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8.1: Case Study: Genes and Inheritance

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• Page ID 16760

• Suzanne Wakim & Mandeep Grewal
• Butte College

Case Study: Cancer in the Family

People tend to look similar to their biological parents, as illustrated by the family tree in Figure \(\PageIndex{1}\). But, you can also inherit traits from your parents that you can’t see. Rebecca becomes very aware of this fact when she visits her new doctor for a physical exam. Her doctor asks several questions about her family's medical history, including whether Rebecca has or had relatives with cancer. Rebecca tells her that her grandmother, aunt, and uncle, who have all passed away, all had cancer. They all had breast cancer, including her uncle, and her aunt additionally had ovarian cancer. Her doctor asks how old they were when they were diagnosed with cancer. Rebecca is not sure exactly, but she knows that her grandmother was fairly young at the time, probably in her forties.

Rebecca’s doctor explains that while the vast majority of cancers are not due to inherited factors, a cluster of cancers within a family may indicate that there are mutations in certain genes that increase the risk of getting certain types of cancer, particularly breast and ovarian cancer. Some signs that cancers may be due to these genetic factors are present in Rebecca’s family, such as cancer with an early age of onset (e.g. breast cancer before age 50), breast cancer in men, and breast cancer and ovarian cancer within the same person or family.

Based on her family medical history, Rebecca’s doctor recommends that she see a genetic counselor because these professionals can help determine whether the high incidence of cancers in her family could be due to inherited mutations in their genes. If so, they can test Rebecca to find out whether she has the particular variations of these genes that would increase her risk of getting cancer.

When Rebecca sees the genetic counselor, he asks how her grandmother, aunt, and uncle with cancer are related to her. She says that these relatives are all on her mother’s side — they are her mother’s mother and siblings. The genetic counselor records this information in the form of a specific type of family tree, called a pedigree, indicating which relatives had which type of cancer and how they are related to each other and to Rebecca. He also asks her ethnicity. Rebecca says that her family, on both sides, are Ashkenazi Jews, meaning Jews whose ancestors came from central and eastern Europe. “But what does that have to do with anything?” she asks. The counselor tells Rebecca that mutations in two tumor-suppressor genes called BRCA1 and BRCA2, located on chromosome 17 and 13, respectively, are particularly prevalent in people of Ashkenazi Jewish descent and greatly increase the risk of getting cancer. About 1 in 40 Ashkenazi Jewish people have one of these mutations, compared to about 1 in 800 in the general population. Her ethnicity, along with the types of cancer, age of onset, and the specific relationships between her family members who had cancer indicate to the counselor that she is a good candidate for genetic testing for the presence of these mutations.

Rebecca says that her 72-year-old mother never had cancer, and nor had many other relatives on that side of the family, so how could the cancers be genetic? The genetic counselor explains that the mutations in the BRCA1 and BRCA2 genes, although dominant, are not inherited by everyone in a family. Also, even people with mutations in these genes do not necessarily get cancer — the mutations simply increase their risk of getting cancer. For instance, 55 to 65% of women with a harmful mutation in the BRCA1 gene will get breast cancer before age 70, compared to 12% of women in the general population who will get breast cancer sometime over the course of their lives.

Rebecca is not sure she wants to know whether she has a higher risk of cancer. The genetic counselor understands her apprehension but explains that if she knows that she has harmful mutations in either of these genes, her doctor will screen her for cancer more often and at earlier ages. Therefore, any cancers she may develop are likely to be caught earlier when they are often much more treatable. Rebecca decides to go through with the testing, which involves taking a blood sample, and nervously waits for her results.

Chapter Overview: Genetics

At the end of this chapter, you will find out Rebecca ’s test results. By then, you will have learned how mutations in genes such as BRCA1 and BRCA2 can be passed down and cause disease. Especially, you will learn about:

• How Gregor Mendel discovered the laws of inheritance for certain types of traits.
• The science of heredity, known as genetics, and the relationship between genes and traits.
• Simple and more complex inheritance of some human traits.
• Genetic Disorders.

As you read this chapter, keep Rebecca’s situation in mind and think about the following questions:

• What do the BRCA1 and BRCA2 genes normally do? How can they cause cancer?
• Are BRCA1 and BRCA2 considered linked genes? And are they on autosomes or sex chromosomes?
• After learning more about pedigrees, draw the pedigree for cancer in Rebecca’s family. Use the pedigree to help you think about why it is possible that her mother does not have one of the BRCA gene mutations, even if her grandmother, aunt, and uncle did have it.
• Why do you think certain gene mutations are prevalent in certain ethnic groups?

Attributions

• Caelius and Valerius family tree by Ann Martin , licensed CC BY 2.0 via Flickr
• Text adapted from Human Biology by CK-12 licensed CC BY-NC 3.0

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Interactive case study for natural selection in an outbreak.

• Pathogens & Disease
• Natural Selection

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• Interactive Videos

Description

This interactive video explores how two scientists tracked the 2013 Ebola outbreak in West Africa. 

Geneticist Pardis Sabeti investigated the evolution of the virus over time, whereas epidemiologist Lina Moses investigated the societal factors that contributed to the outbreak. Their experiences illustrate some of the factors that can cause an outbreak to occur and why it is important to curb the spread of infection as rapidly as possible. As students watch the video, they are prompted to answer questions that require them to predict steps in the research process and interpret data. Students also make connections to their own experiences with infectious diseases.

The “Student Worksheet” lists the questions embedded in the video. The “Educator Materials” document provides implementation tips from educators who have used interactive case studies in their classroom. It also provides additional discussion questions and guidance on assessing students’ responses.

The “Resource Google Folder” link directs to a Google Drive folder of resource documents in the Google Docs format. Not all downloadable documents for the resource may be available in this format. The Google Drive folder is set as “View Only”; to save a copy of a document in this folder to your Google Drive, open that document, then select File → “Make a copy.” These documents can be copied, modified, and distributed online following the Terms of Use listed in the “Details” section below, including crediting BioInteractive.

Student Learning Targets

• Identify some of the factors that can fuel an infectious disease outbreak in humans.
• Explain how viruses evolve by natural selection during an epidemic.
• Describe how the evolution of viruses can be studied using their genetic information.
• Explain why outbreaks should be stopped as early as possible.

Estimated Time

Ebola, epidemic, epidemiology, health profession, healthcare, infection, spillover, zoonotic disease 

Primary Literature

Gire, Stephen K., Augustine Goba, Kristian G. Andersen, Rachel S. G. Sealfon, Daniel J. Park, Lansana Kanneh, Simbirie Jalloh, et al. “Genomic surveillance elucidates Ebola virus origin and transmission during the 2014 outbreak.” Science 345, 6202 (2014): 1369–1371. https://www.science.org/doi/10.1126/science.1259657 .

Terms of Use

Please see the Terms of Use for information on how this resource can be used.

Accessibility Level (WCAG compliance)

Version history, curriculum connections.

HS-LS3-2, HS-LS4-4; SEP1, SEP6, SEP8

AP Biology 2019

SYI-3.A, IST-1.K, IST-1.O, IST-4.B, EVO-1.D, EVO-1.M, ENE-3.D; SP1, SP6

IB Biology 2016

5.2, 6.3, B.5

Vision and Change 2009

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As scientists, we take a lot of STEM classes, including biology, chemistry, physics, and math. But we often don’t have time to connect all of this information together. That’s where case studies are so incredibly helpful especially to organizations such as the CDC and World Health Organization. This course will use real world examples to help teach students about the scientific process and how theories and hypotheses are developed. Sometimes the answers aren’t clear, and even experts can’t agree. Using case studies focused on climate and it's connection to health, we will analyze data and apply biology concepts to learn about how to form a solid argument, supported by evidence from published research. This is your chance to learn how to conduct systematic literature reviews and meta-analyses to analyze scientific controversies and develop your own theories. Students with an interest in both biology and environmental science are welcome.

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5.1 Case Study: Genes and Inheritance

Created by: CK-12/Adapted by Christine Miller

Case Study: Cancer in the Family

People tend to carry similar traits to their biological parents, as illustrated by the family tree. Beyond just appearance, you can also inherit traits from your parents that you can’t  see.

Rebecca becomes very aware of this fact when she visits her new doctor for a physical exam. Her doctor asks several questions about her family medical history, including whether Rebecca has or had relatives with cancer. Rebecca tells her that her grandmother, aunt, and uncle — who have all passed away — had cancer. They all had breast cancer, including her uncle, and her aunt also had ovarian cancer. Her doctor asks how old they were when they were diagnosed with cancer. Rebecca is not sure exactly, but she knows that her grandmother was fairly young at the time, probably in her forties.

Rebecca’s doctor explains that while the vast majority of cancers are not due to inherited factors, a cluster of cancers within a family may indicate that there are mutations in certain genes that increase the risk of getting certain types of cancer, particularly breast and ovarian cancer. Some signs that cancers may be due to these genetic factors are present in Rebecca’s family, such as cancer with an early age of onset (e.g., breast cancer before age 50), breast cancer in men, and breast cancer and ovarian cancer within the same person or family.

Based on her family medical history, Rebecca’s doctor recommends that she see a genetic counselor, because these professionals can help determine whether the high incidence of cancers in her family could be due to inherited mutations in their genes. If so, they can test Rebecca to find out whether she has the particular variations of these genes that would increase her risk of getting cancer.

When Rebecca sees the genetic counselor, he asks how her grandmother, aunt, and uncle with cancer are related to her. She says that these relatives are all on her mother’s side — they are her mother’s mother and siblings. The genetic counselor records this information in the form of a specific type of family tree, called a pedigree, indicating which relatives had which type of cancer, and how they are related to each other and to Rebecca.

He also asks her ethnicity. Rebecca says that her family on both sides are Ashkenazi Jews (Jews whose ancestors came from central and eastern Europe). “But what does that have to do with anything?” she asks. The counselor tells Rebecca that mutations in two tumor-suppressor genes called BRCA1 and BRCA2 , located on chromosome 17 and 13, respectively, are particularly prevalent in people of Ashkenazi Jewish descent and greatly increase the risk of getting cancer. About one in 40 Ashkenazi Jewish people have one of these mutations, compared to about one in 800 in the general population. Her ethnicity, along with the types of cancer, age of onset, and the specific relationships between her family members who had cancer, indicate to the counselor that she is a good candidate for genetic testing for the presence of these mutations.

Rebecca says that her 72-year-old mother never had cancer, nor had many other relatives on that side of the family. How could the cancers be genetic? The genetic counselor explains that the mutations in the BRCA1 and BRCA2 genes, while dominant, are not inherited by everyone in a family. Also, even people with mutations in these genes do not necessarily get cancer — the mutations simply increase their risk of getting cancer. For instance, 55 to 65 per cent of women with a harmful mutation in the BRCA1 gene will get breast cancer before age 70, compared to 12 per cent of women in the general population who will get breast cancer sometime over the course of their lives.

Rebecca is not sure she wants to know whether she has a higher risk of cancer. The genetic counselor understands her apprehension, but explains that if she knows that she has harmful mutations in either of these genes, her doctor will screen her for cancer more often and at earlier ages. Therefore, any cancers she may develop are likely to be caught earlier when they are often much more treatable. Rebecca decides to go through with the testing, which involves taking a blood sample, and nervously waits for her results.

Chapter Overview: Genetics

At the end of this chapter, you will find out Rebecca’s test results. By then, you will have learned how traits are inherited from parents to offspring through genes, and how mutations in genes such as BRCA1 and BRCA2 can be passed down and cause disease. Specifically, you will learn about:

• The structure of DNA.
• How DNA replication occurs.
• How DNA was found to be the inherited genetic material.
• How genes and their different alleles are located on chromosomes.
• The 23 pairs of human chromosomes, which include autosomal and sex chromosomes.
• How genes code for proteins using codons made of the sequence of nitrogen bases within RNA and DNA.
• The central dogma of molecular biology, which describes how DNA is transcribed into RNA, and then translated into proteins.
• The structure, functions, and possible evolutionary history of RNA.
• How proteins are synthesized through the transcription of RNA from DNA and the translation of protein from RNA, including how RNA and proteins can be modified, and the roles of the different types of RNA.
• What mutations are, what causes them, different specific types of mutations, and the importance of mutations in evolution and to human health.
• How the expression of genes into proteins is regulated and why problems in this process can cause diseases, such as cancer.
• How Gregor Mendel discovered the laws of inheritance for certain types of traits.
• The science of heredity, known as genetics, and the relationship between genes and traits.
• How gametes, such as eggs and sperm, are produced through meiosis.
• How sexual reproduction works on the cellular level and how it increases genetic variation.
• Simple Mendelian and more complex non-Mendelian inheritance of some human traits.
• Human genetic disorders, such as Down syndrome, hemophilia A, and disorders involving sex chromosomes.
• How biotechnology — which is the use of technology to alter the genetic makeup of organisms — is used in medicine and agriculture, how it works, and some of the ethical issues it may raise.
• The human genome, how it was sequenced, and how it is contributing to discoveries in science and medicine.

As you read this chapter, keep Rebecca’s situation in mind and think about the following questions:

• BCRA1 and BCRA2 are also called Breast cancer type 1 and 2 susceptibility proteins.  What do the BRCA1 and BRCA2 genes normally do? How can they cause cancer?
• Are BRCA1 and BRCA2 linked genes? Are they on autosomal or sex chromosomes?
• After learning more about pedigrees, draw the pedigree for cancer in Rebecca’s family. Use the pedigree to help you think about why it is possible that her mother does not have one of the BRCA gene mutations, even if her grandmother, aunt, and uncle did have it.
• Why do you think certain gene mutations are prevalent in certain ethnic groups?

Attributions

Figure 5.1.1

Family Tree [all individual face images] from Clker.com used and adapted by Christine Miller under a CC0 1.0 public domain dedication license (https://creativecommons.org/publicdomain/zero/1.0/).

Figure 5.1.2

Rebecca by Kyle Broad on Unsplash is used under the Unsplash License (https://unsplash.com/license).

Wikipedia contributors. (2020, June 27). Ashkenazi Jews. In  Wikipedia.  https://en.wikipedia.org/w/index.php?title=Ashkenazi_Jews&oldid=964691647

Wikipedia contributors. (2020, June 22). BRCA1. In Wikipedia . https://en.wikipedia.org/w/index.php?title=BRCA1&oldid=963868423

Wikipedia contributors. (2020, May 25). BRCA2. In  Wikipedia.  https://en.wikipedia.org/w/index.php?title=BRCA2&oldid=958722957

Human Biology Copyright © 2020 by Christine Miller is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License , except where otherwise noted.

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A Case Study Documenting the Process by Which Biology Instructors Transition from Teacher-Centered to Learner-Centered Teaching

Gili marbach-ad.

† College of Computer, Mathematical and Natural Sciences, University of Maryland, College Park, MD 20742

Carly Hunt Rietschel

‡ College of Education, University of Maryland, College Park, MD 20742

Associated Data

A case study approach was used to obtain an in-depth understanding of the change process of two university instructors who were involved with redesigning a biology course to implement learner-centered teaching. Implications for instructors wishing to transform their teaching and for administrators who wish to support them are provided.

In this study, we used a case study approach to obtain an in-depth understanding of the change process of two university instructors who were involved with redesigning a biology course. Given the hesitancy of many biology instructors to adopt evidence-based, learner-centered teaching methods, there is a critical need to understand how biology instructors transition from teacher-centered (i.e., lecture-based) instruction to teaching that focuses on the students. Using the innovation-decision model for change, we explored the motivation, decision-making, and reflective processes of the two instructors through two consecutive, large-enrollment biology course offerings. Our data reveal that the change process is somewhat unpredictable, requiring patience and persistence during inevitable challenges that arise for instructors and students. For example, the change process requires instructors to adopt a teacher-facilitator role as opposed to an expert role, to cover fewer course topics in greater depth, and to give students a degree of control over their own learning. Students must adjust to taking responsibility for their own learning, working collaboratively, and relinquishing the anonymity afforded by lecture-based teaching. We suggest implications for instructors wishing to change their teaching and administrators wishing to encourage adoption of learner-centered teaching at their institutions.

This is the analogy I thought of, the first semester was where you drop a ball on a hard floor, and at first it bounces really high, then the next bounce is a little lower, hopefully it’s going to be a dampened thing, where we make fewer and fewer changes. Alex

It seems to take a village to send a course in a new direction!! Julie

INTRODUCTION

This study documents the process by which instructors transition from teacher-centered instruction to emphasizing learner-centered teaching in an introductory biology course. Weimer (2013 ) defines teacher-centered instruction as lecture-based teaching wherein students are “passive recipients of knowledge” (p. 64). She characterizes learner-centered teaching as “teaching focused on learning—what the students are doing is the central concern of the teacher” (p. 15). Weimer delineates five principles of learner-centered teaching, which are 1) to engage students in their learning, 2) to motivate and empower students by providing them some control over their own learning, 3) to encourage collaboration and foster a learning community, 4) to guide students to reflect on what and how they learn, and 5) to explicitly teach students skills on how to learn. Of note, various terms are used in the literature to refer to strategies that are related to learner-centered teaching (e.g., active learning, student-centered teaching).

The literature suggests that teacher-centered instruction as opposed to learner-centered teaching promotes memorization ( Hammer, 1994 ) rather than desired competencies like knowledge application, conceptual understanding, and critical thinking emphasized in national reports (American Association for the Advancement of Science [AAAS], 2011). Further, lecture-based teaching fails to promote understanding of the collaborative, interdisciplinary nature of scientific inquiry ( Handelsman et al ., 2007 ). Notably, female and minority students have expressed feelings of alienation and disenfranchisement in classrooms using teacher-centered instruction ( Okebukola, 1986 ; Seymour and Hewitt, 1997 ).

A recommended practice that can support implementation of learner-centered teaching is the use of the backward design ( Wiggins and McTighe, 2005 ). The backward design model involves articulation of learning goals, designing an assessment that measures achievement of the learning goals, and developing activities that are aligned with the assessment and learning goals.

Despite robust evidence documenting the superiority of learner-centered teaching over teacher-centered instruction (as reviewed by Freeman et al ., 2014 ), instructors continue to adhere to teacher-centered instruction. A recent study showed that the majority of faculty members participating in professional development programs designed to help them adopt learner-centered teaching practices continue to rely on lecture-based pedagogy as indicated by classroom observational data ( Ebert-May et al ., 2011 ). Possible reasons for such loyalty to lecturing include the following: 1) instructors’ own personal experiences with lecture as undergraduates ( Baldwin, 2009 ); 2) personal beliefs that transmission of knowledge to students through lecture is the best way to teach ( Wieman et al ., 2010 ); 3) the perception that lecture preparation is more time-effective than preparing learner-centered activities ( Dancy and Henderson, 2010 ); 4) student resistance to active learning ( Henderson and Dancy, 2007 ; Seidel and Tanner, 2013 ; Bourrie et al ., 2014 ); 5) initial difficulties are often encountered when transitioning to learner-centered teaching, requiring several iterations to perfect a new teaching style; 6) learner-centered teaching encourages instructors to cover fewer topics in greater depth to promote meaningful learning ( Weimer, 2013 ), and many instructors are uncomfortable with such loss of content coverage ( Fink, 2013 ); and 7) the learner-centered instructor must change his/her role from an expert who delivers knowledge to a “teacher-facilitator,” giving a degree of control over the learning process to students, and many instructors are uncomfortable with the unpredictability and vulnerability that comes with relinquishing control in the classroom ( Weimer, 2013 ). Further, universities oftentimes fail to incentivize and encourage faculty members to prioritize teaching to a similar degree as research ( Fairweather et al ., 1996 ). It has been argued that the professional culture of science assigns higher status to research over teaching, encouraging scientists to adopt a professional identity based on research that typically ignores teaching ( Brownell and Tanner, 2012 ).

Given that many instructors face challenges and intimidation while implementing learner-centered teaching in their classrooms, there is a need to explore their experiences and learn what support instructors need as they engage in the process of transforming their courses. Science education researchers have recently emphasized the critical need “to better understand the process by which undergraduate biology instructors decide to incorporate active learning teaching strategies, sustain use of these strategies, and implement them in a way that improves student outcomes” ( Andrews and Lemons, 2015 , p. 1).

Case studies have been shown as a useful tool to understand change processes ( Yin, 2003 ). A case study approach represents a qualitative method of inquiry that allows for in-depth description and understanding of the experience of one or more individuals ( Creswell, 2003 ; Merriam, 2009 ). Yin (2003 , p. 42) provides a rationale for using single, longitudinal case studies that document participants’ perspectives at two or more occasions to show how conditions and processes change over time. In this study, we used a case study approach to obtain an in-depth understanding of the change process of two university instructors (Julie and Alex) who were involved with redesigning a biology course. The instructors sought to transform the course from a teacher-centered, lecture-style class to one that incorporated learner-centered teaching. We interviewed the two instructors on multiple occasions; we also interviewed a graduate teaching assistant (GTA) and an undergraduate learning assistant (ULA) to gain their perspectives on teaching the course. We explored the motivation, challenges, and thought processes of the instructors during the interviews. We used several data sources in addition to the interviews to build the case study, including class observations by external observers and student feedback data.

Given that faculty members have difficulty changing their teaching, there are recommendations to use theoretical models of change to examine processes of change ( Connolly and Seymour, 2015 ). We looked for theoretical models of change ( Ellsworth, 2000 ; Rogers, 2003 ; Kezar et al ., 2015 ) and found that the innovation-decision model ( Rogers, 2003 ) has recently been used by science education researchers ( Henderson, 2005 ; Bourrie et al ., 2014 ; Andrews and Lemons, 2015 ). Therefore, we decided to use this model to theoretically approach our data. Specifically, we decided to use the adapted model developed by Andrews and Lemons (2015) , which they modified to represent the change process that biology instructors experience when redesigning a course. This model includes the following stages: 1) knowledge, in which the instructor learns about the innovation and how it functions; 2) persuasion/decision, in which the instructor develops an attitude, positive or negative, toward the innovation and decides whether or not to adopt the innovation; 3) implementation, when the instructor behaviorally implements the innovation; and 4) reflection, in which instructor considers the benefits and challenges of using the innovation. On the basis of reflection, an instructor decides to stay with the present version of the implementation or to start the process once again in an iterative manner by seeking new knowledge (see Figure 1 ). According to Rogers (2003) , a condition to begin the change process is that an instructor must be dissatisfied with his or her current teaching approach. Such dissatisfaction is one contributing factor leading an instructor to begin seeking new knowledge about new teaching strategies. Other external and internal factors usually influence an instructor’s decision to change his or her teaching, including release time, institutional commitment, and instructor attitude ( Andrews and Lemons, 2015 ).

Innovation-decision model adapted from Rogers (2003) , Henderson (2005) , and Andrews and Lemons (2015) .

Context of the Study

This study was conducted at a research-intensive university on the East Coast of the United States. The instructors cotaught Principles of Biology III: Organismal Biology (BSCI207). BSCI207 follows two prerequisite courses, BSCI105 and BSCI106. BSCI105 covers molecular and cellular biology, while BSCI106 covers ecology, evolution, and diversity. BSCI207 requires students to synthesize concepts and principles taught in prerequisite courses, apply them across contexts in biology, and generally engage in higher-order learning (e.g., interdisciplinarity, conceptual understanding, quantitative reasoning). The course enrolls between 100 and 200 students per semester.

In Fall 2013, the provost’s office distributed a call for grant proposals encouraging instructors to redesign their courses to incorporate evidence-based teaching approaches. The call specifically required applicants to design experimental studies to evaluate their course redesign approaches in comparison with their usual teaching approaches. Julie and Alex applied for the grant and were funded. Their proposed evidence-based teaching approach was to incorporate a series of small-group active-engagement (GAE) exercises throughout the semester. The traditional section would retain the usual three 50-minute lectures per week schedule. The experimental section would replace one 50-minute lecture with a shortened 20-minute lecture followed by a 30-minute GAE exercise with content matched to the traditional class occurring that day.

The instructors designed the GAEs to accomplish a series of learning goals that were consistent with Weimar’s five principles of learner-centered teaching. For example, one of the GAE goals was to foster collaboration among students in order to mimic the scientific process of inquiry. This goal was in accord with Weimer’s (2013 ) learner-centered teaching principle of collaboration, creating a learning community with a shared learning agenda, and modeling how experts learn. To accomplish this goal, the instructors implemented the GAEs in a small-group setting and required students to exchange ideas and achieve consensus on a single worksheet.

A second goal, which accords with Weimer’s (2013 ) framework, was to engage students in their learning and motivate them to take responsibility and control over their learning process. For example, one of the GAEs asked students to complete a humorous, fictional case study involving a spaceship captain and deadly neurotoxins. In this activity, students needed to use mathematical equations to calculate membrane potentials and to create simulations of conditions that impact membrane potential. Another activity was to collaboratively create a plot of ion transport rate versus concentration. Students were given a computer simulation that they used to generate data; they then entered the data into a Google documents Excel spreadsheet. This created a classroom database that was used to build the plot, which the instructor displayed using the lecture hall projector at the end of class. This activity involved multiple components of learner-centered teaching, including collaboration, student engagement, and student responsibility for learning. Detailed descriptions of a selection of GAEs are published elsewhere ( Carleton et al ., in press, 2017 ; Haag and Marbach-Ad, in press, 2017 ).

The provost grant offered funding that could be used for various purposes. The instructors decided to use the funding for summer salary to develop GAEs and to pay for support from a science education expert. Grant awardees were required to participate in Faculty Learning Communities (FLCs) and teaching workshops arranged by the campus teaching and learning center.

In Fall 2014, the instructors started to implement their experiment. Jeffrey, a third instructor, joined Alex and Julie to teach both sections; each of them was responsible for teaching several topics associated with their specific research expertise. In the GAE class, students were divided into small groups to complete a learning activity pertaining to the course topic. In total, 12 GAE sessions were held during the semester. Both GAE and traditional classes were taught in large auditoriums. For each GAE session, students self-selected into groups of three to five students. Four GTAs circulated among the groups to facilitate group work. Students were asked to leave empty rows around their respective groups to allow GTAs to move throughout the groups. This same topic was covered only by lecture format in the traditional class.

In Fall 2015, the instructors no longer conducted a comparative experiment while teaching. Julie and Alex continued to coteach the course with the GAE format with many modifications to the activities and other aspects of the course (see Results ). Jeffrey continued to teach a different section of the course independently. Henceforth, we will describe the experience of Julie and Alex in their process of transforming the course.

Teaching Staff

Julie and Alex are associate professors. Lisa is a doctoral-level teaching assistant (TA) in the biology department. Lisa was a GTA in the Fall 2014 and Fall 2015 semesters. Jason was a freshman student in the GAE section of the Fall 2014 semester. In Fall 2015, Jason served as a guided study session (GSS) peer leader in BSCI207. GSS leaders are students who have taken a course on implementing evidence-based teaching approaches, and who have also completed the course they are tutoring with a high grade. GSS students are expected to facilitate small-group discussions outside class. Jason also volunteered to attend all GAE sessions to help facilitate.

Data Collection Instruments

Yin (2003) notes that multiple data sources are important in building case studies. As such, we use interview data, class observations, student feedback on the course, and information written in the grant proposal.

Interview Protocol.

Julie and Alex were interviewed independently immediately following Fall 2014 for 20 minutes each. Julie was also interviewed independently in the beginning of Fall 2015 for 1 hour. Julie and Alex were interviewed together immediately following Fall 2015 for approximately 1 hour. Lisa and Jason were also interviewed following Fall 2015 for 20–30 minutes each. We used semistructured interview protocols (see the Supplemental Material) with additional questions to probe for clarification. The questions probed participants’ motivation for change, attitudes toward change, barriers and challenges, administrative supports, details about the implementation, and teaching philosophies.

Class Observations.

Two independent raters conducted class observations. Each year, raters attended six classes. In Fall 2014, they observed GAE class sessions and the parallel, content-matched class sessions that took place in the traditional class (overall 12 sessions). This procedure allowed the raters to compare the class sessions covering the same material but with differing teaching approaches (i.e., learner-centered vs. teacher-centered instruction). The two raters attended each class session together. Once in the class, the raters used a rubric to evaluate the class. In Fall 2014, raters used a rubric based on a previously constructed rubric that was created by the biology department for peer observations ( http://extras.springer.com/2015/978-3-319-01651-1 , in SM-Evaluation of teaching performance.pdf). In Fall 2015, to better document group work, the raters used the rubric developed by Shekhar and colleagues (2015) .

Student Feedback.

Students were invited to reflect on GAEs by providing anonymous written feedback on note cards following the activity. We use some of these data in the present study.

Data Analysis

Interviews were conducted by a science education researcher, audiotaped, and transcribed. A science education researcher and a doctoral student in counseling psychology separately analyzed the interviews and the note cards to define emergent themes. Then, they negotiated the findings until they could agree upon the themes ( Maykut and Morehouse, 1994 ). The instructors were shown the interpretation of data to verify accuracy of interpretations. We present the results in accordance with the adapted Rogers (2003) model presented in Andrews and Lemons (2015) . We slightly adapted the Andrews and Lemons (2015) model to the iterative process through which our instructors progressed to modify the course (see Figure 1 ).

Motivation for Change

Before 2014, the traditional BSCI207 class as taught was a three-credit course with three 50-minute lectures per week. Alex described the traditional course:

Before the GAEs came into being, we taught in the very standard, traditional lecture. We used mostly PowerPoint to show text and images, occasionally we would bring a prop in, like sometimes I would bring a piece of a tree to gesture towards as I was lecturing about water transport or something like that. But it was basically standard lecture.

The instructors were dissatisfied with the traditional lecture format for the following reasons:

• Evidence for inferiority of teacher-centered instruction compared with learner-centered teaching . The instructors expressed awareness of the empirical data documenting the superiority of learner-centered teaching over teacher-centered instruction, “There’s a lot of research that suggests that [teacher-centered instruction] may not be the best way to help the students understand what we’re trying to get them to understand” (Alex).
• Lecture hinders understanding of the process of science. The instructors also expressed a desire to get students to learn the process of science early in their education, rather than to passively receive information. “We are being asked as science professors more and more to try and get our students to understand that science is a process, earlier and earlier in their career, and to model what real science is like in their education” (Alex).
• Lecture promotes overreliance on memorization. The instructors discussed a goal to modify the course so as to decrease focus on memorization and increase emphasis on problem solving and conceptual understanding. Julie described: “BSCI207 is the biology majors’ class, and it’s a lot of what the pre meds are taking, and so, critical thinking I think [is important], we’re constantly trying to get them to not just memorize and regurgitate but to put the ideas together.”

We also rearranged the material. So they [the lectures] used to be in a taxonomic orientation, I would give a whole lecture titled the biology of fungi, and the students complained that this taxonomic focus seemed to resemble the structure of BSCI106 [the prerequisite course]. I decided to explode those taxonomic lectures, and take the bits of content that I still thought were valuable, and spread them into other parts. So for example the stuff on mating types, which is wacky and interesting to me, and I hope to the students, is now in a lecture on sex. And they don’t realize half the lecture is on fungi. So they’re susceptible to packaging I think, and we don’t get the complaint any more that the course is redundant to BSCI106 (Alex).

Organisms don’t care about our disciplinary boundaries of research. The organism doesn’t understand that there’s biophysics, and biochemistry, and evolutionary biology, and ecology, and genetics. All these attributes of their biology have to function simultaneously on several different spatial and temporal scales … if we think they do, then we continually miss things that otherwise would fall out naturally if we were a little less wedded to our disciplines.

Relatedly, the instructors noted that most students enrolled in BSCI207 without having taken introductory physics or chemistry, which they thought was preventing students from drawing upon highly relevant concepts (e.g., thermodynamics) from these courses for biology.

• Underrepresented groups do poorly in traditional classes. The instructors quantitatively examined student performance for specific student subgroups (i.e., underrepresented minority students, female students) in previous BSCI207 semesters. They observed that there were disproportionate D/F/W grades for underrepresented students. Coupled with the science education literature documenting the ability of active learning to help underrepresented groups ( Preszler, 2009 ; Haak et al ., 2011 ; Eddy and Hogan, 2014 ), the instructors speculated that adding active learning to the traditional class might help underrepresented students.

In Fall 2014, the instructors went through the process of course revision that follows the adapted model by Rogers (2003) and Andrews and Lemons (2015 ; see Figure 1 ). In the following sections, we discuss their progression through the innovation-decision model. Table 1 shows a summary of the change process for the Fall 2014 semester.

First Iteration of the instructors’ change process

Before the Fall 2014 semester, the instructors engaged in several efforts to increase knowledge about evidence-based teaching approaches to modify the course. The knowledge sources were as follows:

I will go ask [physics education professional] questions. When something doesn’t go well I’ll meet with the postdocs [from physics education research group (PERG)] over there and say, what are they not getting here, how can we make this better, so I’m always trying to get resources to help.

• Reading the science education literature. As a new instructor, Julie participated in the college workshop for new instructors. The workshop was led by the director of the teaching and learning center, who provided several resources for using evidence-based teaching approaches, including an article giving an overview of learning styles ( Felder, 1993 ), a book on teaching tips ( McKeachie and Svinicki, 2006 ), and the book Scientific Teaching ( Handelsman et al ., 2007 ). In her interview, Julie commented, “So I read a lot of books,… I think it was getting students to think about math, I read one of the books [that the director of the college teaching and learning center] had given me [ Scientific Teaching ].”
• Observing other instructors teaching. The instructors had observed another instructor who implemented evidence-based teaching approaches in a small class of BSCI207 (<40 students). This pilot implementation was successful, and the instructors were interested in investigating whether the learner-centered teaching model used could be scaled up to a large-enrollment class.

Persuasion/Decision.

Following the knowledge-generation phase, the instructors felt prepared to change their teaching to a more learner-centered teaching style. They decided to conduct a comparative experiment during the first implementation of the GAEs (i.e., traditional vs. GAE classes; see Marbach-Ad et al ., in press, 2017 ). Although the instructors were aware of the literature documenting the effectiveness of learner-centered teaching, they had several reasons to execute the experiment:

• Obtain evidence for overall effectiveness. The instructors were unsure whether their activities were the best way to change the course (e.g., they were unsure of the challenges that would emerge, how the intervention would impact students). The instructors also wished to explore cost-effectiveness, since they knew that changing the course would require a high instructor time commitment.
• Convince colleagues to adopt learner-centered teaching approaches. The instructors noted that faculty in the department were unconvinced of the superiority of learner-centered teaching approaches, and they thought that a comparison study bringing empirical evidence might demonstrate that changing one’s teaching style is worthwhile. Alex stated, “[A] lot of my motivation for this experiment was to try to provide some evidence that these approaches were worth the effort, and because there is resistance clearly, from some of our colleagues who have been teaching the course for a long time.”
• Respond to grant award requirements. As mentioned earlier, the institution announced a call for proposals for instructors to revise their teaching. The instructions required applicants to propose comparative experiments during course revision to document effectiveness.

Implementation.

As proposed in the provost grant application, the instructors executed the comparison study. In the traditional class, instructors delivered a 50-minute lecture three times per week. In the GAE class, one lecture was replaced with a GAE. The GAE consisted of a brief 20-minute introductory lecture (a short version of the lecture presented to traditional class students) and a 30-minute group activity. As scientists, the instructors wished to manipulate the addition of the GAE day only and to keep remaining variables constant across classes. Therefore, homework assignments, examinations, optional computer tutorials, and office hours availability were consistent in both classes (see Table 2 ).

Fall 2014 class comparison

In the GAE class, on the day of the GAEs, students were instructed to sit with groups of three to five students (of their own choosing) and to leave empty rows between groups. Students were asked to have at least one laptop per group. As discussed previously, the GAEs were designed to be more learner centered relative to traditional lecture classes. To illustrate this here, we give Alex’s description of the membrane transport GAE: “The students had a little computer simulation, and they used that to generate data that they then entered into a Google docs spreadsheet in real time in the class, and there were enough students in the class that their responses produced this beautiful textbook plot of transport rate versus concentration. They built that relationship in a way that otherwise I would have just told them.”

Reflection.

Following the Fall 2014 semester, the instructors reflected on the various pros and cons of the learner-centered teaching intervention in the interviews. Observers and students also provided feedback that was used by the instructors to reflect on both sections of the course and on the comparative experiment. Several themes emerged from these data:

It’s much less about my spouting facts, it’s about my thinking ahead of time to get them to draw conclusions and get them to cement ideas. My role was partly just to control the chaos sometimes, and to control that the TAs had the information they needed so they could provide guidance to the students.

Importantly, observers noted that the instructors were very actively engaged with student groups throughout the GAEs, helping students to work through problems and understand concepts. Julie also commented that teaching with GAEs requires greater proficiency with material than lecturing: “To use these activities, you have to know the material better than if you’re going to straight lecture. And I think some instructors are maybe still learning BSCI207, what is all the material in it. And until you teach it straight a couple of times you probably don’t have the background to really understand.”

We spent less time talking about dating the origins of life using various methods (fossil record, carbon dating); we got rid of a lecture on prokaryotes and had to shrink some of the nutrient assimilation information from two lectures to one.

The instructors explained that, in order to minimize loss of content coverage, they decided to have a GAE class only once per week and to pick GAEs corresponding to lecture topics for which “there was the least amount of lost material by focusing on a particular exercise” (Alex). An additional solution was to move in-class lectures to online, preclass lectures. Julie described this change: “We also ask students to review some of the material that is lost during lecture time into the prep slides they review ahead of time.” However, Julie wondered whether students would benefit from online lectures to the same degree as in-person lectures: “I am still worried they don’t get so much out of those [online lectures] and so miss much of that information.”

• Engagement in learning. Overall, the instructors reflected that most GAEs provided a space for students to interact with one another, TAs, and instructors: Julie added, “I think it was nice to see the energy in the class and the way the students took to the activities, it was different for them.” Observers noted that the GAE class treatment condition was usually associated with increased student interactivity. Specifically, they noted that students in the GAE class were not only more engaged in the GAEs, but that they also tended to raise more questions during the PowerPoint presentations relative to students in the traditional class. Students reflected on their note cards following GAEs, and in the end-of-semester survey, noting that they felt that many of the GAEs were engaging (see Marbach-Ad et al ., in press, 2017 ).
• Giving students control over learning. The instructors noted, “The GAEs represented a chance to turn the class over to the students for some part of the time, where they could do something actively, instead of just sitting there listening to us” (Alex).

It’s actually a bit more how real science works, right, even as somebody who runs a lab, I don’t go into my lab and sit there and talk to my graduate students for four hours, I mean we have a brief conversation about how they should tackle something, and then they go off and work more on it. So it’s more of a checking in and then separating again. That’s kind of how this class works, the GAEs do give the students a little more of a feel of how collaborative real science works, and how no one person is sort of dictating everything, everyone needs to be a bit independent. … I think that this active model gives the students, for the first time, a real taste of how a real scientist would approach a problem.

Students commented on the opportunity afforded by GAEs to take an active role in their learning: “I learned how to apply what we learn in lecture class to actual problems”; “I kind of felt like a real scientist since I was put in a situation in which I had to make a hypothesis myself.”

• Disengagement. The instructors noted that, for some GAEs, students were disengaged. For example, in the GAE on stress and strain, two students were doing measurements in front of the class for 10–15 minutes, and the remaining students were instructed to input data into Excel files. These data were then used to make calculations. Students also expressed their dissatisfaction with this activity on the note cards that they handed in to the instructors: “I feel I understood the concept well once Dr. Julie wrote the plots on the board. This activity was more tedious and like busy work”; “ We could have easily compared values without experimentally finding them. I didn’t feel this deepened my understanding of concepts.”
• Insufficient time for reflection. The instructors noted that most exercises were too long, which did not leave sufficient time for reflection. Alex noted, “Well I think also making sure that if we get the exercise done in the right, short amount of time, then that does give us time to add a reflection at the end. Connecting the results of our exercise back to some larger idea.”
• Student preparation. The instructors felt that students would gain more from the exercise, if they were to come to GAE classes with better understanding of concepts relevant to the GAE. Then, more time could also be allotted for summary and reflection on important concepts. Alex commented, “We probably will need the students to do a bit of preparation before they come in to these active exercises, so that we can spend less time setting it up, and more time summing it up.”
• Assessments and grading misaligned with GAEs. In this implementation, instructors kept the same assessment plan for both the traditional class and the GAE class in order to compare achievement across classes. This resulted in a mismatch between the course activities and the assessments in the GAE section. For example, there were no final examination questions specifically covering GAE material. Of note, the instructors analyzed their final examination questions before conducting the experiment and saw that the questions required students to demonstrate high levels of thinking ( Bloom and Krathwohl, 1956 ; e.g., knowledge application, quantitative analysis), and they believed the GAEs would improve students’ abilities in these areas. Further, the instructors did not count GAE participation toward final grades, which instructors and observers believed had a detrimental effect on GAE attendance. Julie noted that “on the GAE days, only 60% of the students would come. That was partly because they wouldn’t get any credit for it, and they weren’t seeing that it was helping them learn the material better.” Analyses showed that students with higher grade point averages (GPAs) were those who chose to attend on the GAE days (see Marbach-Ad et al ., in press, 2017 ). Given this, the instructors felt that attendance should be incentivized in future implementations of the learner-centered teaching intervention to motivate and benefit a wider range of students.
• Resistance to learner-centered activities. The instructors felt that students’ low attendance specifically on GAE days may also have been because the students did not perceive the benefit of GAEs for their learning. “I feel sort of parental here, maybe the GAEs are like broccoli and brussels sprouts, they need them, they just don’t know it yet” (Alex).
• Group dysfunction. The instructors and observers noted several issues with the groups. Some groups were not engaged, and some students were not participating within their groups (e.g., one student would be left out). In some activities, some groups would finish the activity very quickly and would subsequently appear bored and waiting for further summary or instruction. Julie was frustrated with these occurrences and noted, “People would be sitting there on their phones.” One reason for student disengagement could be that students groups were unassigned and could include different students each week: students “would sit and associate with whoever was around them” (Julie).
• Auditorium-setting challenges. The instructors commented on the difficulty of doing GAEs in the large auditorium: “It’s still tricky to think about how you actually stage all of this, there is a bit of theater to running a large class with 200 students, how you move from one aspect of the process to another [lecture to group activities] quickly, without losing people, without too much noise and disturbance” (Alex).
• Little impact on grade distributions. Alex and Julie were hopeful that the GAEs would lead to large improvements in students’ grades as compared with traditional learning. However, the effect of GAEs was very small. Alex commented, “This was the biggest outcome from my perspective, and it drove much of the revisions for 2015. This is interesting, as it shows that even though we were unable to realize a big payoff in the first year, we nevertheless saw something that we thought was worth keeping and hopefully improving upon.”
• TA training required. The instructors reflected that they did not provide adequate TA preparation for the GAEs: “We hadn’t really prepared the GAEs enough ahead of time so that we could talk about them with the TAs. The TAs at times were really clueless about what was supposed to be happening” (Julie). TAs, although instructed to guide and facilitate groups, apparently lacked the skills to engage students, as observers noted that most of them passively waited for students to ask questions rather than actively approaching students with questions, instructions, etc.

On the basis of their reflection, Julie and Alex decided to continue teaching with GAEs and to seek new knowledge to improve GAEs. In the following sections, we discuss their continued progression through the innovation-decision model (see Figure 1 ). A summary of the change process in Fall 2015 is shown in Table 3 .

Second iteration of the instructors’ change process

• Learn about methods to form successful groups. The instructors reviewed the literature and consulted with the director of the teaching and learning center and other faculty members in the department to form new strategies on building effective groups in auditorium settings. The literature shows that groups work best when they are permanent and students are held accountable to other group members ( Michaelsen and Black, 1994 ; Michaelsen et al ., 2004 , 2008). The literature also shows that taking student diversity into account is important in creating successful groups ( Watson et al ., 1993 ). For example, Watson and colleagues (1993) reported that, although it takes time, heterogeneous groups outperformed homogeneous groups on several performance measures, including generating perspectives and alternative solutions. The instructors also learned from the director of the teaching and learning center about the Pogil method ( pogil.org ), in which students are assigned different roles during group work (e.g., recorder, facilitator). They weighed the pros and cons of implementing this method in the classroom.
• Learn about methods to flip courses. The instructors learned from models of flipped classes ( Hamdan et al ., 2013 ; Jensen et al ., 2015 ), which highlight how to capitalize on out-of-class time to cover material to prepare for face-to-face active learning. In this regard, instructors sought assistance from the information technology office about presentation software (i.e., Camtasia) that can deliver automated lectures effectively.
• Seek expert guidance. During the summer, the instructors again consulted with science education experts to enhance the GAEs. For example, they consulted with a science education expert on how to revise the concept map assignment. Julie described how this guidance helped her “leave the activity a bit more free form and get the students to make a graphic organizer of their own design rather than trying to fill in some pre-designed boxes.” As another example, the science educator recommended strategies about how to streamline GAEs to maximize time spent on developing conceptual understanding and minimize time spent on the mechanics of exercises.
• Learn about strategies to enhance TA support. The instructors wished to decrease student to TA ratio. However, GTAs require departmental funding, which was unavailable. The teaching and learning center director and the biological sciences administration offered to involve ULAs who are unpaid but receive alternative benefits, such as leadership and teaching experience and undergraduate course credit. This model was reported to be successful in our university ( Schalk et al ., 2009 ) and in other institutions ( Otero et al ., 2010 ).

Following reflection on the comparative experiment, instructors sought to keep improving the course and decided to make several changes:

• Teach all sections with learner-centered teaching. Although the instructors reported that keeping the GAE class format requires more time to prepare relative to lecturing and takes time from their research (“fine tuning the GAEs—that took weeks” [Julie]), they decided to implement the GAEs in all sections and to work to improve them.

[Last semester] I had a couple of students up front doing the experiment, and everyone else was kind of twiddling their thumbs while we gathered the data. We talked about the data but we didn’t really have time [to do data analysis and summarize concepts]. I think this year I’m just going to give them last year’s data, and have each group do some analysis.

As another way to modify GAEs, instructors decided to utilize more outside resources such as published, case-based activities. Julie described, “I’d love to come up with some more case studies that we could do. You know the Buffalo site [ http://sciencecases.lib.buffalo.edu/cs/collection ] has all the case studies for all the science classes. So I’m constantly perusing that. A couple of the GAEs that I developed actually come from there.”

I haven’t figured out what the best prep work is. What Alex has been doing is taking the slides he showed last year and just posting them online. I’m not sure that’s the best, or really enough.… But, then they just read. I mean he tries to put more words on them. I tried to find some videos that I thought were appropriate, and I’m not sure that’s any better. I was going to do some of these with Camtasia. In this way you can actually have the slides and actually talk over them and record. But I couldn’t make the software work. I haven’t really gone there yet, I will have to figure that out.

To encourage students to prepare for the GAEs, the instructors decided to give a preclass quiz covering the out-of-class preparatory materials. Julie described,

We’re also doing a quiz this time, we’re giving that preparatory information, they have to have done it by the morning before, they have to take a little 2-point quiz [before class] to show that they’ve covered that material. Then we have the whole class time [for the GAE] so that we’re not so rushed in trying to do to many things at one time.

• Train the TAs better, add ULAs, and involve both teams in the process of GAE development. The instructors decided to expand the team of assistants to decrease the ratio between students and TAs. Julie described the change from Fall 2014 to Fall 2015: “We have a bigger team. We have two of these ULAs, and then we have three UTAs, and two GTAs. So a team of seven helpers, and each person has a different job. The ULAs are specifically supposed to be trying out the GAEs ahead of time. So we kind of run things past them. And then we meet with all the TAs, and then talk through the GAEs beforehand. They have an assigned part of the class, where each of them is hopefully seeing the same students over and over, and hopefully getting to work with them to develop a rapport, and they go in the middle of the activity, so kind of checking in, so what do you think, kind of getting students to verbalize.” The benefit of this new format, where each TA was responsible for a subsection of the large class, was that it approximated a smaller class discussion session in which students could get to know their TAs more personally.
• Revise group structure. On the basis of the literature and their previous experiences, the instructors decided to assign permanent, diverse groups of four at the beginning of the semester. They also decided to instruct students on how to sit in the auditorium with their groups (in two rows rather than in a single line, to enhance group communication) and to award points for completing group work exercises.

In the Fall 2015 implementation, there were several changes to the course (for a comparison of 2014 and 2015 GAE classes, see Table 4 ).

GAE class comparison between Fall 2014 and Fall 2015

• Modify the activities. The instructors devoted a full weekly class period to the GAE instead of 30 minutes. On the basis of their experiences in the previous semester, they revised some GAEs and adapted them to the time frame. Although they had more time for the GAEs, they wished to make them more efficient and interactive: “I think we had to cut some, with the GAEs, because they were taking way too long, but I think in a few cases we simplified them, took out 1/3 of them or something” (Alex). Instead of the 20-minute pre-GAE lecture that was presented in the Fall 2014 implementation, students were asked to prepare for activities at home by watching videos, reviewing lecture slides, and reading textbook materials. In contrast with Fall 2014, the students were awarded three points for participating in the GAE activity and two points for completing a quiz covering preparatory materials that was due before the GAE class. The instructors wished to assign points to these activities in order to “really give them weight” (Julie). “[The activities] formed a large part of the exams as well. So making the activities more integral to the class was a big change” (Julie).

So the next time I drew a map in the room, [which showed] two students in the front, and two students in the back. When you have a very formal auditorium, you have to try and help them assort with each other and talk with each other. The other thing we did was, we were giving each group two copies of the assignment, so they didn’t each have one. So that kind of helped, that kind of had them sharing things.

Finally, TAs and ULAs were assigned to stay with one section of the lecture hall throughout the semester. Thus, TAs and ULAs developed a rapport with a large group of students throughout the semester and were able to learn their names, which facilitated communication.

• Add more and better-trained TAs. Before Fall 2015, the instructors trained the TAs to better engage with student groups in class. Class observation data showed that, in Fall 2014, some TAs were lacking in their ability to engage actively with students. One observer described, “When I observed the classes last year [Fall 2014], they [TAs] were standing in the side [of the auditorium], and sometimes they got to students, but just students that raised their hands. They weren’t active. They were very passive, most of them, because they didn’t know what to do.” Following the implementation in Fall 2015, the observer noticed a change in TA involvement: “Now, it’s more about instruction, they circulate between groups and encourage them to ask questions, they encourage students that aren’t participating … it’s not enough to throw them [the TAs] in the classroom.”

Overall, instructors noticed improvements in the areas that they targeted to improve, and they also felt there were areas that they wished to continue improving.

• Student preparation. Julie described that although new techniques were put in place to increase student preparation, students often seemed unprepared for the activities: “And my data for that is essentially for the first 20 minutes of the GAE they would spend saying, what are we doing? There was a lot of flailing. It took them a lot longer to get going with the GAE than I thought, and I’m not sure if that’s because the preparatory material is not really preparing them, or that they just took the online quiz and didn’t really go through the preparatory material.” Julie thought about changing the nature of the preparatory lectures, “I would still like to explore turning those into little online lectures rather than having them read the slides.”
• Student attendance . Alex commented that the strategy of assigning points to participating in GAEs “made a big difference in attendance […] by incentivizing their attendance, at least on GAE days, they were coming.” The instructors commented that incentivizing participation in the GAEs and the preactivity quizzes increased the amount of student–instructor interaction regarding point grabbing. Alex stated, “The downside of associating points with everything is that I think we spent the largest fraction of our student interaction time dealing with the points related to the GAEs, excused absences, non-excused absences, anxiety about the points, I mean these are tiny amounts of points, but the students took it very seriously. But I think it was one of the top 3 issues that students came up with this semester.”
• Mechanics of exercises. Julie was very frustrated with how students could not effectively operate Excel software: “And they still don’t know Excel. My biggest frustration was that I thought Excel would make their lives easier, and it made their lives harder. I’m almost ready to go back to pencil and paper, just to get them to plot things and think about things, because they’re not getting back to the scientific inquiry and hard thinking, they’re just so stuck in which box do I click.” Alex added, “My issue is that the preparatory materials do a good job preparing them intellectually for what’s the point, but then they do get stuck on the mechanics, what they’re doing with their hands.”
• Allocating time for reflection. The instructors described that they improved substantially in the area of summarizing major concepts and timing activities: “I think we did a pretty good job of every 15 or 20 minutes bringing them back together and saying ok, you would have done this by now. There were a couple that worked really well, and a couple where we were still pressed for time. I think that generally it was far improved” (Julie). Because the instructors had the full class period to devote to the GAE and did not need to compare learner-centered teaching with teacher-centered instruction, they felt that the timing of the activities was much improved. Julie noted, however, “I always overestimate what students can do. I’m still adjusting.”
• Technical issues. There were difficulties with connecting to the wireless Internet in the lecture hall, particularly among students who failed to download the appropriate tools before coming to class. Further, students have different types of computers and software programs and knowledge of software programs required for the course.

The organized approach helped students see the material as well as make a few friends, in fact, I remember coming onto my dorm floor and seeing four people from my class working together, and they were actually in that GAE group, they had made a study group because they were used to working together. One of the aims of this project gets students communicating instead of competing.

Julie commented that there is still room for improvement in the student groups: “I saw a number of groups where at least one person would be left out. I don’t know if that’s a physical orientation, if we could point them toward each other it would be better. Next year one thing we talked about is going to groups of 3, because with 3 you can always get across each other and be more … everybody can talk to each other.” The instructors considered the benefits of the Pogil. Julie explained that they tried to appoint a different group member to act as the scribe each week during GAE activities as a way to increase student participation in groups. The instructors did not strictly enforce this policy, as they were not sure it was beneficial.

And we also had some undergraduates this year, … and I think they were really helpful because they understand what the students are capable of, more than we do … a lot of times they can give you some insight into what’s going on or what classes undergraduates are most likely taking at the same time. It was very helpful.

Finally, Lisa felt that the level of engagement among the teaching staff was higher than for a standard lecture course: “Everyone was very engaged, it’s a unique class to TA for, because I feel like the TAs and the professors are far more engaged than in a standard lecture course, so it was kind of nice.” Alex reflected that, in the future, “It would be even better,” since they will have “a whole floor of ULAs that had us for 207,” and they “will be well-positioned” to assist in the redesigned course.

This case study examines instructor change processes when moving from teacher-centered instruction toward learner-centered teaching. In this study, we examined the change process through the lens of the innovation-decision model ( Rogers, 2003 ; Andrews and Lemons, 2015 ), which recognizes several stages of change: knowledge, decision/persuasion, implementation, and reflection. The model is iterative, recognizing that transforming courses may require multiple revisions as instructors reflect on the inherent challenges and imperfections that arise when changing a course ( Henderson, 2005 ). Consistent with this literature, the first implementation of learner-centered course revision was fraught with imperfections, and the instructors persisted through two rounds of course revision before gaining satisfaction with their teaching approach, although they plan to continue enhancing the course with each semester.

Andrews and Lemons (2015) note that dissatisfaction with one’s current teaching approach is an important motivator leading instructors to change their teaching. Our instructors were dissatisfied with the lecture mode of teaching in their courses due to personal dislike for it, and the sense that it encouraged student reliance on memorization and hindered interdisciplinary thinking. Other motivators for change included 1) awareness of national recommendations to use learner-centered teaching ( AAAS, 2011 ); 2) a hope that underrepresented students would benefit from learner-centered instruction, based on education literature documenting such benefits ( Okebukola, 1986 ; Seymour and Hewitt, 1997 ); and 3) institutional support (i.e., a provost office grant initiative).

These motivations led the instructors to seek new knowledge about learner-centered teaching approaches and how to implement them, which, according to the adapted innovation-decision model ( Andrews and Lemons, 2015 ), is a first step toward changing a biology course. In the present study, knowledge-seeking strategies included consultation with science education experts and information technology experts, reading the empirical literature, observing other faculty members who had adopted evidence-based teaching practices, and involvement with a discipline-based FLC. Following the knowledge stage, the instructors progressed through the decision/persuasion and implementation stages of change. In the reflection stage, the instructors discussed what worked well, challenges, and areas they wished to improve in the subsequent iteration. We present here implications from this study for instructors seeking to change their courses, and also for administrators wishing to promote learner-centered instruction at their institutions.

IMPLICATIONS FOR INSTRUCTORS

Weimer (2013) noted that engaging students in their own learning is messy, unpredictable, and challenging as compared with teacher-centered instruction. The process can be difficult for the faculty members who want to change as well as for the students. First, the instructor must adopt a new role as “instructor-facilitator” ( Weimer, 2013 ), giving up a degree of control to the students to take responsibility for their own learning. Relating to their new role, our instructors reported that, on the one hand, the instructor-facilitator role felt like controlling chaos at times, particularly in the beginning, but that it was markedly beneficial for student learning and for their own teaching. For instance, it gave students an opportunity to be independent learners and to engage with their peers in collaborative problem solving, more closely modeling the process of science. Thus, although it may be intimidating to share control over the learning process with students, it appears that there are benefits for both students and instructors.

Second, learner-centered teaching encourages instructors to cover fewer topics in greater depth, as opposed to more topics in less depth ( Weimer, 2013 ). Despite being uncomfortable with losing content coverage due to the function of BSCI207 as a preparation course for the MCAT and a prerequisite, our instructors decided to remove some course topics and consolidate others into shorter units. Next, they implemented several solutions to the necessary loss of content coverage. First, they moved lecture content to required preclass, online lectures that substituted for in-class content coverage. Second, they were strategic about which course topics they used to redesign as GAEs. Specifically, they selected course topics that were historically conceptually challenging for students (e.g., membrane transport). Our faculty members’ transition process provides an example of how faculty members can identify and implement solutions for concerns about loss of content coverage.

Third, a fundamental principle of learner-centered teaching is to encourage collaboration in the classroom ( Weimer, 2013 ). To this end, our instructors implemented GAEs, a series of group work–based activities. Student collaboration is important, because it promotes sharing of the learning agenda ( Johnson et al ., 1984 ; Weimer, 2013 ), and collaboration is a skill that is essential for the workplace ( Hart Research Associates, 2015 ). Group work is a common and accessible strategy that instructors can use to increase learner-centered teaching in their classrooms. Our instructors experienced various challenges and implemented several revisions to group work activities throughout their change process. The most successful strategies for optimizing group work included 1) increasing the number of TAs and the amount of TA training; 2) creating diverse and permanent student groups to increase accountability ( Michaelsen et al ., 2004 ); 3) assigning grades and preparation assignments for group work activities; and 4) restructuring group work activities to provide more time for whole-class summary and reflection on concepts. Group work is just one type of teaching strategy that can increase learner-centered teaching. Each instructor needs to discover what kinds of approaches are most suitable to increase their level of learner-centered teaching. When selecting and implementing new teaching strategies, it is highly recommended to seek guidance from experts, more experienced faculty members, or from a teaching and learning community.

Transitioning away from lecture-based instruction to learner-centered instruction can be challenging for students as well as instructors. The literature has shown that students resist many learner-centered approaches that require them to engage in the classroom rather than sit anonymously in lecture ( Michaelsen et al ., 2008 ; Shekhar et al ., 2015 ). Our instructors learned about student resistance through several means: 1) student feedback that was collected on note cards at the end of GAE classes, 2) end-of-semester surveys asking students to reflect on each activity, and 3) low attendance on GAE days as compared with lecture class days. It is important for instructors transitioning their courses to monitor student resistance and satisfaction, as our instructors used these data to modify the activities from the first to second iteration.

The instructors used several strategies to reduce student resistance. First, through student feedback, instructors learned that they needed to provide students with better explanations for the purpose of doing GAEs as opposed to sitting in lecture class. Weimer (2013) emphasizes the importance of providing students explicit instruction on how to best learn. Therefore, at the second iteration of the learner-centered implementation, the instructors were explicit about the rationale for the GAEs. At various points throughout the semester, the instructors explained how the GAEs were helpful in enhancing skills (e.g., critical thinking, problem solving, collaboration, understanding the interdisciplinary nature of science, relating course material to everyday life and to scientific research) that are recommended by national organizations ( AAAS, 2011 ) and employers ( Hart Research Associates, 2015 ). Second, instructors awarded class participation points for completing GAE exercises and grades for completing the preclass online quiz. This strategy resulted in better alignment between requirements of students and course assessments, which accords with Wiggins and McTighe’s (2005) backward design theory. This method of GAE grading resulted in much higher student attendance as compared with the first iteration. Third, instructors used evidence-based strategies to reduce resistance within student groups, including creating permanent, diverse groups at the start of the semester. Fourth, instructors took student feedback into account with regard to their satisfaction with specific activities and modified activities with the goal of maximizing student engagement.

IMPLICATIONS FOR ADMINISTRATORS

Given that changing one’s teaching from teacher-centered instruction to learner-centered teaching is challenging, there must be administrative support for these efforts.

First, administrators can play a key role in acknowledging the importance of learner-centered teaching. Historically, universities have failed to encourage faculty members to prioritize teaching to a similar degree as research ( Fairweather et al ., 1996 ). Unfortunately, many tenure-track faculty members at research-intensive universities fear that they may be penalized for investing the time to adopt learner-centered teaching. Research-oriented universities should prioritize teaching in order to support more widespread adoption of evidence-based teaching approaches. Julie reflected on her frustration with the university’s message that teaching is devalued relative to research:

I think for assistant professors, I was actually scolded for putting time into teaching and trying to participate in teaching improvements and so, I think it’s discouraged, perhaps rightly so, because they’re not going to value it, so if that’s going to take away from what’s required to get tenure, to get promoted, they want you to know that. So they’re just being honest perhaps.

As part of a university culture that values learner-centered teaching, administrators (e.g., chairs, promotion committees) should acknowledge instructors who are making the effort to transition their courses and understand if their teaching evaluations are lower during the initial semesters of transition.

Second, as evidenced by our study and by others in the literature, transitioning from lecture-based teaching to learner-centered teaching requires a large time commitment from instructors. Thus, funding and release time are valuable supports that administrators can provide to improve the quality of teaching at their institutions. The provost grant was a fundamental support contributing to our instructors’ success in transitioning a core biology course. Further, the fact that teaching fellowships were awarded from the university provost shows that our research-intensive university is beginning to value faculty members’ adoption of learner-centered teaching. Alex commented on these fellowships:

The message comes through that the university values teaching, otherwise we wouldn’t have these fellowships from the Provost, that’s about as high up as it gets, I mean there is this signal, a voice that says, great, please do this. But then when the rubber meets the road, are you going to get promoted? It is not considered a substitute for quality research productivity as a research-active faculty.

Third, learner-centered instruction requires more human resources relative to teacher-centered instruction (e.g., for grading, facilitating small-group discussions, demonstrations, assisting in revising course activities). Administrators should consider ways to assign more TAs to courses that use learner-centered teaching. TAs and/or ULAs could be compensated through financial means or through other methods like course credit. Our university, for example, has developed a training program for undergraduate TAs, in which they receive training in how to facilitate small groups.

Fourth, in universities where there are state-of-the art facilities for teaching and learning, there should be a priority for courses that adopt innovative teaching approaches. In our university, such facilities are in a state of development, and administrators are planning to incentivize faculty who are using evidence-based teaching approaches by giving them priority to teach in the new, state-of-the art teaching and learning facility, which includes classrooms with round tables, movable seats, and advanced technology.

Finally, universities should provide support for a campus teaching and learning expert and an FLC. These resources were fundamental in the transition process of our faculty members. FLCs may be discipline-based ( Marbach-Ad et al ., 2010 ) or campus-wide ( Cox, 2001 ). FLCs and teaching and learning experts can provide pedagogical and curricular guidance, as well as emotional support for the stressors associated with teaching.

Supplementary Material

Acknowledgments.

This work has been approved by the University of Maryland Institutional Review Board (IRB protocol 601750-2). We thank our teaching team members who participated in the study.

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North-East Research Conclave

NERC 2022: Trends in Teaching-Learning Technologies pp 97–111 Cite as

Importance of Biology for Engineers: A Case Study

• Chinmaya Panda   ORCID: orcid.org/0000-0002-9575-6913 5 ,
• R. Shreya 5 &
• Lalit M. Pandey 5  
• Conference paper
• First Online: 29 August 2023

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The field of biological sciences has grown multitude in the past decade to address real-life challenges and industrial innovations to cater to the needs of society. Different biological phenomena can be approximated in terms of physical processes of mechanical work, electrical signals, and chemical energy. Considering the immense importance that biology and life-sciences hold for humankind, simplification of complex biological phenomena is a must for imparting greater understanding to multidisciplinary researchers. Therefore, many Universities have diversified their undergraduate bioscience program to include interdisciplinary courses focusing on biomechanics, bioinformatics, nanobiotechnology, and many more. Together with the study aspect, research is also being conducted in the diverse research areas of biotechnology. Keeping sustainability and co-existence in mind, students and engineers should be trained to initiate better innovations and contribute their ideas for protecting the ecosystem around them.

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Panda, C., Shreya, R., Pandey, L.M. (2023). Importance of Biology for Engineers: A Case Study. In: Kaushik, H.B., Dixit, U.S., Jose, J., Jaganathan, B.G. (eds) Trends in Teaching-Learning Technologies. NERC 2022. Springer, Singapore. https://doi.org/10.1007/978-981-99-4874-1_8

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Case Study #1

The Biology Corner

Biology Teaching Resources

Case Study – Carrying Capacity and Rabbits

European settlers introduced rabbits to both England and Australia. In the absence of natural predators, rabbits were able to multiply rapidly and establish large populations. Rabbits are prolific breeders, with females capable of producing several litters of offspring each year. This high reproductive rate allows rabbit populations to grow exponentially under favorable conditions.

The case begins with the historic introduction of rabbits to England in the 12th century. Originally, humans imported rabbits for hunting as as a food source. The rabbit populations quickly grew out of control, damaging the ecosystem. For instance, native herbivores, like deer were impacted. Rabbits even caused erosion damage to soil, further limiting biodiversity.

Students learn that in most cases, animal populations have limiting factors that keep their numbers at a near stable level, the carrying capacity . Without limiting factors, the population can grow exponentially, as the rabbits did.

Next, students learn that the population of rabbits, having eaten all the vegetation, had a massive die off. Not all rabbits died, and their numbers recover quickly, known as a “Boom and Bust Cycle.” In both areas where rabbits were introduced, humans tried a number of measures to control the population. These included hunting and poisoning rabbits to reduce their numbers. However, none of the measures have worked well. In other areas, the myxoma virus reduced rabbit population numbers, though over time, the virus has become less effective. Go, evolution!

Finally, students examine a graph showing a logistic growth pattern. Limiting factors, such as food availability and predation, will keep the number of rabbits near the carrying capacity. In some areas of Europe, ecologists reintroduced the lynx, which is a natural predator of rabbits and helped to control the rabbit populations. A follow-up activity explores the lynx and conservation efforts.

Related Activities

Case Study – Loggerhead Turtles and Population Models  – explore the number of eggs hatched and survivorship

Ecology Case Study – The Wolves of Isle Royale  – population decline and reintroduction of wolves

Predator Prey Graph  – graph data on deer and wolf populations (growth curves)

Saving a Fussy Predator – reintroduction of the lynx to control rabbit populations

Rabbit Skeleton – model for use in comparative anatomy, showing teeth and skeletal features

Rabbit Digestive System – label the rabbit digestive system for comparative anatomy units

• Open access
• Published: 13 April 2024

Reevaluating Adiponectin’s impact on obesity hypertension: a Chinese case-control study

• Ou Wu 1 , 2   na1 ,
• Xi Lu 3   na1 ,
• Jianhang Leng 4 ,
• Xingyu Zhang 5 ,
• Wei Liu 6 ,
• Fenfang Yang 4 ,
• Hu Zhang 7 ,
• Jiajia Li 8 ,
• Saber Khederzadeh 9 , 10 ,
• Xiaodong Liu 11 &
• Chengda Yuan 12  

BMC Cardiovascular Disorders volume  24 , Article number:  208 ( 2024 ) Cite this article

Metrics details

Obesity and hypertension are major risk factors for cardiovascular diseases that affect millions of people worldwide. Both conditions are associated with chronic low-grade inflammation, which is mediated by adipokines such as adiponectin. Adiponectin is the most abundant adipokine that has a beneficial impact on metabolic and vascular biology, while high serum concentrations are associated with some syndromes. This “adiponectin paradox” still needs to be clarified in obesity-associated hypertension. The aim of this study was to investigate how adiponectin affects blood pressure, inflammation, and metabolic function in obesity hypertension using a Chinese adult case-control study.

A case-control study that had finished recruiting 153 subjects divided as four characteristic groups. Adiponectin serum levels were tested by ELISA in these subjects among these four characteristic Chinese adult physical examination groups. Waist circumference (WC), body mass index (BMI), systolic blood pressure (SB), diastolic blood pressure (DB), and other clinical laboratory data were collected. Analyzation of correlations between the research index and differences between groups was done by SPSS.

Serum adiponectin levels in the| normal healthy group (NH group) were significantly higher than those in the newly diagnosed untreated just-obesity group (JO group), and negatively correlated with the visceral adiposity index. With multiple linear egression analysis, it was found that, for serum adiponectin, gender, serum albumin (ALB), alanine aminotransferase (ALT) and high-density lipoprotein cholesterol (HDLC) were the significant independent correlates, and for SB, age and HDLC were the significant independent correlates, and for DB, alkaline phosphatase (ALP) was the significant independent correlate. The other variables did not reach significance in the model.

Conclusions

Our study reveals that adiponectin’s role in obesity-hypertension is multifaceted and is influenced by the systemic metabolic homeostasis signaling axis. In obesity-related hypertension, compensatory effects, adiponectin resistance, and reduced adiponectin clearance from impaired kidneys and liver all contribute to the “adiponectin paradox”.

Peer Review reports

Introduction

Obesity, having an inexorable rise with over 650 million obese worldwide [ 1 ], is globally a significant public health challenge and accounts for 65–78% of cases of primary hypertension [ 2 ]. The pathways through which obesity causes hypertension are complicated, including sympathetic nervous system overactivation, stimulation of the renin-angiotensin-aldosterone system, alterations in adipose-derived cytokines, insulin resistance, and structural and functional renal changes [ 2 ]. Adipose tissue is one of the largest endocrine organs in the body playing multiple intricate roles including secretion of a number of biologically adipokines, of which the most abundant is adiponectin [ 1 ].

Adiponectin, a 28-kDa protein adipocytokine, mainly produced and secreted into the circulation by lean adipocytes [ 3 , 4 ], has been very widely studied, over the past 25 years, since mid-1990s [ 5 ]. The primary function of adiponectin is the regulation of carbohydrate and lipid metabolism [ 6 ]. However, the full extent of its biological action remains to be elucidated, with a variety of effects on different cell and tissue types [ 3 , 7 ]. Adiponectin is initially considered a guardian angel adipocytokine owing to its protective functions against various disease states associated with obesity, such as immune modulatory, insulin­sensitizing, antidiabetic, anti­obesogenic, anti­inflammatory, antiatherogenic, anti-fibrotic, cardio­ and neuroprotective properties [ 3 , 4 , 7 ]. Adeno-viral over-expression of adiponectin in obese KKAy/a mice resulted in reduced blood pressure and reversed salt-induced hypertension [ 8 ]. Contrariwise to its protective effects against various pathological events in different cell types, adiponectin may have links to several systemic diseases and malignancies [ 1 ]. Accumulating reports of results of several meta-analyses demonstrated that elevated serum levels of both total and High Molecular Weight (HMW) adiponectin have been positively associated with both cardiovascular and, what is quite surprising and confusing, even with the all-cause mortality rate in the population above 65 years of age [ 9 ]. The biology underlying this paradox is still being studied [ 9 ].

This “adiponectin paradox” is remained, when coming to the role of adiponectin in hypertension. On one hand, compared to the patients with essential hypertension, adiponectin plasma levels were found to be significantly higher in the normotensive subjects [ 1 , 10 ]. And lower adiponectin levels were associated higher blood pressure or with incident hypertension [ 11 , 12 , 13 , 14 ]. These phenomena may be due to their protecting role on vascular functions through improving the functions of macrophages and endothelial cells. These mechanisms may include attenuating the phenotype of macrophages M1 and to promote the phenotype of macrophages M2 and preventing endothelial dysfunction through enhancing endothelial nitric oxide synthase (eNOS) activity and nitric oxide (NO·) production via adiponectin receptors AdipoR1/R2-AMPK (Adenosine 5′-monophosphate (AMP)-activated protein kinase)-endothelial signaling and cyclooxygenase-2 (COX-2) expression and prostaglandin I2 (PGI2) production by means of calreticulin/CD91-dependent Akt (protein kinase B) signaling [ 15 ]. And adiponectin also can lower blood pressure by decreasing renal sympathetic nervous system activity through its short-lived action on brain in adiponectin knock-out mice [ 15 , 16 , 17 , 18 , 19 , 20 , 21 ].

On the other hand, chronic intracerebroventricular infusion of adiponectin did not alter blood pressure in normotensive or hypertensive rats [ 10 , 22 ]. And Sprague-Dawley rats fed a high salt diet exhibited hypertension associated with elevated levels of adiponectin, suggesting that adiponectin does not play a protective role against salt-induced hypertension [ 20 , 23 ]. Adiponectin KO mice developed hypertension without insulin resistance when maintained on a high-salt diet, indicating that hypoadiponectinemia, per se, is not sufficient for the development of hypertension but contributes to its development under insulin resistance and/or salt overload [ 8 ]. In normotensives and untreated hypertensives with normal kidney function, adiponectin is not associated with blood pressure even after adjustment for many risk factors [ 24 ]. Several longitudinal studies offer mixed insights into adiponectin’s influence on metabolic diseases like hypertension, with some linking high levels to reduced metabolic syndrome risk and others to increased mortality and no protection against hypertension [ 11 , 13 , 25 , 26 , 27 , 28 , 29 ]. These studies highlight the complexity of adiponectin’s role in metabolic health and the need for further research to clarify its impact. This study aimed to provide more clues for distinguishing the antinomy of adiponectin in obesity hypertension.

Data and methods

Study design and participants.

This was a case-control study involving 153 Chinese adults (aged 40.78 ± 11.77 years; 119 men, 34 women) who underwent annual physical examinations in a hospital from September 2012 to July 2014 [ 30 ]. The participants were divided into four groups based on their body mass index (BMI) and blood pressure: the normal healthy (NH) group, the newly diagnosed untreated just-obesity (JO) group, the newly diagnosed untreated just-hypertension (JH) group, and the newly diagnosed untreated obesity-hypertension (OH) group. The inclusion and exclusion criteria for each group were set as previously reported [ 30 , 31 , 32 , 33 , 34 ] and are shown in Table  1 . The number of subjects included in each group is also shown in this table. BMI was obtained by dividing the body weight by the square of the respective subject’s height (weight/height 2 (kg/m 2 )) .

This study followed the Declaration of Helsinki and received approval from the Hangzhou Center for Disease Control and Prevention’s ethical committee. All participants agreed to join this study and signed a free and informed consent form [ 30 , 31 , 32 , 33 , 34 ].

Measurement protocol

The participants’ weight, height, waist circumference (WC) were measured according to standard protocols as previously described [ 30 , 31 , 32 , 33 , 34 ]. Before the measurement, the participants removed their shoes, heavy clothing, belts, and any other items that could interfere with the waist circumference (WC) measurement [ 35 ]. The WC was measured at the midpoint between the lower rib margin and the iliac crest while the participants gently exhaled [ 36 ].

General Obesity was defined as BMI ≥ 28 kg/m 2 and central obesity was defined as WC ≥ 85 cm for males and ≥ 80 cm for females according to the definition created by the Chinese Obesity Working Group [ 30 , 31 , 32 , 33 , 34 ]. In the present study, BMI was used to identify obesity, i.e., the general obesity was used to define the subject groups [ 37 , 38 ]. The visceral adiposity index (VAI) was calculated using a formula that incorporates WC, BMI, triglyceride (TG), and high-density lipoprotein cholesterol (HDLC) levels, i.e.,VAImen = [WC/(39.68 + 1.88 × BMI)] × (TG/1.03) × (1.31/HDLC); VAIwomen = [WC/(36.58 + 1.89 × BMI)] × (TG/0.81) × (1.52/HDLC) [ 39 , 40 ].

The blood pressure is considered a good indicator of the status of the cardiovascular system. The blood pressure can be measured by direct intraarterial and indirect sphygmomanometer methods [ 41 ]. In this study, all participants had blood pressure measured using indirect method with electronic sphygmomanometer (HEM-4021, Omron, Kyoto, Japan) [ 42 , 43 ]. Blood pressure was measured after at least 10 minutes of rest in a seated position using a standard protocol [ 44 ]. And the subject should avoid smoking, drinking caffeine, or exercising within 30 minutes of the test [ 45 ]. The inflatable cuff of the sphygmomanometer wrapped around the right upper arm at the same level as the heart and the arm was supported on a flat surface [ 46 , 47 ]. Three measurements were taken with 5 to 15 minutes intervals and the average of three such systolic and diastolic blood pressure readings was taken as the examination blood pressure for the further analysis [ 44 ].

Hypertension was defined according to the recommendation of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure and the World Health Organization–International Society of Hypertension as a systolic blood pressure of 140 mmHg or higher and/or a diastolic blood pressure of 90 mmHg or higher at each of the three appointments [ 44 , 48 , 49 ].

Serum adiponectin level and other metabolic parameters

The routine clinical laboratory tests were carried out on the subjects’ blood and urine samples. Blood samples were collected after an overnight fast and frozen for later analysis. Serum adiponectin level was quantified using a commercially available ELISA kit that measures the total adiponectin concentration (including all isoforms) [ 31 , 50 ]. According to the anamnesis and other clinical records, general demographic data, such as age and gender, as well as some biochemical parameters (see Table  2 ), were obtained [ 30 , 31 , 32 , 33 , 34 ].

Statistical analysis

R software ( https://www.r-project.org ) and SPSS for Windows V22.0 (IBM Corp., Armonk, NY) were used to perform the statistical analyses. The median and the interquartile range (P25, P75) were reported as descriptive statistics. Pearson’s test were applied to assess the associations between groups when the data (or transformed data) met the normality and equal variance assumptions; otherwise, the Mann–Whitney rank sum test and Spearman’s correlation test were used. The tested index among the four subgroups were compared using the rank-sum or T-test. Logistic regression, partial correlation or Fisher exact test were also employed when appropriate. The significance level at 0.05 was set for two-sided tests. Multiple regression models were fitted to study the independent association of the study variables with serum adiponectin, and SB (or DB).

Characteristics

The table 2 shows the baseline characteristics of the subjects in the four groups, including their general and anthropometric data and biochemical parameters. The table presents the median, the quartiles (P25, P75), and the number of the following variables: GGT, ALB, ALT, LDLC, TG, HDLC, FA, SCR, IB, ALP, CB, GLU, TC, TB, TP, Ua, UREA, age, gender, and WC, BMI, SB, and DB. The full names of these indicators can be found in the notes below the Table 2 .

The relationship between VAI and serum concentrations of adiponectin

The median (P25, P75) of VAI and serum adiponectin levels of the four groups are shown in Table 2 .

After adjustment for gender and age, analysis of covariance (ANCOVA) revealed that the serum adiponectin level in the NH group was significantly higher than in the JO groups ( P  = 0.036). No significant differences of the serum adiponectin between other two groups. The order of serum adiponectin levels among the groups was NH > OH > JH > JO.

The difference of VAI between NH group and JO group (or the OH group) is statistically significant ( P  < 0.05) after adjusting for gender and age. The VAI of NH group is the smallest among the four subgroups. The difference of VAI between NH group and JO group is nearly statistically significant ( P  = 0.071). The P -value for the comparison of VAI between JO and OH groups was 0.376, which means that the difference was not statistically significant after adjustment for gender and age.

And, after adjustment for gender and age, partial correlation analysis revealed that serum adiponectin had a negative association with VAI that was trending towards significance ( P =  0.055, r  = − 0.157). All the data were log-transformed to follow a normal distribution before analysis.

Multiple regression models for the independent association of the study variables with serum adiponectin

A linear regression model towards serum adiponectin is shown in Table  3 ( R 2  = 0.314). Gender, ALB, ALT and HDLC were found to be independent determinants. The other variables did not reach significance in the model ( P  > 0.1). This model was responsible for 31.4% of the original variation of the serum adiponectin.

The difference of serum adiponectin levels between genders in the four group

Table  4 shows the comparisons of the serum adiponectin levels between genders in the four groups of subjects: JO, OH, JH, and NH. The table presents the median and the interquartile range of the serum adiponectin levels for each group and gender. The table also reports the P -values of the differences between males and females within each group. The results indicate that after the age was controlled, the serum adiponectin levels were significantly higher in females than in males in the OH and NH groups, but not in the JO and JH groups. This suggests that there is a sexual difference in the serum adiponectin levels, which may be influenced by the presence or absence of obesity and hypertension.

Multiple regression models for the independent association of the study variables with SB and DB

The linear regression models towards SB and DB are shown in Table  5 ( R 2  = 0.333) and Table  6 ( R 2  = 0.230), respectively. For SB, age and HDLC were found to be independent determinants, and ALB was borderline significant. ALP barely escaped statistical significance The other variables did not reach significance in the model ( P  > 0.08). This model was responsible for 33.3% of the original variation of the SB serum adiponectin. For DB, ALP was found to be the independent determinant, and age had a considerable trend toward significance.

Adiponectin is primarily produced and released by energy-storing cells in adipose tissue (body fat) called adipocytes [ 51 , 52 , 53 , 54 , 55 ]. Yet, other tissues and other types of cells can produce adiponectin, including osteoblasts, myocytes, heart muscle cells, liver parenchyma cells,endothelial cells and placental tissue [ 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ]. Adiponectin is known as the most abundant adipokine and its paradoxical elevation in some disorders is receiving more attention [ 62 , 63 , 64 ]. Adeno-viral over-expression of adiponectin in genetically obese KKAy/a mice with obesity-related hypertension resulted in reduced blood pressure [ 8 ]. However, normal wild-type mice and mice with specific genetic backgrounds may exhibit different mechanisms for obesity-related hypertension and may also show varying roles of adiponectin in the context of this condition [ 65 , 66 ].

This study investigated the role of adiponectin in obesity-hypertension by measuring its serum levels and correlations with various parameters in four groups of Chinese adults: NH, JO, JH, and OH.

Though adiponectin is mainly secreted by adipose tissue (AT), its circulating concentration is decreased in obesity [ 51 , 52 , 53 , 54 , 55 ]. The results in this study also demonstrated that the serum adiponectin level in the NH group is significantly higher than in the JO group. AT can broadly be divided into two types with distinct roles: white AT (WAT) and brown AT (BAT) [ 56 , 67 ]. BAT has smaller lipid droplets and more blood vessels than WAT, resulting in a darker, brown macroscopic look [ 68 , 69 ]. And beige adipose tissue, a type of inducible BAT, intermingles with WAT depots and occurs in response to cold exposure and pharmacological modulation of WAT [ 70 , 71 , 72 ]. This phenomenon of decreased serum adiponectin level in obese people might be attributed to fat cell dysfunction and/or hypermethylation of the adiponectin gene in morbid obesity [ 73 , 74 ]. Some previous literature also shows that the adiponectin paradox, which refers to the paradoxical elevation of adiponectin in some disorders, is more evident in non-obese than in obese patients with diabetic microvascular complications [ 75 ]. The authors suggested that the paradoxical elevation of adiponectin in vascular damage might be a compensatory response, and that the responsive upregulation might be insufficient in obese patients [ 75 ]. Previous studies revealed that the quality of adipose tissue is largely compromised in patients with severe cardiovascular disorders [ 76 , 77 ]. Additionally, during caloric restriction (CR), increased circulating adiponectin is observed to come from bone marrow adipose tissue (MAT) [ 78 , 79 ].

And, it was found in this study that serum adiponectin levels negatively correlated with VAI. VAI is a mathematical formula that estimates the amount and function of visceral adipose tissue (VAT), which is the fat that surrounds the internal organs in the abdomen [ 80 , 81 , 82 , 83 ]. WAT can be divided into two major depots: VAT and subcutaneous adipose tissue (SAT). SAT is located under the skin. The distribution of WAT affects the production and function of adiponectin [ 84 , 85 ]. Generally, VAT is associated with lower adiponectin levels and higher risk of metabolic and cardiovascular complications, such as diabetes, hypertension, and atherosclerosis [ 86 , 87 , 88 ]. This is because VAT is more prone to inflammation, insulin resistance, and lipolysis, which can impair adiponectin secretion and action [ 86 , 87 , 88 ]. On the other hand, SAT is mainly considered to be associated with higher adiponectin levels and lower risk of metabolic diseases [ 89 , 90 ], though with the oppsite results exsiting [ 91 ]. This is because SAT is more responsive to insulin, has anti-inflammatory properties, and can store excess lipids away from harmful sites [ 92 , 93 ]. However, not all SAT depots are equal. Fat on the lower extremities, such as the legs, is more beneficial than fat on the upper body, such as the abdomen [ 93 , 94 ]. This is because lower-body fat has higher adiponectin expression and secretion, and can protect against the adverse effects of VAT [ 84 , 94 , 95 ]. Therefore, the role of WAT distribution in adiponectin levels and metabolic health is complex and depends on the location, amount, and function of different fat depots [ 91 , 93 , 96 , 97 ]. A better understanding of the molecular mechanisms that regulate adipocyte differentiation and adiponectin secretion in different WAT subtypes may lead to new therapeutic strategies for obesity and its related complications [ 91 , 93 , 96 , 97 ]. VAI takes into account waist circumference, body mass index, triglycerides, and HDLC levels, and it is different for men and women [ 80 , 81 , 82 ]. VAI has been shown to be a reliable indicator of visceral fat dysfunction and cardiometabolic risk [ 98 ]. VAI seems to represent a better predictive tool than common clinical parameters for metabolic disorders in Chinese and Caucasian samples [ 82 , 99 , 100 ].

And, in this study, we found that the NH group had a much lower VAI than almost all other groups (JO, JH, OH). The JH group also had a lower VAI than the OH group. Previous study reported weekend warrior activity patterns (WWs) and regular activity patterns offer the same benefits for reducing the VAI [ 101 ]. This suggests that the NH group and JH group might have higher level of physical activity and a larger proportion of muscle mass in their body weight than the other two groups. Aditionally, the serum adiponectin levels negatively correlated with VAI in this study. These results reflect that serum adiponectin levels positively correlated with physical activity and muscle mass proportion of the body. It has been shown that physical exercise can reduce fat mass [ 76 ], especially the accumulation of VAT [ 102 , 103 , 104 ], and lead to hypersecretion of adiponectin [ 102 , 103 , 104 ], which results in increased adiponectin production in adipose tissue and enhanced concentration of adiponectin in the blood [ 105 , 106 , 107 , 108 ]. Our study result accords with the phenomena discovered in those previous literature.

In this study, the comparison of VAI between JO and OH groups revealed no significant difference. This indicates that the VAI, a marker of visceral adiposity and cardiometabolic risk, was similar between the two groups. However, the increase of the serum adiponectin level in OH compared to JO may seem paradoxical, as adiponectin is generally considered to have anti-obesity and anti-hypertensive effects [ 9 , 109 ]. Nevertheless, the result was in line with the phenomenon called “adiponectin paradox” in which adiponectin levels are elevated in some pathological conditions, such as cardiovascular disease, diabetes, and chronic kidney disease [ 76 ]. This may reflect a compensatory response of the body to maintain metabolic homeostasis and protect against further damage [ 9 , 110 ]. Moreover, adiponectin levels may be influenced by other factors, such as gender, albumin, alanine aminotransferase, and high-density lipoprotein cholesterol, as we showed in the multiple regression analysis. And the interaction between adiponectin and other adipokines, such as leptin, resistin, and visfatin, should be taken into account [ 111 , 112 ]. In addition to white adipokines (adipokines produced by WAT), the brown adipokines, adipokines present in brown adipose tissue, such as fibroblast growth factor 21 (FGF21), interleukin-6 (IL-6), neuregulin-4 (NRG4), insulin-like growth factor-1 (IGF-1), and tumor necrosis factor-alpha (TNF-α), may also play a role in the process known as the ‘adiponectin paradox [ 112 , 113 ]. And these adipokines also have tortuous relationship with hypertension. As shown in previous studies, leptin’s effect on Trpm7 (TRP [transient receptor potential] melastatin 7) expression, via epigenetic changes and the pSTAT3(phosphorylated signal transducer and activator of transcription 3)-JAK2(Janus kinase 2) pathway, contributes to obesity-associated hypertension, but leptin’s role is additive, not essential, in the complex regulatory network leading to hypertension in obesity [ 33 , 114 , 115 , 116 ]. Depending on the context, resistin appears to have both protective and detrimental effects to obesity-related hypertension, highlighting the complexity of resistin’s role in obesity and hypertension [ 30 ]. And, IL-6 may have diverse effects in the pathogenesis of obesity and hypertension, depending on the presence or absence of these conditions [ 34 ]. Therefore, the role of adiponectin in obesity-hypertension should be considered in the context of the systemic signaling axis and not in isolation [ 117 ].

Next, with the multiple regression model, it was found serum adiponectin level was significantly higer in females than in males (with std.β = 0.323). This result is in line with many previously studies, which demonstrate that adiponectin levels are generally higher in females than in males, especially in adulthood [ 118 , 119 ]. This may be partly explained by the effects of sex hormones, such as testosterone and estrogen, on adiponectin production and secretion [ 119 , 120 ]. Testosterone has been shown to suppress adiponectin expression in fat cells, whereas estrogen has been shown to stimulate it [ 120 ]. Therefore, during puberty, when sex hormones increase, adiponectin levels tend to decline in males and rise in females [ 119 , 121 ]. However, the sex differences in adiponectin levels are not consistent across different ethnic groups and obesity levels. For example, some studies have found that Hispanic females have lower adiponectin levels than non-Hispanic white females, and that this difference is more pronounced in obese individuals [ 122 , 123 , 124 ]. And dietary patterns may also affect adiponectin levels and the sex differences in this hormone [ 125 , 126 , 127 , 128 ]. Healthy dietary patterns rich in fruits, vegetables, whole grains, fish, nuts, and unsaturated fats are linked to higher adiponectin levels, likely due to their bioactive compounds that promote adipose tissue function and insulin sensitivity [ 128 , 129 , 130 , 131 ]. Conversely, unhealthy diets high in red and processed meats, refined grains, sweets, fast foods, and saturated/trans fats correlate with lower adiponectin levels, potentially due to inflammation, oxidative stress, and insulin resistance that hinder adiponectin secretion and activity [ 128 , 129 , 130 , 131 ]. And a negative association between the Dietary Approaches to Stop Hypertension (DASH) diet index and VAI was reported among older Americans [ 132 ].

And the interaction between diet and genetics may modulate adiponectin levels and metabolic outcomes [ 133 ]. For eample, ADIPOQ variants conferred more metabolic risks in healthy dietary patterns than in adverse dietary patterns [ 133 , 134 ]. And some literature indicated that moderate amounts of ethanol-containing beverages increased adiponectin concentrations, and sex-specific effects might depend on type of beverage consumed [ 135 ]. This may suggest that other factors, such as genetic, environmental, or lifestyle factors, may also influence adiponectin levels and modify the sex differences [ 118 , 136 , 137 , 138 ]. In this study, blood samples were obtained after a 12-hour of fasting, which can avoid the short-term effects of the diet. And, after the age was controlled, the serum adiponectin levels were significantly higher in females than in males in the OH and NH groups, but not in the JO and JH groups. This suggests that there is a sexual difference in the serum adiponectin levels, which may be influenced by the presence or absence of obesity and hypertension [ 139 ].

According to vast majority of reports, adiponectin has been exhibited to have protective effect on vascular functions and thus has negative relationship with blood pressure, against incidence of obesity-hypertension [ 21 , 140 , 141 ]. But the contrary opinion holds that, in different subject groups, the relationships between the adiponectin and blood pressure are various, with positive and non-correlation existing [ 24 , 142 , 143 , 144 ]. The preclinical expriments, longitudinal studies and clinical trials have reported inconsistent outcomes regarding the antihypertensive effects of adiponectin [ 11 , 13 , 25 , 26 , 27 , 28 , 29 , 145 ]. In this study, using the multiple regression model, it was found that adiponectin was not associated with blood pressure (SB and DB) after adjustment for other risk factors (the anthropometric and biochemical characteristics mentioned in Table 2 ) used in multiple linear regression models. Age and HDLC were found to be independently positively correlate with SB, and ALB was at the edge of significance. ALP were found to be independently positively correlate with DB, and age has a considerable trend toward significance.

This study results revealed that ALB independently negatively and ALT, HDLC, and gender positively associate with serum level of adiponectin. These results were in line with many previous research outcomes. Serum adiponectin levels have been recorded to display a sexual difference, being higher in females than in males [ 118 , 146 , 147 , 148 ], and were observed having inverse correlation with circulating albumin [ 120 , 149 , 150 ]. And recently, higher plasma adiponectin abundance was discovered in albumin knockout (KO) mice [ 151 ].

The associations between adiponectin and ALT have been shown to be different. Many research detailed the opposite connections [ 152 , 153 , 154 , 155 ], however positive and non-connections are likewise existing [ 156 , 157 ]. And adiponectin knockout could ablate the significant rise in serum ALT elicited by high-fat diet feeding in mice [ 158 ].

Consistent with our study results, the serum HDLC has been reported to be independently positively associated with serum adiponectin in almost all the previous studies [ 159 , 160 , 161 , 162 , 163 , 164 , 165 ]. Adiponectin could upregulate ATP-binding cassette transporter A1 and G1 expression and hepatic apo-AI (Apolipoprotein A-I), reduce lipid accumulation, and efficiently promote nascent HDLC formation [ 166 , 167 , 168 , 169 , 170 , 171 ]. Lower adiponectin (ADIPOQ) gene expression are associated with diabetic dyslipidemia [ 172 , 173 ].

Accounting for the mentioned above, in this mixed subjects of four Chinese subgroups, adiponectin did not have the dose-response conjunction with the blood pressure after adjustment for potential confounding factors, which was little illustrated in earlier investigations [ 11 ]. These conflicting results in different studies may be mostly due to the diversity of subjects included [ 24 ]. The direct relationship between adiponectin and hypertension (or blood pressure) may be influenced by many factors, among which the liver and kidney dysfunctions are often mentioned. Disorders of kidney or liver can lead to the elevation of the blood pressure and incident of hypertension [ 174 , 175 ]. Meanwhile, the impaired liver function can affect adiponectin’s degradation in the liver, and the kidney dysfunctions can reduce renal clearance of adiponectin [ 174 , 175 , 176 ]. High serum ALT is known to reflect the situation of severe liver disease. In addition, in this study, ALP was found to independently positively correlate with DB and nearly with SB. High levels of ALP in the blood may indicate liver disease or certain bone disorders. Furthermore, in this study, ALB was found to have a negative association with SB that was trending towards significance. Low albumin levels in the blood are known to indicate serious liver and kidney problems.

Another explanation for the increase of adiponectin in individuals with risk towards mortality is that is a failing attempt of the body to do the protection [ 177 ], as pathological adiponectin resistance develops with its receptors down regulation in metabolically active organs including the adipose tissue, the heart, the liver and the vasculature [ 172 , 173 , 178 ]. Adiponectin exerts its both beneficial and detrimental effects via normal or impaired signaling through its receptors: Adiponectin receptor 1 and 2 (AdipoR1 and AdipoR2), T-cadherin and calreticulin [ 1 ]. Adiponectin exists in various isoforms in the circulation, including trimer (~ 67 kDa; low molecular weight, LMW), hexamer (136 kDa; middle molecular weight, MMW), 12-32mer (> 300 kDa, high molecular weight, HMW), and globular forms [ 76 , 179 , 180 ]. Different adiponectin isoforms bind to different receptors, resulting in various functions. Globular adiponectin preferentially binds to AdipoR1, influencing muscle cells [ 56 ]. T-cadherin, a non-transmembrane binding protein, is a key partner for HMW adiponectin, potentially accumulating it in heart, vascular endothelium, and muscle, with its downstream effects being studied [ 181 , 182 , 183 ]. Αdiponectin may bind to calreticulin on macrophage surfaces and other cells [ 184 , 185 ]. AdipoR2 binds full-length adiponectin and is predominantly expressed in the liver [ 186 ]. However, the relative contributions of different adiponectin isoforms to obesity and hypertension are not fully understood and may vary depending on the population and the disease stage [ 180 ].

In general, our research investigated the role of adiponectin in obesity-hypertension using a case-control study with four groups of Chinese adults: normal healthy, just-obesity, just-hypertension, and obesity-hypertension. This design allows for a comprehensive comparison of the serum adiponectin levels and their associations with various anthropometric and biochemical parameters among different subgroups of obesity and hypertension. Thus, this research provided more clues for distinguishing the antinomy of adiponectin in obesity-hypertension by analyzing the correlations between adiponectin and visceral adiposity index, gender, serum albumin (ALB),alanine aminotransferase (ALT) and high-density lipoprotein cholesterol (HDLC), blood pressure, and other indicators. This research also indicated some factors that influence the sex differences in adiponectin. Next, the results of this research suggested that adiponectin may not always have a direct relationship with blood pressure. The importance of adiponectin must be viewed within the framework of the body’s key signaling pathways that regulate metabolic equilibrium in the face of obesity and cardiovascular disorders [ 187 ], such as the modulation by other adipokines (leptin, resistin, and visfatin, as well as brown adipokines, such as FGF21, IL-6, NRG4, IGF-1, and TNF-α). This research also indicated the potential mechanisms of adiponectin in regulating carbohydrate and lipid metabolism, inflammation, and vascular function. Furthermore, Different explanations for the adiponectin paradox have been discussed including adiponectin resistance, compensatory effects of adiponectin to subclinical pathologies, impaired renal function and decreased hepatic clearance of adiponectin [ 188 , 189 , 190 ]. And this research revealed that adiponectin’s role in obesity-hypertension is complex and depends on the systemic metabolic homeostasis signaling axis. And in the end, the results of this research indicated that in the context of obesity-related hypertension, compensatory effects, adiponectin resistance, and decreased adiponectin clearance due to impaired renal and hepatic function occur simultaneously, contributing to the “adiponectin paradox”.

Some limitations and strengths of our study should be addressed. At first, our results need to be interpreted in the context of a few limitations. One limitation is that the cross-sectional design and small sample size of our study and the subjects restricted to Chinese adults may limit the generalizability and causal inference of our findings. Therefore, Our results should be interpreted with caution and should be confirmed by larger, longitudinal studies across various genetic populations in the future. Another limitation is that we did not measure the adiponectin isoforms, which could have provided more nuanced insights into the role of adiponectin in obesity-hypertension. Previous studies have reported conflicting results on the associations of adiponectin isoforms and other adipokines (WAT or BAT adipokines) with blood pressure and metabolic parameters in different populations [ 56 , 112 , 179 , 180 ]. Therefore, further studies are needed to investigate the differential effects of adiponectin isoforms on obesity-hypertension and to explore the potential mechanisms underlying the adiponectin paradox. Third limitation is that while the present study attempts to control for various confounders, there are still potential variables that might influence the results, such as dietary patterns, genetic predispositions, and environmental factors. We did not have comprehensive dietary data and we did not delve into the relationship between adiponectin and other adipokines (other BAT adipokines or other WAT adipokines). Finally, the VAI is not a direct and accurate measure of physical activity and that it may not capture the intensity, duration, and type of physical activity that the participants engaged in.

Notwithstanding these limitations, the multiple strengths of our study should be kept in mind. Firstly, the chosen population in the present study allowed us to investigate the role of adiponectin in obesity-hypertension axis in a relatively homogeneous and early-stage group, without the confounding effects of medication or other comorbidities. Secondly, to minimize the effects of diet, blood samples were obtained after a 12-hour fast in the present study to avoid the short-term effects of recent dietary intake. Thirdly, we have controlled for potential confounding factors, such as age, gender, and other biochemical indicators. And the use of multiple regression models adds rigor to the findings, offering insights into the independent determinants of serum adiponectin levels. Fourthly, the Visceral Adiposity Index (VAI), utilized in this study, serves as a comprehensive indicator of physical activity levels [ 98 , 101 ]. It inversely correlates with physical activity and positively correlates with visceral fat dysfunction and cardiometabolic risk, making it a superior predictive tool for metabolic disorders in both Chinese and Caucasian populations [ 82 , 99 , 100 ]. Fifthly,we believe that our findings may have some relevance and applicability to other populations and settings because of the consistent with some previous studies that have reported no directly associations between adiponectin and blood pressure in different ethnic groups and regions, such as African Americans, Europeans, and Japanese [ 27 , 191 , 192 ]. These studies suggest that the “adiponectin paradox” may be a common phenomenon in obesity-hypertension, regardless of the population characteristics.

In summary, our study findings provide new insights into the “adiponectin paradox”. Adiponectin’s role in obesity-hypertension is multifaceted and is influenced by the systemic metabolic homeostasis signaling axis. In obesity-related hypertension, compensatory effects, adiponectin resistance, and reduced adiponectin clearance from impaired kidneys and liver all contribute to the “adiponectin paradox”.

And to further elucidate the role of adiponectin in obesity-hypertension, more studies are needed to investigate the adiponectin isoforms, the adiponectin receptors, and the signaling pathways involved in different tissues and organs. Moreover, the interactions between adiponectin and other adipokines, hormones, and inflammatory mediators should be explored in the context of obesity-hypertension. Additionally, the genetic, environmental, and lifestyle factors (such as dietary assessments including alcohol intake and direct measurement of physical activity) that influence adiponectin levels and function should be considered [ 173 ]. Finally, the therapeutic potential of adiponectin or its analogues for obesity-hypertension should be evaluated in clinical trials.

Availability of data and materials

The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.

Abbreviations

Waist circumference

Body mass index

Systolic blood pressure

Diastolic blood pressure

High molecular weight

Endothelial nitric oxide synthase

Nitric oxide

Adenosine 5’-monophosphate (AMP)-activated protein kinase

cyclooxygenase-2

Prostaglandin I2

Protein kinase B

Gamma-glutamyltransferase

Alanine aminotransferase

Low density lipoprotein cholesterol

Triglyceride

High density lipoprotein cholesterol

Fructosamine

Serum creatinine

Indirect bilirubin

• Alkaline phosphatase

Conjugated bilirubin

Fasting blood glucose

Total cholesterol

Total bilirubin

Total protein

• Visceral adiposity index

Adipose tissue

White adipose tissue

Brown adipose tissue

Bone marrow adipose tissue

Caloric restriction

Visceral adipose tissue

Subcutaneous adipose tissue

Fibroblast growth factor 21

Interleukin-6

Neuregulin-4

Insulin-like growth factor-1

Tumor necrosis factor-alpha

TRP [transient receptor potential] melastatin 7

Janus kinase 2

Phosphorylated signal transducer and activator of transcription 3

Apolipoprotein A-I

Low molecular weight

Middle molecular weight

Adiponectin receptor 1

Adiponectin receptor 2

Dietary approaches to stop hypertension

Weekend warrior activity patterns

Analysis of covariance

ATP-binding cassette transporter A1

ATP-binding cassette transporter G1

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Acknowledgements

The authors would like to give special thanks to all participants in this study.

This work was supported by Zhejiang Shuren University Basic Scientific Research Special Funds (2024XZ012), grants from the National Natural Science Foundation of China (81102200/H2610), and “Teacher professional development project” for domestic visiting scholars in colleges and universities of Zhejiang Province in 2020 (043).

Author information

Ou Wu and Xi Lu are the first and co-first author.

Authors and Affiliations

Shulan International Medical College, Zhejiang Shuren University, Hangzhou, Zhejiang, People’s Republic of China

Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China

Hangzhou Vocational and Technical College, Hangzhou, Zhejiang, People’s Republic of China

Department of Central Laboratory/Medical Examination Center of Hangzhou, The Frist People’s Hospital of Hangzhou, Hangzhou, Zhejiang, People’s Republic of China

Jianhang Leng & Fenfang Yang

Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

Xingyu Zhang

JFIntelligent Healthcare Technology Co., Ltd Building No.5-7, No.699 Tianxiang Avenue, Hi-Tech Zone, Nanchang, Jiangxi Province, People’s Republic of China

Department of Thoracic Surgery, Sir Run Run Shaw Hospital Affiliated with Medical College of Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China

Department of Central Laboratory, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China

Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, Zhejiang, People’s Republic of China

Saber Khederzadeh

Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, Zhejiang, People’s Republic of China

Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, People’s Republic of China

Xiaodong Liu

Department of Dermatology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, People’s Republic of China

Chengda Yuan

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Contributions

Ou Wu: Conceptualization, Data curation, Writing – original draft, Methodology, Supervision, Validation, Funding acquisition, Project administration, Formal analysis. Xi Lu: Conceptualization, Data curation, Writing – original draft, Methodology, Supervision, Validation. Jianhang Leng: Project administration, Data curation. Xingyu Zhang: Writing – review & editing, Software. Wei Liu: Project administration, Data curation. Fenfang Yang: Project administration, Data curation. Hu Zhang: Project administration, Data curation. Jiajia Li: Project administration, Data curation. Saber Khederzadeh: Writing – review & editing, Software. Xiaodong Liu: Resources. Chengda Yuan: Conceptualization, Project administration, Investigation, Writing – review & editing.

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Correspondence to Chengda Yuan .

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All procedures performed in this study involving human participants were in accordance with ethical standards of institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Institutional ethics committee of Hangzhou Center for Disease Control and Prevention approved the study. Informed consent was obtained from all the participants.

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Wu, O., Lu, X., Leng, J. et al. Reevaluating Adiponectin’s impact on obesity hypertension: a Chinese case-control study. BMC Cardiovasc Disord 24 , 208 (2024). https://doi.org/10.1186/s12872-024-03865-4

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Received : 03 December 2023

Accepted : 28 March 2024

Published : 13 April 2024

DOI : https://doi.org/10.1186/s12872-024-03865-4

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