Disorder Examination-Questionnaire, the Eating Disorder Diagnostic Scale, and the Adult Eating Behavior Questionnaire. Adjusting for age and race/ethnicity, ANCOVAs explored mean differences between groups in DE and appetitive traits, and a modified Poisson regression model examined differences in binge-eating prevalence across the four FI groups. The "current FI only" group consistently endorsed the highest levels of DE and related appetitive traits followed by the "current and childhood FI" group, suggesting newly food-insecure women may be at highest risk for DE. Interestingly, across almost all constructs, the "childhood FI only" group did not differ significantly from the "no FI" group. These findings suggest that improved access to food may help offset risk for adult DE related to experiences of FI in childhood.

Disadvantage and disordered eating in boys: Examining phenotypic and genotype × environment associations across development.

Socioeconomic disadvantage may be a significant risk factor for disordered eating, particularly for individuals with underlying genetic risk. However, little to nothing is known about the impact of disadvantage on disordered eating in boys during the critical developmental risk period. Crucially, risk models developed for girls may not necessarily apply to boys, as boys show different developmental patterns of disordered eating risk (i.e., earlier activation of genetic influences during adrenarche, an early stage of puberty). This is the first study to examine phenotypic and Genotype × Environment (G × E) effects of disadvantage in boys. Analyses examined 3,484 male twins ages 8-17 (Mage = 12.27, SD = 2.96) from the Michigan State University Twin Registry. Disordered eating (e.g., body dissatisfaction, binge eating) was measured using the parent-report Michigan Twins Project Eating Disorder Survey. Neighborhood disadvantage was measured using a census-tract level Area Deprivation Index, and family socioeconomic status was determined from parental income and education. Adrenarche status was determined using multiple indicators, including age and Pubertal Development Scale scores. G × E models suggested that genetic influences on disordered eating were activated earlier for boys experiencing familial or neighborhood disadvantage, with substantial genetic influences in early adrenarche, when genetic influences were low in more advantaged boys. Phenotypically, both neighborhood and familial disadvantage were associated with greater disordered eating for boys in late adrenarche, which could indicate a lasting impact of earlier activation of genetic influences on later risk. Results highlight disadvantage as a novel risk factor for disordered eating in boys, particularly those with genetic vulnerabilities. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Addressing Health-Related Social Needs Via Community Resources: Lessons From Accountable Health Communities.

The Center for Medicare and Medicaid Innovation launched the Accountable Health Communities (AHC) Model in 2017 to assess whether identifying and addressing Medicare and Medicaid beneficiaries' health-related social needs reduced health care use and spending. We surveyed a subset of AHC Model beneficiaries with one or more health-related social needs and two or more emergency department visits in the prior twelve months to assess their use of community services and whether their needs were resolved. Survey findings indicated that navigation-connecting eligible patients with community services-did not significantly increase the rate of community service provider connections or the rate of needs resolution, relative to a randomized control group. Findings from interviews with AHC Model staff, community service providers, and beneficiaries identified challenges connecting beneficiaries to community services. When connections were made, resources often were insufficient to resolve beneficiaries' needs. For navigation to be successful, investments in additional resources to assist beneficiaries in their communities may be required.

Genetic and environmental influences on thin-ideal internalization.

OBJECTIVE: Current research on the etiology of thin-ideal internalization focuses on psychosocial influences (e.g., media exposure). The possibility that genetic influences also account for variance in thin-ideal internalization has never been directly examined. This study used a twin design to estimate genetic effects on thin-ideal internalization and examine if environmental influences are primarily shared or nonshared in origin. METHOD: Participants were 343 postpubertal female twins (ages: 12-22 years; M = 17.61) from the Michigan State University Twin Registry. Thin-ideal internalization was assessed using the Sociocultural Attitudes toward Appearance Questionnaire-3. RESULTS: Twin modeling suggested significant additive genetic and nonshared environmental influences on thin-ideal internalization. Shared environmental influences were small and non-significant. DISCUSSION: Although prior research focused on psychosocial factors, genetic influences on thin-ideal internalization were significant and moderate in magnitude. Research is needed to investigate possible interplay between genetic and nonshared environmental factors in the development of thin-ideal internalization.

Attention/Deficit Hyperactivity Disorder in Adolescent and Young Adult Males With Fragile X Syndrome.

This study characterized the rates of attention-deficit/hyperactivity disorder (ADHD) in adolescent and young adult males with fragile X syndrome (FXS) using a multi-method approach integrating a DSM-based parent interview (Children's Interview for Psychiatric Syndromes; P-ChIPS, Fristad et al., 1998) and a parent rating scale (Child Behavior Checklist; CBCL, Achenbach, 2001). Thirty-one males with FXS, aged 16-24 years, participated. Forty-two percent met DSM-5 criteria for ADHD and 35% exceeded the CBCL cut-offs. Agreement between the two classification methods was fair (κ = 0.38). Autism symptom severity and nonverbal cognitive ability did not predict ADHD diagnoses/symptoms. Results show high rates of ADHD in males with FXS during late adolescence and young adulthood, which are not accounted for by impaired nonverbal cognitive skills or autism symptom severity. DSM-based ADHD-specific scales are recommended over broadband symptom scales to improve accurate identification.

The effects of adipokines on cartilage and meniscus catabolism.

Obesity is one of the primary risk factors for osteoarthritis. Increased adiposity is associated not only with alterations in joint loading, but also with increased systemic and joint concentrations of adipose tissue-derived cytokines, or "adipokines", that promote a state of chronic, low-grade inflammation that may act in concert with other cytokines in the joint to increase joint degeneration. However, the direct effect of adipokines, such as leptin, visfatin, and interleukin-6 (IL-6), on joint tissues, such as articular cartilage and meniscus, are not fully understood. In this study, we examined the hypothesis that these adipokines act synergistically with interleukin-1 (IL-1) to increase catabolism and the production of proinflammatory mediators in cartilage and meniscus. Explants of porcine cartilage and meniscus were treated with physiologically relevant concentrations of leptin, IL-6, or visfatin, alone or in combination with IL-1. Visfatin and IL-1 promoted the catabolic degradation of both cartilage and meniscus, as evidenced by increased metalloproteinase activity, nitric oxide production, and proteoglycan release. However, leptin or IL-6 at physiologic concentrations had no effect on the breakdown of these tissues. These findings suggest that the effects of obesity-induced osteoarthritis may not be through a direct effect of leptin or IL-6 on cartilaginous tissues, but support a potential role for increased visfatin levels in this regard. These data provide an important first step in understanding the role of adipokines in regulating cartilage and meniscus metabolism; however, these adipokines may have different effects in the context of the whole joint and must be evaluated further.