{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T09:11:42Z","timestamp":1780477902618,"version":"3.54.1"},"reference-count":72,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Investments and European Projects through the Health Program","award":["100418"],"award-info":[{"award-number":["100418"]}]},{"name":"Ministry of Investments and European Projects through the Health Program","award":["350525"],"award-info":[{"award-number":["350525"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antioxidants"],"abstract":"<jats:p>Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized as a systemic disorder linked to cardio-kidney\u2013metabolic (CKM) syndrome, early vascular injury and redox imbalance. Inflammatory adipokines such as retinol-binding protein 4 (RBP4) and lipocalin-2 (LCN2) may contribute to this hepatic\u2013vascular interplay by integrating metabolic inflammation, oxidative stress and endothelial dysfunction. Therefore, the present study aimed to investigate the contribution of the inflammatory adipokines retinol-binding protein 4 (RBP4) and lipocalin-2 (LCN2) to the hepatic\u2013vascular interplay in MASLD within the cardio-kidney\u2013metabolic (CKM) syndrome. Materials and Methods: We performed a systematic review and meta-analysis of studies evaluating circulating RBP4 and LCN2 levels in MASLD. PubMed, Scopus, and Web of Science were searched. Twenty studies were included in the qualitative synthesis, and ten in the quantitative meta-analysis. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated. Vascular findings were synthesized narratively because of heterogeneity in outcomes. Results: Circulating RBP4 levels were significantly higher in MASLD patients than in controls (SMD = 0.64, 95% CI: 0.08 to 1.20, p = 0.026; I2 = 91.2%). LCN2 levels were also significantly elevated (SMD = 1.92, 95% CI: 0.83 to 3.00, p &lt; 0.001; I2 = 98.0%). Compared with RBP4, LCN2 showed a larger pooled effect size, although heterogeneity remained very high. In the qualitative synthesis, adipokines, particularly LCN2, were associated with markers of vascular injury, including carotid intima\u2013media thickness, plaque burden, arterial stiffness, endothelial dysfunction, coronary severity, and cardiovascular events. Conclusions: Both RBP4 and LCN2 were elevated in MASLD, supporting a link between adipokine dysregulation and hepatic metabolic dysfunction within the broader cardio-kidney\u2013metabolic (CKM) syndrome. LCN2 appeared to better reflect the inflammatory, metabolic, and vascular burden of disease. These findings support the view of MASLD as a systemic disorder within the CKM syndrome and highlight the potential of inflammatory adipokines as non-invasive biomarkers of integrated hepatic, metabolic, and vascular dysfunction.<\/jats:p>","DOI":"10.3390\/antiox15060684","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T07:58:38Z","timestamp":1780473518000},"page":"684","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Inflammatory Adipokines and Potential Oxidative Stress-Related Mechanisms Linking MASLD with Subclinical Atherosclerosis Within CKM Syndrome: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-4090-0164","authenticated-orcid":false,"given":"Cezara-Andreea","family":"Gerdanovics","sequence":"first","affiliation":[{"name":"4th Department of Internal Medicine, Faculty of Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Republicii Street, No. 18, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2208-5132","authenticated-orcid":false,"given":"\u0218oimi\u021ba-Mihaela","family":"Suciu","sequence":"additional","affiliation":[{"name":"Department of Physiology, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 1\u20133 Clinicilor Street, 400006 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4435-142X","authenticated-orcid":false,"given":"Olga-Hilda","family":"Or\u0103\u0219an","sequence":"additional","affiliation":[{"name":"4th Department of Internal Medicine, Faculty of Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Republicii Street, No. 18, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioana","family":"Para","sequence":"additional","affiliation":[{"name":"4th Department of Internal Medicine, Faculty of Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Republicii Street, No. 18, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2033-8872","authenticated-orcid":false,"given":"Vladiana-Romina","family":"Turi","sequence":"additional","affiliation":[{"name":"University Clinic of Internal Medicine IV, Faculty of Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy of Timisoara, 2 Eftimie Murgu Square, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8590-4583","authenticated-orcid":false,"given":"Adela-Sitar","family":"T\u0103ut","sequence":"additional","affiliation":[{"name":"4th Department of Internal Medicine, Faculty of Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Republicii Street, No. 18, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mircea-Vasile","family":"Milaciu","sequence":"additional","affiliation":[{"name":"4th Department of Internal Medicine, Faculty of Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Republicii Street, No. 18, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8327-2444","authenticated-orcid":false,"given":"Mirela-Georgiana","family":"Perne","sequence":"additional","affiliation":[{"name":"4th Department of Internal Medicine, Faculty of Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Republicii Street, No. 18, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2756-5784","authenticated-orcid":false,"given":"Teodora-Gabriela","family":"Alexescu","sequence":"additional","affiliation":[{"name":"4th Department of Internal Medicine, Faculty of Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Republicii Street, No. 18, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorena","family":"Cium\u0103rnean","sequence":"additional","affiliation":[{"name":"2nd Department, Faculty of Nursing and Health Sciences, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Republicii Street, No. 18, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5185-9512","authenticated-orcid":false,"given":"Alexandru","family":"Gerdanovics","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology, \u201cIuliu Ha\u0163ieganu\u201d University of Medicine and Pharmacy, Victor Babe\u015f Street, No. 2\u20134, 400012 Cluj-Napoca, Romania"},{"name":"Clinical Rehabilitation Hospital, Viilor Street, No. 46\u201350, 400066 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0007-8962","authenticated-orcid":false,"given":"Vlad-Dumitru","family":"Brata","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Regional Institute of Gastroenterology and Hepatology \u201cProf. Dr. Octavian Fodor\u201d, 400394 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3989-2291","authenticated-orcid":false,"given":"Angela","family":"Cozma","sequence":"additional","affiliation":[{"name":"4th Department of Internal Medicine, Faculty of Medicine, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Republicii Street, No. 18, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Acierno, C., Orio, M., Schiavo, L., Saracino, A., and Stabile, E. 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