Changes in inflammatory biomarkers across weight classes in a representative US population: a link between obesity and inflammation

Assessment of the relationship between plasma fibrinogen-to-albumin ratio and slow coronary flow phenomenon in patients without obstructive coronary artery disease

BACKGROUND

Prior studies have suggested that the chronic inflammatory response has an important role in the pathophysiology of slow coronary flow phenomenon (SCFP). However, data are scarce regarding the role of plasma fibrinogen-to-albumin ratio (PFAR) in patients having SCFP without obstructive coronary artery disease (CAD). In this study, we investigated the relationship between PFAR and the presence of SCFP in patients without obstructive CAD.

METHODS

From January 2021 to January 2023, we consecutively recruited 1085 patients without obstructive CAD according to the diagnostic and exclusion criteria. In total, SCFP was diagnosed in 70 patients. A 1:2 age-matched case-control study was then conducted using comparators without SCFP. Ultimately, this study enrolled 70 patients with angiographically normal coronary arteries and SCFP, along with 140 comparators with angiographically normal coronary arteries and normal coronary flow. Plasma fibrinogen and albumin levels were measured, and the PFAR was then calculated for each patient.

RESULTS

PFARs were significantly greater in the SCFP group than in the comparators with normal coronary flow (82.8 ± 15.4 vs 73.1 ± 19.5, p < 0.001). PFAR increased with increasing numbers of vessels affected by SCFP. Multivariate logistic regression analysis showed that PFAR was an independent predictor of SCFP (odds ratio: 1.818, p = 0.015). Receiver operating characteristic (ROC) curve analysis indicated that PFAR showed a better predictive value of SCFP than fibrinogen or albumin, although not significantly (p > 0.05).

CONCLUSION

PFAR is an independent predictor of SCFP in patients without obstructive CAD. PAFR could improve the predictive value of SFCP than albumin or fibrinogen alone, but not significantly.

Influence of bariatric surgery on the peripheral blood immune system of female patients with morbid obesity revealed by high-dimensional mass cytometry

Introduction

Obesity is associated with low-grade chronic inflammation, altered levels of adipocytokines, and impaired regulation of gastrointestinal hormones. Secreted, these factors exert immunostimulatory functions directly influencing peripheral immune cells.

Methods

In the realm of this study, we aimed to investigate the composition and activation status of peripheral blood immune cells in female patients with morbid obesity compared to lean controls using high-dimensional mass cytometry. Besides, we also assessed the influence of bariatric surgery with respect to its ability to reverse obesity-associated alterations within the first-year post-surgery.

Results

Patients with morbid obesity showed typical signs of chronic inflammation characterized by increased levels of CRP and fibrinogen. Apart from that, metabolic alterations were characterized by increased levels of leptin and resistin as well as decreased levels of adiponectin and ghrelin compared to the healthy control population. All these however, except for ghrelin levels, rapidly normalized after surgery with regard to control levels. Furthermore, we found an increased population of monocytic CD14⁺, HLA-DR^-, CD11b⁺, CXCR3⁺ cells in patients with morbid obesity and an overall reduction of the HLA-DR monocytic expression compared to the control population. Although CD14⁺, HLA-DR^-, CD11b⁺, CXCR3⁺ decreased after surgery, HLA-DR expression did not recover within 9 - 11 months post-surgery. Moreover, compared to the control population, patients with morbid obesity showed a perturbed CD4+ T cell compartment, characterized by a strongly elevated CD127⁺ memory T cell subset and decreased naïve T cells, which was not recovered within 9 - 11 months post-surgery. Although NK cells showed an activated phenotype, they were numerically lower in patients with morbid obesity when compared to healthy controls. The NK cell population further decreased after surgery and did not recover quantitatively within the study period.

Conclusions

Our results clearly demonstrate that the rapid adaptions in inflammatory parameters and adipocytokine levels that occur within the first year post-surgery do not translate to the peripheral immune cells. Apart from that, we described highly affected, distinct immune cell subsets, defined as CD127⁺ memory T cells and monocytic CD14⁺, HLA-DR, CD11b⁺, CXCR3⁺ cells, that might play a significant role in understanding and further decoding the etiopathogenesis of morbid obesity.

The association between vitamin C dietary intake and its serum levels with anthropometric indices: A systematic review and meta-analysis

BACKGROUND

studies showed inflammatory background of overweight and obesity. Prevalence of weight disorders has dramatically increased over the past few decades. Vitamin C is an antioxidant and may be associated with weight disorders. This study aims to systematically review the relationship between dietary and serum vitamin C levels with anthropometric indices.

METHODS

A systematic search was conducted in Medline database (PubMed), Scopus, Embase, Web of Science, Cochrane library and Google Scholar up to the end of August 2021. All observational studies that assessed the relationship between dietary or circulating vitamin C levels and body mass index (BMI) and waist circumference (WC) on adults were included. The quality of included studies was assessed using the National Institute of Health quality assessment tool.

RESULTS

Among 11,689 studies, 47 and 37 articles were included in the systematic review and meta-analysis, respectively. There was an inverse significant correlation between WC and serum vitamin C levels (r = -0.28, 95% CI: -0.35,-0.21, I² = 14.2%) and between BMI and serum vitamin C levels (r = -0.17, 95% CI: -0.25, -0.09, I² = 72.8%). Higher vitamin C consumption was significantly associated with lower BMI. There were no significant differences in serum vitamin C levels between normal-weight and overweight subjects, but serum vitamin C levels were significantly higher in obese subjects in comparison with normal-weight subjects.

CONCLUSION

Results showed that both dietary and serum vitamin C levels were inversely associated with BMI and WC. More well-designed clinical trials are needed to assess the effect of vitamin C supplementation in prevention and treatment of obesity.

Prepregnancy body mass index, gestational weight gain, and maternal prepartum inflammation in normal pregnancies: findings from a Chinese cohort

BACKGROUND

Obesity has been linked to systemic inflammation in population studies.

OBJECTIVE

To examine the associations of prepregnancy body mass index (pBMI) and total gestational weight gain (tGWG) with maternal prepartum low-grade inflammation (LGI) and clinically significant inflammation (CSI) defined by serum C-reactive protein (CRP) concentration.

METHODS

Five thousand four hundred seventy-six Chinese women with uncomplicated pregnancies and recorded data on pBMI and prepartum body weight were included in this study. Blood samples were drawn before delivery for high-sensitivity CRP assay. Inadequate, optimal, and excessive tGWG were defined using the Institute of Medicine's recommendation. Multivariable Poisson regressions were used to estimate relative risks (RRs) for having prepartum LGI and CSI (defined as CRP concentration 3-10 and > 10 mg/L, respectively) across pBMI and tGWG categories.

RESULTS

The mean pBMI, mean tGWG, and median maternal prepartum CRP concentration were 20.4 kg/m², 13.9 kg, and 3.3 mg/L, respectively. The prevalence of prepartum CSI and LGI was 7.2% and 47.8%. The adjusted RRs (95% confidence interval) of CSI for normal (18.5-24.9 kg/m²) and high (≥ 25 kg/m²) vs. low pBMI (< 18.5 kg/m²) were 1.35 (1.05-1.74) and 2.28 (1.53-3.39), respectively. The respective adjusted RRs of LGI were 1.19 (1.11-1.28) and 1.59 (1.42-1.77). The adjusted RRs for excessive vs. optimal tGWG was 1.18 (0.94-1.48) for CSI and 1.14 (1.07-1.21) for LGI.

CONCLUSIONS

Prepregnancy overweight/obesity and excessive tGWG increase the risk of maternal prepartum systemic inflammation, which further highlights the importance of weight management before and during pregnancy.

Albumin/fibrinogen ratio, an independent risk factor for postoperative delirium after total joint arthroplasty

AIM

Postoperative delirium (POD) is a very common and serious complication after total joint arthroplasty (TJA), which is closely associated with many adverse consequences and a poor prognosis. This study aimed to establish the potential risk factors for POD.

METHODS

In total, 336 patients who underwent elective TJA under general anesthesia between 2018 and 2021 were included and deemed eligible for inclusion. POD was diagnosed based on the criteria by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM V). The receiver operating characteristic curve was drawn to evaluate the predictive and cut-off values of continuous variables for POD. Potential risk factors for POD were evaluated by binary univariate and multivariate analysis with the "Enter" method.

RESULTS

According to the criteria by DSM V, 43 patients were categorized into the POD group, with an incidence of 12.8% (43 of 336). The receiver operating characteristic curve showed that albumin/fibrinogen ratio (AFR) was a good predictor for POD with an area under the curve of 0.754, cut-off value of 9.65, sensitivity of 57.00% and specificity of 83.72% (P <0.001). A low preoperative AFR level (<9.65) was determined as the only independent risk factor for POD by the univariate and multivariate logistic regression analyses (OR: 2.45, 95% CI: 2.01-2.94, P = 0.008).

CONCLUSIONS

Our results indicate that a low AFR is an independent risk factor for POD in elderly subjects after TJA. Geriatr Gerontol Int 2022; 22: 412-417.

A Systematic Review of the Cardiometabolic Benefits of Plant Products Containing Mixed Phenolics and Polyphenols in Postmenopausal Women: Insufficient Evidence for Recommendations to This Specific Population

Menopause is characterized by endocrine and physiological changes and is often accompanied by increased body weight and cholesterol, glucose intolerance, and/or hypertension. These alterations are associated with increased risk for cardiovascular diseases (CVDs) and Type II diabetes mellitus (T2DM) that may be moderate by dietary plant phenolic compounds. In this review, we examine the current evidence of the impact of a variety of plant products (foods, extracts, beverages) rich in a mixture of phenolics and polyphenols on: (i) glucose and insulin levels; (ii) lipid profile; (iii) blood pressure; and (iv) biomarkers of inflammation and oxidative stress in postmenopausal women. We critically evaluate both the results of a range of intervention studies conducted in this specific subpopulation and the level of evidence supporting the benefits of consuming those products after the menopause. Overall, the current available evidence does not allow for specific dietary recommendations of these plant products rich in phenolics and polyphenols in this high-risk subpopulation. Our data show rather variable and small effects of the different products examined on the cardiometabolic biomarkers and further support the need to: (1) improve the quality of the study designs and data reporting; and (2) understand the variability in the response of the different biomarkers and establish clear differences between healthy and cardiometabolic disease levels.

Adiposity and pathogen exposure: An investigation of response to iron supplementation and hypothesized predictors in anemic pre-school-aged children living in a dual burden environment

OBJECTIVES

Peruvians are experiencing rapid dietary and lifestyle changes, resulting in a phenomenon known as the "dual burden of disease." A common manifestation of the dual burden in individuals is the co-occurrence of overweight and anemia. Despite recent initiatives introduced to address these concerns, rates continue to be public health concerns. This study investigates the relationship between immune activation and lack of response to iron supplementation after 1 month of treatment and explores variation in body fat stores as a potential moderator between immune function and response to treatment.

METHODS

Data come from children, aged 2-5 years (n = 50) from a peri-urban community in Lima, Peru. Multivariate logistic regression models were used to explore the associations between response to treatment (Hb > =11.0 g/dl) after 1 month of treatment), markers of immune activation (C-reactive protein [CRP] and reported morbidity symptoms), and measures of body fat (waist-to-height ratio, triceps skinfold thickness, and body mass index [BMI]).

RESULTS

We found that high CRP is associated with a lack of response to iron supplementation after 1 month of treatment and that BMI z-score may moderate this association. Generally, larger body size is associated with response to iron supplementation whether or not the children in this sample have high immune activation. However, the probability of anemic children responding to iron supplementation treatment differed across adiposity measures.

CONCLUSIONS

Our finding suggesting that adiposity and CRP influence response to iron supplementation, furthers our understanding of the relationship between inflammation and anemia treatment in children and has both theoretical and public health implications.

Relationship between body mass index and neuropsychiatric symptoms: Evidence and inflammatory correlates

OBJECTIVE

Neuropsychiatric symptoms are frequent in obese individuals. Mounting evidence suggests that adiposity-related inflammation contributes to this effect. This study assessed the relationship between adiposity, neuropsychiatric symptom dimensions and systemic inflammation in subjects stratified by body-mass-index (BMI).

METHODS

The study included 165 subjects, of whom 70 were very severely obese (BMI ≥ 40 kg/m²), 50 severely obese (BMI: 35-39.99 kg/m²), 21 overweight or moderately obese (BMI: 25-34.9 kg/m²), and 24 lean (BMI < 25 kg/m²). Depressive symptoms were assessed using the Montgomery-Asberg Depression Rating Scale (MADRS) and the Mini-International Neuropsychiatric Interview (MINI). Fatigue and general neurobehavioral symptoms were assessed using the Multidimensional Fatigue Inventory (MFI) and Neurotoxicity Rating Scale (NRS) respectively. Serum levels of the inflammatory markers, high-sensitive (hs) CRP and hsIL-6, were determined by ELISA.

RESULTS

Severely obese subjects exhibited higher MADRS, MFI and NRS scores and were more frequently afflicted with current diagnosis of major depression than lean participants. Scores on psychometric scales were also increased in very severely obese subjects, although to a lesser extent. Alterations in neuropsychiatric dimensions were highly inter-related. HsCRP was significantly increased in subjects with severe or very severe obesity, while hsIL-6 was augmented in all obese groups. Overall, increased neuropsychiatric comorbidity was associated with greater systemic inflammation, notably hsCRP.

CONCLUSION

Obesity is characterized by an increased prevalence of inter-related neuropsychiatric symptoms together with low-grade systemic inflammation augmenting with adiposity. The association between adiposity, systemic inflammation and neuropsychiatric alterations supports the contribution of adiposity-related inflammatory processes to neuropsychiatric comorbidities in obesity. These data suggest that consideration of adiposity characteristics may help identifying subjects at increased risk for neuropsychiatric comorbidity.

Inflammatory and endothelial dysfunction indices among Egyptian females with obesity classes I-III

Background: Obesity is an alarming threat to health in Egypt. More than one in three Egyptians is obese, the highest rate in the world. We aimed to delineate the variability of inflammation and endothelial dysfunction markers among Egyptian females with different obesity classes. Methods: Out of 130 females, 70 were categorized into three obesity groups: Class I, body mass index (BMI) 30–34.9 kg/m²; Class II, BMI 35–39.9 kg/m² and Class III BMI ≥ 40 kg/m², besides 60 control subjects. Anthropometric measurements were recorded and serum levels of tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), interleukin (IL) 6 (IL-6), IL-12, soluble intercellular adhesion molecule 1 (sICAM-1) and soluble vascular adhesion molecule 1 (sVCAM-1) were assessed among participants. Results: In all three classes of obesity, significant increase (P <0.05) in BMI, waist-hip ratio, fat mass and body fat mass % were noted. CRP and sVCAM-1 levels were increased among the three obesity groups. TNF-α levels were increased in class II and III obesity groups. IL-6 and IL-12 levels were elevated in class I and class III groups. While, ICAM-1 levels were increased in class III obesity group. Conclusion: Based on individuals’ BMI, serum levels of TNF-α, CRP, IL-6, IL-12, sVCAM-1 and sICAM-1 are differentially altered with the progression of obesity. We strongly support the hypothesis that, as the obesity rate is still mounting, a subclinical inflammatory reaction has a role in pathogenesis of obesity and emphasize the elevation of endothelial dysfunction in individuals with obesity.

Fibrinogen to Albumin Ratio as an Independent Risk Factor for Type 2 Diabetic Kidney Disease

PURPOSE

Diabetic kidney disease (DKD) is an inflammatory disease. This study aimed to investigate the association of fibrinogen to albumin ratio (FAR) with DKD.

PATIENTS AND METHODS

A total of 1022 type 2 diabetes mellitus (T2DM) patients with DKD and 1203 T2DM patients without DKD were enrolled in this study. Laboratory values including blood cell count, hemoglobin A1c, biochemical parameters, and fibrinogen and albumin creatinine ratio were recorded. Patients were classified according to tertile of admission FAR. Clinical parameters were compared between groups. Logistic regression, linear regression, ROC analysis and spline regression were carried out.

RESULTS

FAR in the DKD group was significantly higher than that in the non-DKD group. FAR had the highest odds ratio as an independent risk factor for the development of DKD and the highest area under ROC curve for predicting DKD compared with albumin (ALB) or fibrinogen (FIB) alone. Simple linear regression analyses revealed a significant and linear correlation of FAR with neutrophil and neutrophil-to-lymphocyte ratio. FAR was an independent risk factor for development of DKD. Spline regression showed that there was a significant linear association between DKD incidence and continuous FAR value when it exceeded 67.3mg/g.

CONCLUSION

FAR is a stronger independent predictor of DKD than FIB and ALB. FAR is an independent risk factor for DKD development when it exceeded 67.3mg/g. FAR might be one of novel diagnostic biomarkers to predict and prevent DKD progression. However, a prospective study to validate the prognostic model is still needed.

Association of fibrinogen/albumin ratio and coronary collateral circulation in stable coronary artery disease patients

Aim: To investigate whether fibrinogen/albumin ratio (FAR) has an association with the coronary collateral circulation (CCC) in patients with stable coronary artery disease. Materials & methods: A total of 391 patients with stable coronary artery disease who underwent coronary angiography were included. The patients were divided into two groups according to the Rentrop score. Results: The poorly developed CCC group had a significantly higher FAR level compared with the well-developed CCC group (p < 0.001). In the multivariate analysis, the FAR (odds ratio: 1.700; 95% CI: 1.420-2.036; p < 0.001) was an independent predictor of poorly developed CCC. Conclusion: FAR can be used as one of the independent predictors of CCC formation.

Prealbumin to fibrinogen ratio is closely associated with diabetic peripheral neuropathy

The aim of our study was to explore the diagnostic value of prealbumin to fibrinogen ratio (PFR) for predicting prognosis with the optimal cut-off value in diabetic peripheral neuropathy (DPN) patients. A total of 568 type 2 diabetes mellitus (T2DM) patients were enrolled in this study. The values including Toronto clinical neuropathy score (TCNS), nerve conduction velocity (NCV), vibration perception threshold (VPT), blood cells count, biochemical parameters, fibrinogen and PFR were recorded. The patients were divided into tertiles based on admission PFR value. First, clinical parameters were compared among the groups. Secondly, a logistic regression and ROC analysis were performed as the statistical model. The percentage of DPN, TCNS and VPT were significantly higher in the lowest PFR tertile than in the middle PFR tertile and the highest PFR tertile (P < 0.01-0.001). NCV was significantly lower in lowest PFR tertile than in the middle PFR tertile and the highest PFR tertile (P < 0.01-0.001). The Spearman correlation analysis showed that PFR was negatively correlated with TCNS and VPT (P < 0.001), while PFR was positively correlated with median motor NCV (P < 0.001), peroneal motor NCV (P < 0.001), median sensory NCV (P < 0.001), and peroneal sensory NCV (P < 0.001). After adjusting these potentially related factors, PFR was independently related to DPN (P = 0.007). The area under ROC curve was 0.627. This study finds the first evidence to suggest PFR may be the key component associated with DPN in T2DM, while PFR might underlie the pathophysiologic features of DPN.

Obesity is associated with postinjury hypercoagulability

BACKGROUND

Obesity is linked to hypercoagulability with an increased risk of venous thromboembolic events (VTE) in the uninjured population. Therefore, we hypothesize that obesity (body mass index [BMI] ≥30 kg/m [BMI30]) is associated with a hypercoagulable state postinjury characterized by increased clot strength and resistance to fibrinolysis.

METHODS

Our prospective Trauma Activation Protocol database includes all trauma activations patients for whom a rapid thrombelastography is obtained within 60 minutes postinjury prior to any transfusions. The data set was then stratified by BMI and subjects with BMI30 were compared with those with BMI less than 30 kg/m). The following thrombelastography measurements were obtained: activated clotting time, clot formation rate (angle), maximum clot strength (MA), and % clot lysis 30 minutes after MA (LY30, %). Fibrinolysis shutdown (SD) was defined as LY30 < 0.6% and hyperfibrinolysis (HF) as LY30 greater than 7.6%. Continuous variables are expressed as median (interquartile range).

RESULTS

Overall, 687 patients were included of whom 161 (23%) had BMI30. The BMI30 group was older, had a lower proportion of males and of blunt trauma, and was less severely injured. After adjustment for confounders, BMI30 was independently associated with lower odds of MA less than 55 mm (odds ratio [OR], 0.28; 95% confidence interval [CI], 0.13-0.60) and of HF (OR, 0.31; 95% CI, 0.10-0.97) and higher odds of SD (OR, 1.82; 95% CI, 1.09-3.05). No independent association was observed with angle less than 65° (OR 0.57 95% CI 0.30-1.05). While VTEs were more frequent among BMI30 patients (5.0 vs. 3.3%), this did not reach significance after confounding adjustment (p = 0.11).

CONCLUSION

Obesity was protective against diminished clot strength and hyperfibrinolysis, and obesity was associated with an increased risk of fibrinolytic SD in severely injured patients. These findings suggest a relative hypercoagulability. Although no difference in VTEs was noted in this study, these findings may explain the higher rate of VTEs reported in other studies.

LEVEL OF EVIDENCE

Prognostic and Epidemiological, level III.

Excess body weight as a predictor of response to treatment with antidepressants in patients with depressive disorder

BACKGROUND

Depression and obesity are debilitating conditions representing an enormous health and economic burden worldwide. Depression is common among patients with excess weight, but more importantly, these patients may be at risk for poor response when treated with antidepressant medications (AD).

METHODS

We conducted a comprehensive scoping review to summarize the evidence regarding the difference in response to treatment of depression with AD among patients with excess weight as compared to normal weight patients and to identify knowledge gaps.

RESULTS

The search of the Medline and PsycINFO (2004-2019) identified twelve relevant studies. Tabulation and frequency analysis of the charted data along with a narrative synthesis were performed. Nine studies (75%) reported clinically relevant negative association between patients' high BMI or obesity and treatment response to either nortriptyline, fluoxetine, or various AD; one study (8.3%) reported no difference in response to various AD combinations between BMI groups. One study showed benefits of bupropion and escitalopram combination in patients with morbid obesity (BMI > 35 kg/m²) as compared with escitalopram monotherapy. Another study reported benefits when using venlafaxine-XR in patients with morbid obesity. We also acknowledge the possible role of sex and genetic factors predicting AD treatment response.

LIMITATIONS

The search was restricted to two most relevant sources, publications in four languages and adult population.

CONCLUSION

The synthesized data may be useful to physicians in their decision regarding the choice of AD in patients with excess weight. Researchers need to address causality of association between obesity and treatment response to individual AD types.

The Dietary Inflammatory Index and Chronic Lymphocytic Leukaemia in the MCC Spain Study

Chronic inflammation plays a role in the development of chronic lymphocytic leukaemia (CLL), and diet might modulate chronic inflammation. This study aims to evaluate the association between the dietary inflammatory index (DII®) and CLL. A total of 366 CLL cases and 1643 controls of the Spanish multicase-control (MCC) Spain study were included. The inflammatory potential of the diet was assessed using the energy-adjusted dietary inflammatory index (E-DII) based on 30 items from a validated semi-quantitative food frequency questionnaire. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using logistic regression models controlling for potential confounders. Overall, a modest, non-statistically significant, positive association was observed between CLL and E-DII scores (OR for a one-unit increase in E-DII: 1.05 (CI 95%: 0.99, 1.12), p-value = 0.09 and by tertiles: ORT2vsT1: 1.20 (CI 95%: 0.90, 1.59); OR T3vsT1: 1.21 (CI 95%: 0.90, 1.62), p trend = 0.21). These results were independent from disease severity (p-het: 0.70), time from diagnosis (p-het: 0.67) and CLL treatment received (p-het: 0.56). No interactions were detected. In conclusion, the consumption of a diet with high pro-inflammatory components was not significantly associated with CLL. Changes towards a more pro-inflammatory dietary pattern in younger generations not included here warrant future research.

Supplementation of Stingless Bee Honey from Heterotrigona itama Improves Antiobesity Parameters in High-Fat Diet Induced Obese Rat Model

Heterotrigona itama is a common stingless bee species found in Southeast Asia. Studies on the health benefits of its honey are limited in comparison with other stingless bee species. This study examines the antiobesity benefits found in stingless bee honey (SBH) from H. itama. The parameters used to measure the benefits were weight change, morphological structures, and biochemical characteristics. The research was conducted by using rats that were given a high-fat diet (HFD). In total 48 male Sprague Dawley (SD) rats were given a formulated HFD to increase the levels of obesity, the HFD was administered with a value of 0.68 g/cm2. The duration of the treatment was six weeks, and the results show that the induction obesity using the HFD was successful. Following this, the rats were then treated with SBH (at dosages of 1000 mg/kg, 750 mg/kg or 500 mg/kg), with orlistat or with a placebo. Compared with typical obesity treatment methods, the one that used the three dosages of SBH showed a higher reduction in body mass index (BMI), percentage of body weight gain, adiposity index, and relative organ weight (ROW). The levels of liver enzymes (ALT, AST, and ALP) were also significantly lower in SBH-treated groups. The levels of triglycerides and LDL-cholesterol were significantly lower, while the level of HDL-cholesterol was significantly higher in comparison with the control obese group. In terms of morphological structures, the number of adipocyte cells was reduced, and the hepatocytes found in the liver were less prone to rupturing when treated with SBH. In conclusion, the administration of SBH led to an improvement in indicators associated with obesity reduction. SBH also possesses a hepatoprotective potential which can reduce the health risks related to obesity.

Anti-obesity effects of Diospyros lotus leaf extract in mice with high-fat diet-induced obesity

Diospyros (D.) lotus has been demonstrated to have antioxidant and anti‑inflammatory properties. The purpose of the present study was to evaluate the effect of D. lotus leaf water extract (DLE) on high‑fat diet (HFD)‑induced obesity in C57BL/6 mice. The present study first investigated the effect of DLE on the lipid accumulation and triglyceride (TG) contents in 3T3‑L1 cells, and the results revealed that treatment with DLE suppressed the lipid accumulation and TG level. Subsequently, the anti‑obesity effects of DLE were investigated in vivo. Oral administration of DLE reduced the body weight gain, food efficiency ratio, and liver and visceral fat weight in mice fed with a HFD. DLE administration in these mice also reduced TG, total cholesterol, low‑density lipoprotein cholesterol, glucose, insulin and leptin levels, as well as the atherogenic index. Furthermore, DLE administration decreased hepatic steatosis, as well as serum aspartate transaminase, alanine transaminase and alkaline phosphatase levels in mice fed with HFD. It was further observed that treatment of the HFD‑fed mice with DLE prevented lipid peroxidation, while it recovered glutathione depletion and the activities of superoxide dismutase, catalase and glutathione peroxidase. In conclusion, the current study suggests that the anti‑obesity effect of DLE may provide positive insights as a potential functional food ingredient for the prevention of obesity.

Association between Dietary Inflammatory Index and the Risk of Prostate Cancer: A Meta-Analysis

BACKGROUND

Diet is a known source of pro- and anti-inflammatory mediators, and inflammatory markers have been associated with mechanisms involved in prostate cancer initiation and progression. The Dietary Inflammatory Index (DII^®) is a tool to assist researchers in determining the inflammatory potential of diet. The aim of this study was to conduct a meta-analysis to assess the association between DII and prostate cancer.

METHODS

EMBASE and MEDLINE were searched from inception to February 2018, for relevant observational studies. The random effects model was used to calculate the overall relative risks (RRs) with 95% confidence intervals (CIs).

RESULTS

Data from five case-control and one cohort study were eligible for inclusion. The adjusted pooled RR of prostate cancer for the highest (the most pro-inflammatory diet) versus lowest (the most anti-inflammatory diet) DII categories was 1.74 (95% CI: 1.24-2.43). The analysis in the DII score as a continuous variable was also performed and the results showed that the risk of prostate cancer was 9% higher for each one-point increase in the score.

CONCLUSION

This meta-analysis suggests that promoting diets rich in anti-inflammatory food components (i.e., whole grains, fish, green vegetables, and fruits) should help in reducing preventing prostate cancer.

Two new inflammatory markers associated with disease activity score-28 in patients with rheumatoid arthritis: Albumin to fibrinogen ratio and C-reactive protein to albumin ratio

BACKGROUND

The albumin to fibrinogen ratio (AFR) and C-reactive protein to albumin ratio (CAR) have emerged as useful biomarkers to predict systemic inflammation. The aim here is to investigate the relation between AFR/CAR and Disease Activity Score of 28 joints (DAS 28) in rheumatoid arthritis (RA).

METHODS

This retrospective study included 160 patients with RA and 159 healthy controls. We divided the RA patients into two groups according to the DAS 28-ESR score. Group 1 included 40 patients with a score of lower than 2.6 (patients in remission) and Group 2 included 120 patients with a score of 2.6 or higher (patients with active disease). The correlations between AFR, CAR and the disease activity were analyzed.

RESULTS

For RA patients, the AFR was lower than those in the control group (P < 0.001). Patients in group 2 had higher CAR than those in group 1 (P < 0.001). The AFR was lower in group 2 than that in group 1. A positively correlation was observed between DAS 28-ESR score and CAR (r = 0.645, P < 0.001), while the correlation between DAS 28-ESR and AFR (r = -0.836, P < 0.001) was negative. AFR was related with decreased risk of RA disease activity (EXP (B) = 0.33, 95% CI (0.21-0.53), P < 0.001).

CONCLUSIONS

AFR and CAR are two novel inflammatory markers for monitoring disease activity in patients with RA.

Dietary Weight Loss, Exercise, and Oxidative Stress in Postmenopausal Women: A Randomized Controlled Trial

Oxidative stress, a potential mechanism linking obesity and cancer, results from an imbalance between activation/inactivation of reactive oxygen species, byproducts of cellular metabolism. In a randomized controlled trial, we investigated effects of diet and/or exercise on biomarkers of oxidative stress. A total of 439 overweight/obese [body mass index (BMI) > 25 kg/m²] postmenopausal women, ages 50 of 75 years, were randomized to 12 months of (i) reduced-calorie weight loss diet ("diet"; n = 118); (ii) moderate-to-vigorous intensity aerobic exercise ("exercise"; n = 117); (iii) combined diet and exercise intervention ("diet + exercise"; n = 117); or (iv) control (n = 87). Outcomes were circulating markers of oxidative stress, including fluorescent oxidation products (FOP), F₂-isoprostanes, and oxidized low-density lipoprotein (LDL). On average, participants were 57.9 years, with a BMI of 30.9 kg/m² F₂-isprostanes were significantly reduced in the diet (-22.7%, P = 0.0002) and diet + exercise (-23.5%, P < 0.0001) arms versus controls (-2.99%) and nonsignificantly reduced in the exercise arm (-14.5%, P = 0.01). Participants randomized to the diet and diet + exercise arms had significant increases in levels of FOP [control -5.81%; diet +14.77% (P = 0.0001); diet + exercise +17.45%, (P = 0.0001)]. In secondary analyses, increasing weight loss was statistically significantly associated with linear trends of greater reductions in oxidized LDL and in F₂-isoprostanes and increases in FOP. Compared with controls, exercise participants whose maximal oxygen consumption increased had significant decreases in levels of F₂-isoprostanes and in oxidized LDL and increases in FOP. Dietary weight loss, with or without exercise, significantly reduced some markers of oxidative stress in postmenopausal women. Cancer Prev Res; 9(11); 835-43. ©2016 AACR.

Precision Nutrition and Omega-3 Polyunsaturated Fatty Acids: A Case for Personalized Supplementation Approaches for the Prevention and Management of Human Diseases

BACKGROUND

Dietary essential omega-6 (n-6) and omega-3 (n-3) 18 carbon (18C-) polyunsaturated fatty acids (PUFA), linoleic acid (LA) and α-linolenic acid (ALA), can be converted (utilizing desaturase and elongase enzymes encoded by FADS and ELOVL genes) to biologically-active long chain (LC; >20)-PUFAs by numerous cells and tissues. These n-6 and n-3 LC-PUFAs and their metabolites (ex, eicosanoids and endocannabinoids) play critical signaling and structural roles in almost all physiologic and pathophysiologic processes.

METHODS

This review summarizes: (1) the biosynthesis, metabolism and roles of LC-PUFAs; (2) the potential impact of rapidly altering the intake of dietary LA and ALA; (3) the genetics and evolution of LC-PUFA biosynthesis; (4) Gene-diet interactions that may lead to excess levels of n-6 LC-PUFAs and deficiencies of n-3 LC-PUFAs; and (5) opportunities for precision nutrition approaches to personalize n-3 LC-PUFA supplementation for individuals and populations.

CONCLUSIONS

The rapid nature of transitions in 18C-PUFA exposure together with the genetic variation in the LC-PUFA biosynthetic pathway found in different populations make mal-adaptations a likely outcome of our current nutritional environment. Understanding this genetic variation in the context of 18C-PUFA dietary exposure should enable the development of individualized n-3 LC-PUFA supplementation regimens to prevent and manage human disease.

Antidyslipidemic, Anti-Inflammatory, and Antioxidant Activities of Aqueous Leaf Extract of Dioscoreophyllum cumminsii (Stapf) Diels in High-Fat Diet-Fed Rats

Dioscoreophyllum cumminsii (Stapf) Diels leaves are widely used in the treatment of diabetes, obesity, and cardiovascular related complications in Nigeria. This study investigates the anti-inflammatory and antiobesity effect of aqueous extract of Dioscoreophyllum cumminsii leaves in high-fat diet- (HFD-) induced obese rats. HFD-fed rats were given 100, 200, and 400 mgkg-1 body weight of aqueous extract of Dioscoreophyllum cumminsii leaves for 4 weeks starting from 9th week of HFD treatment. D. cumminsii leaves aqueous extract reversed HFD-mediated decrease in the activities of superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase, and glucose 6-phosphate dehydrogenase. Moreover, HFD-mediated elevation in the levels of conjugated dienes, lipid hydroperoxides, malondialdehyde, protein carbonyl, and DNA fragmentation in rats liver was lowered. HFD-mediated alterations in serum total cholesterol, triacylglycerol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and very low-density lipoprotein cholesterol were significantly reversed by the extract. The treatment of HFD-fed rats reduced the levels of insulin, leptin, protein carbonyl, fragmented DNA, and tumour necrosis factor-α and interleukin- (IL-) 6 and IL- 8 and increased the adiponectin level. This study showed that aqueous extract of Dioscoreophyllum cumminsii leaves has potential antiobesity and anti-inflammatory effects through modulation of obesity-induced inflammation, oxidative stress, and obesity-related disorder in HFD-induced obese rats.

Effects of C-reactive protein on the expression of matrix metalloproteinases and their inhibitors via Fcγ receptors on 3T3-L1 adipocytes

The association between obesity and inflammation is well documented in epidemiological studies. Proteolysis of extracellular matrix (ECM) proteins is involved in adipose tissue enlargement, and matrix metalloproteinases (MMPs) collectively cleave all ECM proteins. Here, we examined the effects of C-reactive protein (CRP), an inflammatory biomarker, on the expression of MMPs and tissue inhibitors of metalloproteinases (TIMPs), which are natural inhibitors of MMPs, in adipocyte-differentiated 3T3-L1 cells. We analyzed the expression of Fcγ receptor (FcγR) IIb and FcγRIII, which are candidates for CRP receptors, and the effects of anti-CD16/CD32 antibodies, which can act as FcγRII and FcγRIII blockers on CRP-induced alteration of MMP and TIMP expression. Moreover, we examined the effects of CRP on the activation of mitogen-activated protein kinase (MAPK) signaling, which is involved in MMP and TIMP expression, in the presence or absence of anti-CD16/CD32 antibodies. Stimulation with CRP increased MMP-1, MMP-3, MMP-9, MMP-11, MMP-14, and TIMP-1 expression but did not affect MMP-2, TIMP-2, and TIMP-4 expression; TIMP-3 expression was not detected. Adipocyte-differentiated 3T3-L1cells expressed FcγRIIb and FcγRIII; this expression was upregulated on stimulation with CRP. Anti-CD16/CD32 antibodies inhibited CRP-induced expression of MMPs, except MMP-11, and TIMP-1. CRP induced the phosphorylation of extracellular signal-regulated kinase (ERK) 1/2 and p38 MAPK but did not affect SAPK/JNK phosphorylation, and Anti-CD16/CD32 attenuated the CRP-induced phosphorylation of p38 MAPK, but not that of ERK1/2. These results suggest that CRP facilitates ECM turnover in adipose tissue by increasing the production of multiple MMPs and TIMP-1 in adipocytes. Moreover, FcγRIIb and FcγRIII are involved in the CRP-induced expression of MMPs and TIMP-1 and the CRP-induced phosphorylation of p38, whereas the FcγR-independent pathway may regulate the CRP-induced MMP-11 expression and the CRP-induced ERK1/2 phosphorylation.

Weight Gain Trajectories Associated With Elevated C-Reactive Protein Levels in Chinese Adults

BACKGROUND

Recent longitudinal work suggests that weight change is an important risk factor for inflammation across the full range of BMI. However, few studies have examined whether the risk of inflammation differs by patterns of weight gain over time. Using latent class trajectory analysis, we test whether patterns of weight gain are associated with elevated high-sensitivity C-reactive protein (hs-CRP 2-10 mg/L).

METHODS AND RESULTS

Data come from China Health and Nutrition Survey (CHNS) participants (n=5536), aged 18 at baseline to 66 years in 2009, with measured weight over 18 years. Latent class trajectory analysis was used to identify weight-change trajectories in 6 age and sex strata. Multivariable general linear mixed-effects models fit with a logit link were used to assess the risk of elevated hs-CRP across weight trajectory classes. Models were fit within age and sex strata, controlling for baseline weight, adult height, and smoking, and included random intercepts to account for community-level correlation. Steeper weight-gain trajectories were associated with greater risk of elevated hs-CRP compared to more moderate weight-gain trajectories in men and women. Initially high weight gain followed by weight loss was associated with lower risk of elevated hs-CRP in women aged 18 to 40.

CONCLUSIONS

Latent class trajectory analysis identified heterogeneity in adult weight change associated with differential risk of inflammation independently of baseline weight and smoking. These results suggest that trajectories of weight gain are an important clinical concern and may identify those at risk for inflammation and the development of cardiometabolic disease.

National Estimates of Serum Total 25-Hydroxyvitamin D and Metabolite Concentrations Measured by Liquid Chromatography-Tandem Mass Spectrometry in the US Population during 2007-2010

BACKGROUND

The 2007-2010 NHANES provides the first US nationally representative serum 25-hydroxyvitamin D [25(OH)D] concentrations measured by standardized liquid chromatography-tandem mass spectrometry.

OBJECTIVE

We describe patterns for total 25(OH)D and individual metabolites in persons aged ≥1 y stratified by race-ethnicity and grouped by demographic, intake, physiologic, and lifestyle variables.

METHODS

We measured 25-hydroxycholecalciferol [25(OH)D3], 25-hydroxyergocalciferol [25(OH)D2], and C3-epimer of 25(OH)D3 [C3-epi-25(OH)D3] in serum samples (n = 15,652) from the 2007-2010 cross-sectional NHANES [total 25(OH)D = 25(OH)D3 + 25(OH)D2].

RESULTS

Concentrations (median, detection rate) of 25(OH)D3 (63.6 nmol/L, 100%) and C3-epi-25(OH)D3 (3.40 nmol/L, 86%) were generally detectable; 25(OH)D2 was detectable in 19% of the population. Total 25(OH)D, 25(OH)D3, and C3-epi-25(OH)D3 displayed similar demographic patterns and were strongly correlated (Spearman's r > 0.70). Concentrations of 25(OH)D2 (90th percentile) were much higher in persons aged ≥60 y (17.3 nmol/L) than in younger age groups (≤4.88 nmol/L). We noted significant race-ethnicity differences in mean total 25(OH)D [non-Hispanic blacks (NHBs), Hispanics, and non-Hispanic whites (NHWs): 46.6, 57.2, and 75.2 nmol/L, respectively] and in the prevalence of total 25(OH)D <30 nmol/L overall (24% of NHBs, 6.4% of Hispanics, and 2.3% of NHWs) as well as stratified by season (winter months: 30% of NHBs, 7.5% of Hispanics, and 3.8% of NHWs; summer months: 17% of NHBs, 4.4% of Hispanics, and 1.6% of NHWs). Persons with higher vitamin D intakes (diet, supplements, or both) and those examined during May-October had significantly higher total 25(OH)D. Significant race-ethnicity interactions in a multiple linear regression model confirmed the necessity of providing race-ethnicity-specific estimates of total 25(OH)D.

CONCLUSIONS

Race-ethnicity differences in the prevalence of low total 25(OH)D remained strong even after adjustment for season to account for the NHANES design imbalance between season, latitude, and race-ethnicity. The strong correlation between C3-epi-25(OH)D3 and 25(OH)D3 may be because the epimer is a metabolite of 25(OH)D3. The presence of 25(OH)D2 mainly in older persons is likely a result of high-dose prescription vitamin D2.

Proportion of gestational diabetes mellitus attributable to overweight and obesity among non-Hispanic black, non-Hispanic white, and Hispanic women in South Carolina

Objective was to estimate race-specific proportions of gestational diabetes mellitus (GDM) attributable to overweight and obesity in South Carolina. South Carolina birth certificate and hospital discharge data were obtained from 2004 to 2006. Women who did not have type 2 diabetes mellitus before pregnancy were classified with GDM if a diagnosis was reported in at least one data source. Relative risks (RR) and 95 % confidence intervals were calculated using the log-binomial model. The modified Mokdad equation was used to calculate population attributable fractions for overweight body mass index (BMI: 25.0-29.9 kg/m(2)), obese (30.0-34.9 kg/m(2)), and extremely obese (≥35 kg/m(2)) women after adjusting for age, gestational weight gain, education, marital status, parity, tobacco use, pre-pregnancy hypertension, and pregnancy hypertension. Overall, the adjusted RR of GDM was 1.6, 2.3, and 2.9 times higher among the overweight, obese, and extremely obese women compared to normal-weight women in South Carolina. RR of GDM for extremely obese women was higher among White (3.1) and Hispanic (3.4) women than that for Black women (2.6). The fraction of GDM cases attributable to extreme obesity was 14.0 % among White, 18.1 % among Black, and 9.6 % among Hispanic women. The fraction of GDM cases attributable to obesity was about 12 % for all racial groups. Being overweight (BMI: 25.0-29.9) explained 8.8, 7.8, and 14.4 % of GDM cases among White, Black, and Hispanic women, respectively. Results indicate a significantly increased risk of GDM among overweight, obese, and extremely obese women. The strength of the association and the proportion of GDM cases explained by excessive weight categories vary by racial/ethnic group.

Nutrient Composition and Anti-inflammatory Potential of a Prescribed Macrobiotic Diet

Despite nutrient adequacy concerns, macrobiotic diets are practiced by many individuals with cancer and other life-threatening illnesses. This study compared the nutrient composition and inflammatory potential of a macrobiotic diet plan with national dietary recommendations and intakes from a nationally representative sample. Nutrient comparisons were made using the 1) macrobiotic diet plan outlined in the Kushi Institute's Way to Health; 2) recommended dietary allowances (RDA); and 3) National Health and Nutrition Examination Survey (NHANES) 2009-2010 data. Comparisons included application of the recently developed dietary inflammatory index (DII). Analyses focused on total calories, macronutrients, 28 micronutrients, and DII scores. Compared to NHANES data, the macrobiotic diet plan had a lower percentage of energy from fat, higher total dietary fiber, and higher amounts of most micronutrients. Nutrients often met or exceeded RDA recommendations, except for vitamin D, vitamin B12, and calcium. Based on DII scores, the macrobiotic diet was more anti-inflammatory compared to NHANES data (average scores of -1.88 and 1.00, respectively). Findings from this analysis of a macrobiotic diet plan indicate the potential for disease prevention and suggest the need for studies of real-world consumption as well as designing, implementing, and testing interventions based on the macrobiotic approach.

The dietary inflammatory index is associated with colorectal cancer in the National Institutes of Health-American Association of Retired Persons Diet and Health Study

Diet is a strong moderator of systemic inflammation, an established risk factor for colorectal cancer (CRC). The dietary inflammatory index (DII) measures the inflammatory potential of individuals' diets. The association between the DII and incident CRC was examined, using the National Institutes of Health-American Associations of Retired Persons Diet and Health Study individuals (n 489,422) aged 50-74 years at recruitment, starting between 1995-6, and followed for a mean of 9·1 (sd 2·9) years. Baseline data from a FFQ were used to calculate the DII; higher scores are more pro-inflammatory, and lower scores are more anti-inflammatory. First, primary CRC diagnoses were identified through linkage to state cancer registries. Anatomic location and disease severity also were examined. Cox proportional hazards models estimated CRC hazard ratios (HR) and 95% CI using quartile 1 as the referent. DII quartile 4 compared to quartile 1 was associated with CRC risk among all subjects (HR 1·40, 95% CI 1·28, 1·53; P for trend < 0·01). Statistically significant associations also were observed for each anatomic site examined, for moderate and poorly differentiated tumours, and at each cancer stage among all subjects. Effects were similar when stratified by sex; however, results were statistically significant only in males. The only result reaching statistical significance in females was risk of moderately differentiated CRC tumours (DII quartile 4 v. quartile 1 HR 1·26, 95% CI 1·03, 1·56). Overall, the DII was associated with CRC risk among all subjects. The DII may serve as a novel way to evaluate dietary risk for chronic disorders associated with inflammation, such as CRC.

Environmental, Dietary, and Behavioral Factors Distinguish Chinese Adults with High Waist-to-Height Ratio with and without Inflammation

BACKGROUND

The environmental and behavioral risk factors associated with central obesity and/or inflammation in populations exposed to both obesogenic and pathogenic environments remain unclear.

OBJECTIVES

We tested which of the characteristics distinguished 3 risk groups--high waist-to-height ratio (WHtR; >0.5) without inflammation [high-sensitivity C-reactive protein (hs-CRP) <3 mg/L], normal WHtR (≤ 0.5) with inflammation (hs-CRP: 3-10 mg/L), and high WHtR with inflammation--from the referent group with normal WHtR without inflammation and, secondarily, which factors differed between the groups with high WHtR with and without inflammation.

METHODS

The analytic sample included 8068 adults participating in the China Health and Nutrition Survey in 2009. Adjusted multinomial and logistic regression models were used to assess the risk of being in one of the "unhealthy" groups compared with the referent group.

RESULTS

Men with high WHtR with and without inflammation were more likely to live at higher urbanicity (57-63%) and have higher incomes (26-42%) and household sanitation (26-67%) and were >40% less likely to have high physical activity than the healthy referent group. Men with high WHtR with inflammation had higher odds of infectious symptoms than those with high WHtR without inflammation (OR: 1.73; 95% CI: 1.15, 2.61). Women with high WHtR without inflammation were less likely to have high household sanitation (44%) or perform high levels of physical activity (24%) and were 34% more likely to consume more fiber than the healthy referent group. Women with high WHtR and inflammation were more likely than those with high WHtR without inflammation to have infectious symptoms (OR: 1.45; 95% CI: 1.01, 2.07) and less likely to have higher fiber intake (OR: 0.77; 95% CI: 0.60,1.00) or physical activity (OR: 0.55; 95% CI: 0.41, 0.73).

CONCLUSION

These results document different underlying pathogenic and obesogenic risk factors for visceral adiposity with and without inflammation in Chinese adults, suggesting that context-specific approaches may be needed to prevent and treat inflammation.

Interrelationships of Sex, Physician-Diagnosed Arthritis, Chronic Inflammation, and Physical Functioning in the Third National Health and Nutrition Examination Surveys

Objective: To examine whether serum concentrations of C-reactive protein (CRP) and fibrinogen were associated with total score on a validated 12-item physical functioning scale and whether the magnitude and direction of these associations differed according to sex and physician-diagnosed arthritis. Method: Secondary analyses of cross-sectional data from the Third National Health and Nutrition Examination Survey were conducted using a representative sample of 4,606 older adults, 60 years and older. Results: Linear models suggested that overall physical functioning was strongly and independently associated with CRP (adjusted β = +.68, 95% confidence interval [CI] = [+0.42, +0.94]) and fibrinogen (adjusted β = +1.66, 95% CI = [+0.89, +2.42]); these associations were modified by physician-diagnosed arthritis status, with strongest associations observed among individuals diagnosed with rheumatoid arthritis or no arthritis and weakest association observed among those diagnosed with osteoarthritis. Conclusion: CRP and fibrinogen may be associated with poorer physical functioning in older adults, especially among those having rheumatoid arthritis or no arthritis.

Associations between liver enzymes, psychopathological and clinical features in eating disorders

Elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels are frequently reported in patients with anorexia nervosa (AN) and in subjects who are overweight or with hyperlipidemia, which can be found to be associated with binge eating disorder (BED) and bulimia nervosa (BN). Liver functioning and psychopathological features have been evaluated in 43 patients with AN, 33 with BN, and 32 with BED. Body mass index was found to be inversely associated with AST and ALT in AN, and directly associated with AST and ALT in BED. A positive association between ALT and AST and body shape concern in AN was observed. Liver enzymes could be considered as an index of severity in AN and BED patients.

Effects of long-term developmental patterns of adiposity on levels of C-reactive protein and fibrinogen among North-American men and women: the Spokane Heart Study

This study examined the heterogeneity in BMI development by identifying distinct developmental trajectories. These trajectories were further investigated by relating them to markers of low-grade inflammation later in life. Data from approximately 400 healthy volunteers participating in the Spokane Heart Study were collected in 2-year intervals, and four waves of data were available for the current analyses. Body weight was measured by BMI and low-grade inflammation by high-sensitivity C-reactive protein (CRP) and fibrinogen. Up to date statistical techniques, i.e., latent class growth models, were used to analyse heterogeneity in body weight, and linear regressions were run to analyse possible associations between trajectories of body weight and CRP/fibrinogen levels. Six trajectories were identified (three stable, two increasing, and one decreasing) which differed significantly on CRP/fibrinogen levels, highlighting the importance of weight trajectories. The differences were only partly explained by variations in lifestyle habits.

Everyday Discrimination Prospectively Predicts Inflammation Across 7-Years in Racially Diverse Midlife Women: Study of Women's Health Across the Nation

Self-reported discrimination has emerged as a predictor of negative psychological and physical health outcomes across racial/ethnic groups. The goals of this study were to determine whether C-reactive protein (CRP), a marker of inflammation and risk factor for future cardiovascular disease (CVD) was independently predicted by everyday discrimination or whether race or body mass index (BMI) modified this association over a 7-year period among 2,490 women from racially diverse backgrounds. At baseline, the 10-item Williams' measure of everyday discrimination was administered. Generalized estimating equations were used to assess these associations. Descriptive results showed that Black and Chinese women reported greater discrimination than White, Japanese, and Hispanic women, while Black and Hispanic women had the highest levels of CRP over the 7-year period. There was no main effect of everyday discrimination (B = .003, SE = .005, p = .58) and this association did not differ as a function of race (p's > .05). The everyday discrimination × BMI interaction term significantly predicted higher CRP levels over time in the full sample of women (p = .03). Specifically, in non-obese women (BMI less than 30), higher perceived everyday discrimination was associated with higher CRP levels over the 7-year period. These findings were independent of demographic, negative affect, biomedical, and behavioral factors. The results demonstrate that greater everyday discrimination is associated with increased inflammation over time in non-obese women. These findings highlight the implications of interpersonal sources of social stress for long-term physical health via their impact on intermediary biological pathways, specifically inflammation. Greater emphasis on such linkages is warranted as we work towards ameliorating health disparities exacerbated by individual-level factors.

Diet-gene interactions and PUFA metabolism: a potential contributor to health disparities and human diseases

The “modern western” diet (MWD) has increased the onset and progression of chronic human diseases as qualitatively and quantitatively maladaptive dietary components give rise to obesity and destructive gene-diet interactions. There has been a three-fold increase in dietary levels of the omega-6 (n-6) 18 carbon (C18), polyunsaturated fatty acid (PUFA) linoleic acid (LA; 18:2n-6), with the addition of cooking oils and processed foods to the MWD. Intense debate has emerged regarding the impact of this increase on human health. Recent studies have uncovered population-related genetic variation in the LCPUFA biosynthetic pathway (especially within the fatty acid desaturase gene (FADS) cluster) that is associated with levels of circulating and tissue PUFAs and several biomarkers and clinical endpoints of cardiovascular disease (CVD). Importantly, populations of African descent have higher frequencies of variants associated with elevated levels of arachidonic acid (ARA), CVD biomarkers and disease endpoints. Additionally, nutrigenomic interactions between dietary n-6 PUFAs and variants in genes that encode for enzymes that mobilize and metabolize ARA to eicosanoids have been identified. These observations raise important questions of whether gene-PUFA interactions are differentially driving the risk of cardiovascular and other diseases in diverse populations, and contributing to health disparities, especially in African American populations.

Gender differences in the relationship between symptoms of depression and high-sensitivity CRP

BACKGROUND

Depression has been associated with increased risk of cardiovascular disease. The inflammatory marker C-reactive protein (CRP) has also been identified as an independent predictor of short- and long-term cardiovascular disease events. Inflammation may influence the relationship between depression and cardiovascular disease.

OBJECTIVE

The objective of this study was to investigate the association between symptoms of depression and high-sensitivity CRP (hs-CRP) in an obese clinical population. We also sought to determine whether this relationship was different in men and women, given prior reports of a gender effect.

METHODS

Symptoms of depression and hs-CRP were measured in 390 participants enrolled in a weight loss intervention trial that was delivered in a primary care setting. Symptoms of depression were evaluated with the Patient Health Questionnaire-8 (PHQ-8), in which a score ≥ 10 is consistent with major depression.

RESULTS

A total of 58 (15.2%) participants reported a PHQ-8 score ≥ 10. The median (interquartile range) hs-CRP concentration was significantly higher in participants with symptoms consistent with major depression (7.7 (4.2-13) mg l(-1)) compared with those without depression (5.1 (3-9.7) mg l(-1); P<0.01). Symptoms consistent with major depression were significantly associated with log-transformed hs-CRP concentrations in an analysis adjusted for age, gender, obesity class and other metabolic variables (P=0.04). When interaction by gender was examined, this relationship remained significant in men (P<0.01) but not in women (P=0.32).

CONCLUSIONS

Symptoms consistent with major depression were significantly associated with hs-CRP in men only, even after adjusting for age, obesity class, metabolic variables and medications known to affect inflammation. This finding suggests that there are biologic differences between men and women that may modify the relationship between hs-CRP and depression. Further studies are needed to elucidate the biologic basis for these findings.

Association between inflammatory biomarkers and adiposity in obese patients with heart failure and metabolic syndrome

Obesity, type 2 diabetes mellitus (DM) and metabolic syndrome (MS) are common in patients with heart failure (HF). Studies investigating the association between known biomarkers and adiposity in patient populations are limited. The aim of the present study was to investigate the association between C-reactive protein (CRP) and leptin with adiposity in a sub-group of overweight/obese patients with HF, DM and/or MS. A total of 36 patients (mean age, 56.72±9.78 years; ranging between 27 and 76 years of age; 80.6% male; 52.8% Caucasian) were enrolled and their height, weight, waist circumference and body composition (e.g. percentage body fat and lean mass), as well as the levels of CRP and leptin, were assessed. The results demonstrated that there was a significant association between CRP and leptin, CRP and body mass index (BMI) and gender and percentage body fat (P<0.05, for all associations). Analysis of leptin and CRP levels revealed that patients in the highest BMI quartile (BMI, 40.3-61.2) had higher CRP levels (4.83 μg/ml vs. 3.03 μg/ml; P=0.033) and higher leptin levels (44.97 ng/ml vs. 24.64 ng/ml; P=0.042) compared with patients in the lower BMI quartile (BMI, 28.6-32.4). In conclusion, among obese patients with HF, DM and/or MS, an association between CRP and leptin was identified, providing further evidence that metabolic and inflammatory mechanisms are involved in these diseases. Future investigation to assess the potential impact of inflammation and adiposity, and the role of dietary interventions and weight loss on clinical outcomes in this population of chronically ill patients is warranted.

Postdiagnosis C-reactive protein and breast cancer survivorship: findings from the WHEL study

BACKGROUND

Serum C-reactive protein (CRP) is a marker of acute inflammatory response and has been associated with health outcomes in some studies. Inflammation and immune response may have potential prognostic implications for breast cancer survivors.

METHODS

The Women's Healthy Eating and Living Study includes 2,919 early-stage breast cancer survivors with serum collected 2 years postdiagnosis and follow-up for clinical outcomes over approximately 7 years. CRP concentrations were measured using high-sensitivity electrochemiluminescence assay. Outcomes, including all-cause mortality, breast cancer-specific mortality, and additional breast cancer events were oncologist verified from medical records and death certificates. Cox proportional hazards models were conducted with adjustment for potential confounding factors to generate HRs and 95% confidence intervals (CI).

RESULTS

CRP concentrations in women diagnosed with breast cancer were associated with death due to any cause, death due to breast cancer, and additional breast cancer events, after adjustment for sociodemographic and cancer characteristics (lnCRP: P < 0.05 for all three outcomes). The HR for women with (vs. without) acute inflammation suggests a threshold effect on overall survival, rather than a dose-response relationship (≥ 10.0 mg/L vs. <1 mg/L: HR, 1.96; 95% CI, 1.22-3.13). Associations were similar for breast cancer-specific mortality (HR, 1.91; 95% CI, 1.13-3.23) and any additional breast cancer-related event (HR, 1.69; 95% CI, 1.17-2.43).

CONCLUSIONS

Acute inflammation status (CRP ≥ 10 mg/L) may be an important independent biomarker for long-term survival in breast cancer survivors.

IMPACT

Interventions to decrease circulating CRP concentrations in breast cancer survivors with acute inflammation may improve prognosis.

Pathogenic and obesogenic factors associated with inflammation in Chinese children, adolescents and adults

OBJECTIVES

Influenced by pathogen exposure and obesity, inflammation provides a critical biological pathway linking changing environments to the development of cardiometabolic disease. This study tests the relative contribution of obesogenic and pathogenic factors to moderate and acute CRP elevations in Chinese children, adolescents and adults.

METHODS

Data come from 8795 participants in the China Health and Nutrition Study. Age-stratified multinomial logistic models were used to test the association between illness history, pathogenic exposures, adiposity, health behaviors and moderate (1-10 mg/L in children and 3-10 mg/L in adults) and acute (>10mg/L) CRP elevations, controlling for age, sex and clustering by household. Backward model selection was used to assess which pathogenic and obesogenic predictors remained independently associated with moderate and acute CRP levels when accounting for simultaneous exposures.

RESULTS

Overweight was the only significant independent risk factor for moderate inflammation in children (RRR 2.10, 95%CI 1.13-3.89). History of infectious (RRR 1.28, 95%CI 1.08-1.52) and non-communicable (RRR 1.37, 95%CI 1.12-1.69) disease, overweight (RRR 1.66, 95%CI 1.45-1.89) and high waist circumference (RRR 1.63, 95%CI 1.42-1.87) were independently associated with a greater likelihood of moderate inflammation in adults while history of infectious disease (RRR 1.87, 95%CI 1.35-2.56) and overweight (RRR 1.40, 95%CI 1.04-1.88) were independently associated with acute inflammation. Environmental pathogenicity was associated with a reduced likelihood of moderate inflammation, but a greater likelihood of acute inflammation in adults.

CONCLUSIONS

These results highlight the importance of both obesogenic and pathogenic factors in shaping inflammation risk in societies undergoing nutritional and epidemiological transitions.

The Effect of High-Fat Diet-Induced Pathophysiological Changes in the Gut on Obesity: What Should be the Ideal Treatment?

Obesity is a metabolic disorder and fundamental cause of other fatal diseases including atherosclerosis and cancer. One of the main factor that contributes to the development of obesity is high-fat (HF) consumption. Lipid ingestion will initiate from the gut feedback mechanisms to regulate glucose and lipid metabolisms. But these lipid-sensing pathways are impaired in HF-induced insulin resistance, resulting in hyperglycemia. Besides that, duodenal lipid activates mucosal mast cells, leading to the disruption of the intestinal tight junction. Lipopolysaccharide that is co-transited with dietary fat postprandially, promotes the release of cytokines and the development of metabolic syndrome. HF-diet also alters microbiota composition and enhances fat storage. Although gut is protected by immune system and contains high level of antioxidants, obesity developed presumably when this protective mechanism is compromised by the presence of excessive fat. Several therapeutic approaches targeting different pathways have been proposed. There may be no one single most effective treatment, but all aimed to prevent obesity. This review will elaborate on the physiological and molecular changes in the gut that lead to obesity, and will provide a summary of potential treatments to manage these pathophysiological changes.

Two weeks of reduced activity decreases leg lean mass and induces "anabolic resistance" of myofibrillar protein synthesis in healthy elderly

BACKGROUND

Alterations in muscle protein metabolism underlie age-related muscle atrophy. During periods of muscle disuse, muscle protein synthesis is blunted, and muscle atrophy occurs in young and old. The impact of a short reduction in physical activity on muscle protein metabolism in older adults is unknown.

PURPOSE

The aim of this study was to investigate the impact of 14 days of reduced daily steps on fasted and fed-state rates of myofibrillar protein synthesis (MPS) to provide insight into the mechanisms for changes in muscle mass and markers of metabolic health.

METHODS

Before and after 14 days of reduced daily step-count, 10 healthy older adults (age, 72 ± 1 y) underwent measures of insulin sensitivity, muscle strength, physical function, and body composition. Using a primed constant infusion of L-[ring-(13)C6]phenylalanine with serial muscle biopsies, basal, postabsorptive, and postprandial rates of MPS were determined before and after the 14-day intervention.

RESULTS

Daily step-count was reduced by approximately 76% to 1413 ± 110 steps per day. Leg fat-free mass was reduced by approximately 3.9% (P < .001). Postabsorptive insulin resistance was increased by approximately 12%, and postprandial insulin sensitivity was reduced by approximately 43% after step reduction (P < .005). Concentrations of TNF-α and C-reactive protein were increased by approximately 12 and 25%, respectively, after step reduction (P < .05). Postprandial rates of MPS were reduced by approximately 26% after the intervention (P = .028), with no difference in postabsorptive rates.

CONCLUSION

The present study demonstrates that 14 days of reduced steps in older adults induces small but measurable reductions in muscle mass that appear to be underpinned by reductions in postprandial MPS and are accompanied by impairments in insulin sensitivity and systemic inflammatory markers and postprandial MPS.

Association of optimism with cardiometabolic risk in adolescents

PURPOSE

Dispositional optimism is a psychological trait associated with cardiovascular disease outcomes in adults. However, it is not known whether these associations are present in adolescents. We attempted to determine whether an association exits between optimism and 9 biomarkers of cardiometabolic risk during adolescence. Because cardiometabolic risk differs by race and ethnicity, we also explored whether race and ethnicity moderated the optimism-cardiometabolic risk relationship.

METHODS

This was a cross-sectional study of 529 non-Hispanic white and 421 non-Hispanic black seventh through 12th graders living in greater Cincinnati in 2001-2002. We measured dispositional optimism with the Life-Orientation Test-Revised as a single continuum and as separate optimism and pessimism dimensions. Multivariable regression analyses tested for associations between optimism and nine biomarkers of risk (interleukin-6, tumor necrosis factor-α, lipids, insulin, glucose, and fibrinogen), adjusting for age, gender, parent education, body mass index, smoking, and pubertal stage.

RESULTS

Dispositional optimism with the Life-Orientation Test-Revised as a single continuum was inversely associated with two risks (interleukin-6, β = -.03, p = .02; insulin, β = -.02, p = .01), but only among blacks. Optimism and pessimism were inversely related (R = -.27, p < .001) and both were higher in blacks than whites (p < .001). Optimism was directly associated with high-density lipoprotein among all subjects (β = .42, p = .03), and among blacks (β = .74, p = .02) but not whites. Among blacks, optimism was also inversely associated with interleukin-6 (β = -.07, p = .001) and triglycerides (β = -.02, p = .04). Pessimism was inversely associated with glucose, but only in whites (β = -.38, p = .03).

CONCLUSIONS

Associations between dispositional optimism and cardiometabolic risks are present in adolescence and vary by race and ethnicity. A better understanding of the natural history of these associations over the lifespan may help decrease disparities and prevent cardiometabolic disease.

Effect of dietary composition of weight loss diets on high-sensitivity c-reactive protein: the Randomized POUNDS LOST trial

OBJECTIVE

Overweight and obesity are associated with increased high-sensitivity C-reactive protein (hsCRP) levels. The purpose of this study was to determine if weight loss diets differing in fat, protein, or carbohydrate composition differentially reduce hsCRP.

DESIGN AND METHODS

POUNDS (preventing overweight using novel dietary strategies) LOST was a 2-year trial of overweight and obese adults randomly allocated to one of four weight loss diets with targeted percentages of energy derived from fat, protein, and carbohydrates (20, 15, 65%; 20, 25, 55%; 40, 15, 45%; 40, 25, 35%, respectively). hsCRP was measured at baseline, 6, and 24 months among 710 participants, and adiposity as measured by dual X-ray absorptiometry (N = 340) or abdominal computed tomography (N = 126) was correlated with hsCRP change.

RESULTS

At 6 months, hsCRP was reduced in all trial participants by -24.7% (Interquartile range (IQR) +7%, -50%), weight by -6.7% (IQR -3%, -11%), and waist circumference by -6.0% (IQR -3%, -10%) (all P < 0.002), with no significant differences according to dietary composition. The percent change in hsCRP at 6 and 24 months correlated modestly with change in weight, waist circumference, fasting insulin, fasting glucose, HOMA, and most lipid levels. Reductions in hsCRP persisted despite ∼ 50% regain of weight by 24 months. The percent change in hsCRP at 24 months significantly correlated with changes in total body fat (r = 0.42), total abdominal adiposity (r = 0.52), subcutaneous abdominal adiposity (r = 0.52), visceral adiposity (r = 0.47), and hepatic tissue density (r = -0.34) (all P < 0.0006).

CONCLUSION

Weight loss decreased hsCRP by similar magnitude, irrespective of dietary composition. Clinicians concerned about inflammation and cardiovascular risk should recommend weight loss diets most likely to succeed for their patients.

Retrospective reports of weight change and inflammation in the US National Health and Nutrition Examination Survey

PURPOSE

This study investigated the association between weight change and inflammation in a nationally representative population of US adults aged 40 and older.

METHODS

Using the US National Health and Nutrition Examination Survey (2005-2008), logistic regression models were used to determine the relationship between high levels of inflammation (C-reactive protein [CRP]) and infection (white blood cell count [WBC]) with 1- and 10-year change in self-reported weight status.

RESULTS

Change in 1- and 10-year weight was associated with high CRP but not high WBC. Individuals who gained or lost ≥10 kg had an odds of having high CRP that was 1.96 (95% CI 1.11-3.50) and 1.61 (95% CI 1.02-2.46) as high, respectively, as those who maintained a stable weight (<4 kg change) in the past year. The increased risk of elevated CRP among individuals who experienced at least 10 kg of weight loss or weight gain was also observed for weight change that occurred over the past 10 years; however, weight loss over the 10-year period was no longer associated with high inflammation.

CONCLUSIONS

These results suggest that adult respondents who retrospectively self-reported weight loss or gain had higher levels of inflammation relative to their weight stable counterparts.

Impaired protein metabolism: interlinks between obesity, insulin resistance and inflammation

Metabolic and structural changes in skeletal muscle that accompany obesity are often associated with the development of insulin resistance. The first events in the pathogenesis of this disorder are considered as an accumulation of lipids within skeletal muscle due to blunted muscle capacity to oxidize fatty acids. Fat infiltration is also associated with muscle fibre typology modification, decrease in muscle mass and impairments in muscle strength. Thus, as a result of obesity, mobility and quality of life are affected, and this is in part due to quantitative and qualitative impairments in skeletal muscle. In addition, the insulin resistance related to obesity results not only in defective insulin-stimulated glucose disposal but has also detrimental consequences on protein metabolism at the skeletal muscle level and whole-body level. This review highlights the involvement of fat accumulation and insulin resistance in metabolic disorders occurring in skeletal muscle during the development of obesity, and the impairments in the regulation of protein metabolism and protein turnover in the links between obesity, metabolic inflammation and insulin resistance.