J Investig Med. 2014 Jun;62(5):821-4.

Are human adenovirus-5 and 36 associated with obesity in children?

Cakmakliogullari EK1, Sanlidag T2, Ersoy B3, Akcali S2, Var A4, Cicek C5

1Department of Medical Microbiology, Karabuk State Hospital; Departments of 2Medical Microbiology, 3Pediatrics, and 4Medical Biochemistry, Faculty of Medicine, Celal Bayar University, Manisa; and 5De partment of Medical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey.



The aims of this study were to determine the association between adenovirus-5- and adenovirus-36-specific antibodies and obesity in children and to investigate their relationship with serum lipid and leptin levels.

A cross-sectional study was performed on a total of 120 children who were divided into subgroups according to body mass index percentile as obese (≥ 95th percentile) or nonobese (<95th percentile). The presence of adenovirus-36 and adenovirus-5-neutralizing antibodies was investigated by using the serum neutralization assay. Serum leptin levels were determined by microenzyme immonoassay; high-density lipoprotein, low-density lipoprotein, triglyceride, and cholesterol levels were measured by chemiluminescence method.

The presence of adenovirus-5-specific antibodies was 28.3% and 6.6% in the obese children and in non-obese children, respectively (P = 0.02). The frequency of adenovirus-36-specific antibodies was significantly greater (P = 0.018) in the obese children (26.6%) than in the non-obese children (10.0%). Serum leptin level of the obese group were significantly higher than that of the non-obese group (P = 0.000).

Our data support the association between obesity and the presence of specific antibodies to adenovirus-36 and adenovirus-5 in children. Our research has the feature of being the first national study to indicate the relationship between adenovirus-36 and human obesity as well as the first international study to indicate the relationship between adenovirus-5 and human obesity.




Childhood obesity has increased dangerously over the last 30 years. Approximately %17 of Americans between the ages of 2-19 years are obese while in Europe this percentage is 8. Obesity during the childhood is mostly followed by adulthood obesity which afterwards may lead to hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, stroke, sleep apnea, respiratory problems, osteoarthritis, some types of cancer and psychological problems (1,2).

Obesity has a complex, multifactorial etiology which is mostly affected by factors like genetic inheritance, endocrine alterations, diet, lack of exercise, stress (3).

Evidence emerging over the last 20 years supports the hypothesis that viral infections may be associated with obesity in animals and humans and nowadays, the term ‘infectobesity’ is used to describe cause from infectious origin (4).

In past few years, it has been reported that seven different pathogens can cause obesity in animal models. Adipogenic viruses include canine distemper virus, Rous-associated virus type 7, Borna disease virus, SMAM-1, Ad36, Ad37 and Ad5 are associated with obesity in animals and also affect adipocytes directly. Nonetheless, little information exists about the relation of these pathogens with human obesity (5,6,7).

Studies show that Ad5, Ad36 and Ad37 can cause obesity in animal models. The important point seperating Ad36 from the others is that this pathogen can also cause obesity in humans. Currently, there is only one study about Ad5 showing that;  exposure to Ad5 may create an important increase in adiposity independent of food intake in a murine model (7) which has been published by So et al.

Since there was only one published study about the adipogenic effect of Ad5 on animals, it was decided to bring this subject up and demonstrate effect of Ad5 on obesity. Firstly, the adipogenic effect of Ad5, Ad8 and Ad36 in a Colo‑320 cell line were analyzed (8) and then the correlation between Ad5, Ad8, Ad36 and childhood obesity was investigated.

Therefore, a study which was performed on 120 Turkish children has been planned.  Sixty of these children were obese (≥ 95th percentile), and the other 60 were non-obese(<95th percentile). The presence of Ad36, Ad8 and Ad5 neutralizing antibodies was investigated by using the serum neutralization assay. Lipid profiles and leptin level were tested by chemiluminescence and enzyme immun assay methods, respectively.

The antibodies of Ad5, Ad36, and Ad8 in obese children were 28.3%, 26.6%, and 13.3%, respectively. On the other hand the presence of Ad5, Ad36, and Ad8 antibodies in non-obese children was 6.6%, 10.0%, and 8.3%, also respectively (Table 1).  The statistical analysis showed significantly lower HDL values in the obese group (P< 0.01). Serum leptin levels were notably higher in the obese group than the non-obese group (P< 0.01). Other lipid profiles displayed no significant differences between the groups (P > 0.05). According to logistic regression analyses Ad5 seropositivity caused 6 times higher adiposity risk when compared with seronegative group (CI 1.648-24.755).

Table 1. Ad5, Ad8 and Ad36 antibody status in obese and non-obese children.



There are 3 significant results of our study.

  • The relation between Ad36 and childhood obesity was pointed out in many studies including ours.
  • However the relation between Ad5 and childhood obesity was discovered for the first time with our study. Also, it was observed that the risk of adiposity was 6 times higher with Ad5 infection.
  • Additionally, the adipogenic effect of Ad8 on childhood obesity had been studied and no contributory effect on childhood obesity detected.



  1. Ogden CL, Carroll MD, Curtin LR, et al. 2010 Prevalence of high body mass index in US children and adolescents. 2007-2008. JAMA 303:242–249
  2. Wang Y, Lobstein T 2006 Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes 1:11–25.
  3. McAllister EJ, Dhurandhar NV, Keith SW, et al. 2009 Ten putative contributors to the obesity epidemic. Crit Rev Food Sci Nutr 49:868–913
  4. Ginneken VV, Sitnyakowsky L, Jeffery JE 2009 Infectobesity: viral infections (especially with human adenovirus-36: Ad36) may be a cause of obesity. Medical Hypotheses 72: 383–388
  5. Atkinson RL 2007 Viruses as an etiology of obesity. Mayo Clin Proc 82:1192–1198
  6. Whigham LD, Israel BA, Atkinson RL 2006 Adipogenic potential of multiple human adenoviruses in vivo and in vitro in animals. Am J Physiol Regul Integr Comp Physiol 290:190–194
  7. So PW, Herlihy AH, Bell JD 2005 Adiposity induced by adenovirus 5 inoculation. Int J Obes 29: 603–606
  8. Sanlidag T, Akcali S, Vatansever S, et al. 2013 Investigation of adipogenic effects of human adenovirus serotypes 36 and 5 in a Colo-320 cell line. Future Virology 8(6):617-622


Acknowledgements:  This study was supported by Celal Bayar University grant 2010021.


Tamer Sanlidag, (Ph.D.),


Department of Medical Microbiology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey.

E-mail: trsanlidag@yahoo.com


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