Evaluation of Zinc-Alpha-2-Glycoprotein (ZAG) Level as a Risk Factor in Patients with Metabolic Syndrome

Background: The Metabolic Syndrome is a group of interrelated risk factors that significantly increases the risk of cardiovascular disease, type 2 diabetes mellitus, and overall mortality. Adipose tissue, epithelial cells, and other tissues release zinc-alpha-2-glycoprotein (ZAG) that its role in fat metabolism, insulin sensitivity, and energy expenditure has led to its growing recognition. So, we aimed to determine whether ZAG levels can serve as a biomarker for the diagnosis and severity of metabolic syndrome. Methods: In this case-control study, 120 patients were evaluated in the Endocrinology Unit outpatient clinic of the Internal Medicine Department at Zagazig University hospitals. Three groups of patients were formed: Group A: The control group, which consists of forty individuals in good health. Group B: Forty centrally obese patients without any problems. Group C: Forty patients with metabolic syndrome. Serum ZAG was determined using enzyme-linked immune sorbent assay (ELISA) kits. Results: Serum ZAG levels were significantly inversely correlated with body weight and BMI. ROC curve analysis of serum ZAG in differentiating the healthy individuals from the other two groups (central obesity, and metabolic syndrome), showed area under the curve (AUC) 0.893, and ROC curve analysis of serum ZAG in differentiating metabolic syndrome from the central obesity group showed area under the curve (AUC) for serum ZAG was 0.792. Conclusion: Serum zinc-Alpha-2-Glycoprotein (ZAG) may be a valuable non-invasive biomarker for the early detection of metabolic syndrome, but its moderate specificity indicates the need for combined biomarker strategies to enhance the diagnostic accuracy.