Waist circumference is the main determinant of elevated C-reactive protein in metabolic syndrome

An analysis of the associations of high-sensitivity C-reactive protein and uric acid with metabolic syndrome components in Korean adults by sex: a cross-sectional study using the Korea national health and nutrition examination survey 2016-2018

BACKGROUND

Low-grade inflammation plays a role in the pathogenesis of metabolic syndrome (MetS), and measuring levels of inflammatory molecules, such as high-sensitivity C-reactive protein (hs-CRP), may indicate Mets progression. Serum uric acid (SUA) has also been identified as an independent risk factor for MetS. This study aimed to investigate the association between MetS components and levels of serum hs-CRP and SUA using representative and reliable data for the Korean population.

METHODS

This study used the data of the Korea National Health and Nutrition Examination Survey 2016-2018, a cross-sectional and nationally representative survey performed by the Korean Centers for Disease Control and Prevention.

RESULTS

We analysed the data of 13,454 individuals. High hs-CRP levels were observed in 1,164 (8.7%) subjects while 3,296 (24.5%) subjects had high SUA levels. Moreover, hs-CRP was negatively correlated with serum high-density lipoprotein (HDL) (OR, 1.703; 95% CI, 1.431-2.027). When stratified by sex, this trend remained, but the correlation was stronger in women than in men. Furthermore, high SUA levels were significantly associated with hypertension (HTN) (OR, 1.399; 95% CI, 1.210-1.616), hypertriglyceridemia (OR, 1.735; 95% CI, 1.486-2.026), and low HDL (OR, 1.257; 95% CI, 1.106-1.429), but not with diabetes mellitus (DM) (OR, 0.478; 95% CI, 0.382-0.597). When grouped by sex, this trend remained, however, all MetS components were found to be more prevalent in women with high SUA.

CONCLUSIONS

Our findings showed that low HDL was more prevalent in subjects with high hs-CRP, and high SUA levels were observed in subjects with HTN, hypertriglyceridemia, and low HDL. However, the prevalence of high SUA was lower in diabetic subjects.

Wheat Biscuits Enriched with Plant-Based Protein Contribute to Weight Loss and Beneficial Metabolic Effects in Subjects with Overweight/Obesity

The present study aimed to assess the impact of daily consumption of a snack fortified with plant proteins with high content in amino acids with appetite regulating properties (BCAAs and L-arginine), as part of a dietary intervention, on weight loss. Seventy adults without diabetes (26 male, 44 female) and with overweight/obesity participated in a 12-week restricted dietary intervention and were randomized to either a control or an intervention group, consuming daily 70 g of conventional wheat biscuits (CB) or an isocaloric amount of wheat biscuits enriched with plant proteins (PB) originating from legumes and seeds, respectively. Anthropometric characteristics were measured and venous blood samples were collected at baseline and at the end of the intervention. Decreases in body weight, body fat mass and waist circumference were observed in both groups. Participants in the intervention group experienced greater weight loss (7.6 ± 2.7 vs. 6.2 ± 2.7%, p = 0.025) and marginally significant larger decrease in body fat mass (4.9 ± 2.2 vs. 3.9 ± 2.4 kg, p = 0.059). A moderate reduction in IL-1β levels (p = 0.081), a significantly higher decrease in TNF-α levels (p < 0.001) and a marginally significant greater leptin decrease (p = 0.066) in subjects of the PB group were noticed. Greater reductions in caloric and carbohydrate intake and a trend towards a higher decrease in fat intake were also observed in participants of this group. Incorporation of plant-based proteins with high content in amino acids with appetite-regulating properties in wheat biscuits may contribute to greater weight loss and improvement of metabolic parameters in subjects who are overweight or obese. Protein enrichment of snacks offers a beneficial qualitative manipulation that could be successfully incorporated in a diet plan.

Influence of endogenous estrogen on a network model of female brain integrity

Recent reports document sex differences in midlife brain integrity and metabolic health, such that more relationships are detectable between metabolic syndrome (MetS) components and markers of brain health in females than in males. Midlife is characterized by a rapid decrease in endogenous estrogen levels for women which is thought to increase risk for cardiometabolic disease and neurocognitive decline. Our study used network models, designed to explore the interconnectedness and organization of relationships among many variables at once, to compare the influence of endogenous estrogen and chronological age on a network of brain and metabolic health in order to investigate the utility of estrogen as a biomarker for brain vulnerability. Data were analyzed from 82 females (ages 40-62). Networks consisted of known biomarkers of risk for late-life cognitive decline: the five components of MetS; Brain-predicted age difference calculated on gray and white matter volume; white matter hyperintensities; Default Mode Network functional connectivity; cerebral concentrations of N-acetyl aspartate, glutamate and myo-inositol; and serum concentrations of estradiol. A second network replaced estradiol with chronological age. Expected influence (EI) of estradiol on the network was -1.190, relative to chronological age at -0.524, indicating that estradiol had a stronger expected influence over the network than age. A negative expected influence indicates that higher levels of estradiol would be expected to decrease the number of relationships in the model, which is thought to indicate lower risk. Overall, levels of estradiol appear more influential than chronological age at midlife for relationships between brain integrity and metabolic health.

Network Modeling Sex Differences in Brain Integrity and Metabolic Health

Hypothesis-driven studies have demonstrated that sex moderates many of the relationships between brain health and cardiometabolic disease, which impacts risk for later-life cognitive decline. In the present study, we sought to further our understanding of the associations between multiple markers of brain integrity and cardiovascular risk in a midlife sample of 266 individuals by using network analysis, a technique specifically designed to examine complex associations among multiple systems at once. Separate network models were constructed for male and female participants to investigate sex differences in the biomarkers of interest, selected based on evidence linking them with risk for late-life cognitive decline: all components of metabolic syndrome (obesity, hypertension, dyslipidemia, and hyperglycemia); neuroimaging-derived brain-predicted age minus chronological age; ratio of white matter hyperintensities to whole brain volume; seed-based resting state functional connectivity in the Default Mode Network, and ratios of N-acetyl aspartate, glutamate and myo-inositol to creatine, measured through proton magnetic resonance spectroscopy. Males had a sparse network (87.2% edges = 0) relative to females (69.2% edges = 0), indicating fewer relationships between measures of cardiometabolic risk and brain integrity. The edges in the female network provide meaningful information about potential mechanisms between brain integrity and cardiometabolic health. Additionally, Apolipoprotein ϵ4 (ApoE ϵ4) status and waist circumference emerged as central nodes in the female model. Our study demonstrates that network analysis is a promising technique for examining relationships between risk factors for cognitive decline in a midlife population and that investigating sex differences may help optimize risk prediction and tailor individualized treatments in the future.

Phase Angle: Could Be an Easy Tool to Detect Low-Grade Systemic Inflammation in Adults Affected by Prader-Willi Syndrome?

Prader-Willi syndrome (PWS) is the most common genetic inherited obesity syndrome. Obesity-related complications, mostly related to chronic low-grade systemic inflammation (LGI), are the commonest cause of mortality and morbidity in PWS adults. Phase angle (PhA) is an easy tool to screen a state of LGI in healthy subjects and in subjects with obesity and is obtained from bioelectrical impedance analysis (BIA). The aim of this study was to validate the PhA in PWS adults as a potential biomarker of LGI. In this single-center, cross-sectional study, fifteen PWS adults (six males, aged 19-41 years, and body mass index (BMI) 31.0-68.0 Kg/m2) and fifteen control subjects matched by gender, age, and BMI were evaluated. PhA values were significantly lower (p < 0.001), while high-sensitivity C-reactive protein (hs-CRP) levels were significantly higher (p < 0.001) in PWS adults compared with controls (p < 0.001), without a gender difference in the latter. After adjustment for gender, BMI, and waist circumference, significant correlation was found between PhA and hs-CRP levels (r = -0.69, p = 0.01). At the ROC analysis, the threshold value of PhA predicting the highest hs-CRP levels above the median value was found at PhA ≤ 4.8° (p = 0.01; AUC, 0.82; standard error, 0.12; 95% CI, 0.58 to 1.00). These results suggest that PWS adults had a significant higher degree of LGI compared with their counterparts. Moreover, our finding suggest that PhA is a valid biomarker of LGI also in PWS adults.

Sick fat: the good and the bad of old and new circulating markers of adipose tissue inflammation

Adipose tissue (AT) is one of the largest endocrine organs contributing to metabolic homeostasis. The functional pleiotropism of AT depends on its ability to secrete a large number of hormones, cytokines, extracellular matrix proteins and growth factors, all influencing many local and systemic physiological and pathophysiological processes. In condition of chronic positive energy balance, adipocyte expansion, hypoxia, apoptosis and stress all lead to AT inflammation and dysfunction, and it has been demonstrated that this sick fat is a main risk factor for many metabolic disorders, such as type 2 diabetes mellitus, fatty liver, cardiovascular disease and cancer. AT dysfunction is tightly associated with aberrant secretion of bioactive peptides, the adipocytokines, and their blood concentrations often reflect the expression in the AT. Despite the existence of an association between AT dysfunction and systemic pro-inflammatory state, most of the circulating molecules detectable in obese and dysmetabolic individuals do not identify specifically the condition of sick fat. Based on this premise, this review provides a concise overview of "classic" and novel promising adipocytokines associated with AT inflammation and discusses possible critical approaches to their interpretation in clinical practice.

Therapeutic Treatment for Abdominal Obesity in Adults

BACKGROUND

Abdominal obesity, an accumulation of fat in the abdominal region, is a risk factor for several non-communicable diseases. This review aims to identify non-surgical treatment options for abdominal obesity in adults. Interventions with behavioral, dietary, physical activity, or pharmaceutical components were compared to control conditions.

METHODS

A systematic literature research for randomized controlled trials was conducted in Medline, Embase, and the Cochrane Central Register of Controlled Trials according to a prespecified and registered protocol (PROSPERO CRD42017057898).

RESULTS

Out of 2954 articles, 15 studies with 2918 participants remained after applying inclusion and exclusion criteria. Altogether the programs achieved a -2.65cm (95% confidence interval (CI) [-3.77, -1.53]) reduction in waist circumference (WC), as a measure of abdominal obesity. Eight behavioral interventions reduced WC by -1.88cm (95% CI [-2.55, -1.22]), and six combined interventions with behavioral plus dietary and/or physical activity components by -4.11cm (95% CI [-6.17, -2.05]). The only pharmaceutical trial did not find any effect on WC.

CONCLUSION

Overall, the identified interventions showed a moderate effect on WC. One reason may be that in most studies WC was a secondary outcome parameter, while only a small number of interventions primarily targeted abdominal obesity. Further research regarding the treatment of abdominal obesity is urgently needed.

Is waist circumference a negative predictor of calcaneal bone mineral density in adult Chinese men with normal weight?

Background

Our study aimed to evaluate the association between waist circumference (WC) and calcaneal bone mineral density (BMD) in adult Chinese men with normal weight.

Methods

This was a cross-sectional study. A total of 4,663 male participants aged 40 years or older residing in Ningde and Wuyishan, two cities locating in Fujian province of China, were randomly recruited between 2011 and 2012. Each participant should complete a standard questionnaire, undergo anthropometric and calcaneus quantitative ultrasound (QUS) measurements and have blood sample taken. Anthropometric, biochemical and calcaneal QUS parameters of 1,583 male participants with BMI ranging from 18.5 to 22.9 were included in the analysis. WC was divided into quartiles (Q1-Q4: <71, 71-75, 75-78, >78 cm). The relationship between WC (quartiles) and BMD was analyzed by multiple linear regression models.

Results

Mean age of the whole population was 54.6±9.8 years. Anthropometric and biochemical parameters were almost normal. Multiple linear regression analysis showed that BMD was negatively associated with increasing WC quartiles except for Q2 after adjusting for age and BMI, and this relationship remained negative except for Q2 when further adjustment was made for other covariates. Multiple logistic regression model also showed that the risks of osteopenia and osteoporosis increased across WC quartiles.

Conclusions

The present study indicated that WC was a negative predictor of calcaneal BMD in adult Chinese men with normal weight. It suggests that, even for the normal-weight Asian males, monitoring accrual of abdominal adipose is still helpful for the purpose of preventing bone loss.

Impact of Intensive Lifestyle Modification on Levels of Adipokines and Inflammatory Biomarkers in Metabolically Healthy Obese Women

Background

For the metabolically healthy obese (MHO) subjects, it is unclear whether weight loss provides cardiometabolic benefits. Our objective was to evaluate whether changes in adipokine and inflammatory biomarker levels were related to lifestyle modification (with Mediterranean diet and physical exercise program).

Methods

115 women (35-55 years) with BMI of 30-40 kg/m² and ≤1 metabolic syndrome criteria were included. After a 2-year intervention, participants were classified by percent weight loss: Group 1, <5%; Group 2, ≥5%-<10%; and Group 3, ≥10%. Anthropometric data, inflammatory biomarker (IL-6, TNFa, and hsCRP) and adipokine levels (adiponectin and resistin), and lifestyle program adherence at baseline and 2 years were analyzed.

Results

The final sample comprised 67 women. 23 (38.3%) lost <5%, 22 (36.7%) lost ≥5%-<10%, and 22 (36.7%) lost ≥10% of baseline weight. After 2 years, in Group 1, adiponectin, hsCRP, IL-6, and TNFa decreased (-1.2 ng/ml, p = 0.003; -2.1 mg/l, p = 0.003; -2.4 pg/ml, p < 0.001; and -2.4 pg/ml, p = 0.001, respectively) and resistin increased (+2.4 ng/ml, p < 0.001). In Group 2, hsCRP and IL-6 decreased (-2.0 mg/l, p = 0.009 and -2.6 pg/ml, p = 0.001) but TNFa increased (+0.2 pg/ml, p = 0.02). In Group 3, resistin increased (+3.5 ng/ml, p < 0.001) but hsCRP, IL-6, and TNFa decreased (-2.0 mg/l, p = 0.009; -2.5 pg/ml, p < 0.001; and -4.1 pg/ml, p < 0.001). Adiponectin, hsCRP, and physical exercise correlated significantly to subjects' dietary adherence.

Conclusion

Weight loss reduces inflammatory biomarkers in the MHO but induces a deterioration in the adipokine profile, which does not improve with diet and exercise intervention. These findings allow us to clarify mechanisms behind inflammation and metabolic disorder genesis so as to prevent development of obesity-associated comorbidities.

Association of dietary patterns, anthropometric measurements, and metabolic parameters with C-reactive protein and neutrophil-to-lymphocyte ratio in middle-aged and older adults with metabolic syndrome in Taiwan: a cross-sectional study

Background

Metabolic syndrome is commonly associated with inflammation. The underlying factors of inflammation in metabolic syndrome are not fully understood. The objective of the study was to determine the association of dietary patterns, anthropometric measurements, and metabolic parameters with inflammatory markers in middle-aged and older adults with metabolic syndrome in Taiwan.

Methods

A total of 26,016 subjects aged ≥35 y with metabolic syndrome were recruited from Mei Jau institution between 2004 and 2013 for a cross sectional study. Metabolic syndrome was defined by the International Diabetes Federation. Multivariate logistic regression was performed to evaluate the association of dietary patterns, anthropometric measurements, and metabolic parameters with C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) in men and women with metabolic syndrome. Crude and adjusted models were analyzed by gender.

Results

The western dietary pattern, obesity, high body fat, high waist or hip circumference, and high waist-to-hip ratio were significantly associated with increased odds ratios of high CRP and NLR in both genders. High systolic or diastolic blood pressure (BP), low high-density lipoprotein-cholesterol (HDL-C), high low-density lipoprotein-cholesterol (LDL-C), high total cholesterol (TC), high serum triglycerides (TG), and high fasting blood glucose (FBG) were significantly correlated with increased odds ratios of high CRP in both genders. Low HDL-C, high LDL-C, high serum TG, and high FBG were significantly associated with increased odds ratios of high NLR in both genders. However, high systolic (OR = 1.124, 95% CI 1.047–1.206, P < 0.01) or diastolic BP (OR = 1.176, 95% CI 1.087–1.273, P < 0.001) and high TC (OR = 1.138, 95% CI 1.062–1.220, P < 0.001) were significantly correlated with increased odds ratios of high NLR only in men.

Conclusions

The western dietary pattern, obese-related anthropometric parameters, and most components of metabolic syndrome are positively associated with CRP levels and NLR in men and women with metabolic syndrome.

The co-existence of elevated high sensitivity C-reactive protein and homocysteine levels is associated with increased risk of metabolic syndrome: A 6-year follow-up study

Accumulating evidence has revealed that both high sensitivity C-reactive protein (hsCRP) and homocysteine (HCY) are associated with increased risk of metabolic syndrome (MetS) and cardiovascular disease. However, it is unclear whether the coexistence of these conditions accelerates the risk of metabolic syndrome (MetS). We hypothesized that the combination of high sensitivity C-reactive protein (hsCRP) and homocysteine (HCY) levels could exacerbate the development of MetS in a large prospective cohort study. We selected data from 3,170 individuals (1,614 men and 1,556 women) who participated in the Korean Genome and Epidemiology Study. Participants with high hsCRP and HCY levels were categorized into quartiles. MetS was defined based on the criteria of the modified National Cholesterol Education Program, Adult Treatment Panel III. The prevalence of MetS was higher in participants with concurrent high hsCRP and HCY compared to those with low hsCRP and HCY levels. The incidence of MetS at the 6-year follow-up was the highest in participants with concomitant high hsCRP and HCY levels, regardless of obesity. Even after adjusting for potential confounding factors including body mass index in a multivariate logistic regression model, subjects with elevated hsCRP and HCY levels had a 2.50-fold increased risk of developing MetS at the six-year follow-up compared to those who did not have high hsCRP and HCY level. MetS is more prevalent in the concurrent presence of elevated hsCRP and HCY levels. The combination of the two conditions may contribute to an increased risk of MetS, but these factors may not be synergistic.

Obesity is an independent determinant of elevated C-reactive protein in healthy women but not men

BACKGROUND AND AIMS

High-sensitivity C-reactive protein (hs CRP) has emerged as an inflammatory biomarker to predict metabolic syndrome. Here, we investigate the association of hs CRP with metabolic variables and determine the risks for elevated hs CRP levels in healthy Singaporean adults.

METHODS

We conducted a cross-sectional study of 225 participants (104 men). The levels of hs CRP and fasting lipid parameters were analyzed by COBAS. Body composition was determined with dual-energy X-ray absorptiometry.

RESULTS

Twenty-one (9 %) participants had elevated hs CRP levels (>3 mg/mL). The levels of hs CRP had significant correlations (p <0.05) with obesity and metabolic variables among women. Stepwise multivariate regression analysis identified FM (%) (accounted for 22.5% of the variability in hs CRP levels) as a major determinant of hs CRP levels. On multivariate regression, FM (%) was the independent determinant of intermediate and elevated hs CRP in women after adjustment for the potential confounders.

CONCLUSIONS

Obesity may play a direct role in the elevated hs CRP levels in women, but not men living in Singapore. This is probably due to different body composition or different effects of sex hormones on adipose tissue between men and women.

Evaluation of the effects of roselle (Hibiscus sabdariffa L.) on oxidative stress and serum levels of lipids, insulin and hs-CRP in adult patients with metabolic syndrome: a double-blind placebo-controlled clinical trial

BACKGROUND

Roselle (Hibiscus sabdariffa L.) is a plant with antihyperlipidemic and antihypertensive effects. This study aimed to evaluate the effects of roselle calyces on the serum levels of lipids and insulin, inflammation, and oxidative stress in patients with metabolic syndrome (MetS).

METHODS

Forty adult patients with MetS were randomly assigned to receive either 500 mg of H. sabdariffa calyx powder or placebo once daily for 4 weeks. Systolic and diastolic blood pressures (SBP and DBP) and BMI (body mass index) as well as fasting serum levels of glucose (FPG; fasting plasma glucose), insulin, lipoproteins, triglycerides (TG), high-sensitivity C-reactive protein (hs-CRP), and malondialdehyde (MDA) were determined pre- and post-intervention and compared.

RESULTS

H. sabdariffa significantly reduced serum TG (p=0.044) and SBP (p=0.049) compared to placebo. All other variables were not significantly affected by the interventions.

CONCLUSIONS

Daily consumption of 500 mg of H. sabdariffa L. calyx powder can decrease SBP and serum TG in MetS patients.

Sex Differences in High Sensitivity C-Reactive Protein in Subjects with Risk Factors of Metabolic Syndrome

BACKGROUND

Metabolic syndrome (MetS) is associated with a higher risk of all-cause mortality. High-sensitivity C-reactive protein (hsCRP) is a prototypic marker of inflammation usually increased in MetS. Women with MetS-related diseases present higher hsCRP levels than men with MetS-related diseases, suggesting sex differences in inflammatory markers. However, it is unclear whether serum hsCRP levels are already increased in men and/or women with MetS risk factors and without overt diseases or under pharmacological treatment.

OBJECTIVE

To determine the impact of the number of MetS risk factors on serum hsCRP levels in women and men. Methods One hundred and eighteen subjects (70 men and 48 women; 36 ± 1 years) were divided into four groups according to the number of MetS risk factors: healthy group (CT; no risk factors), MetS ≤ 2, MetS = 3, and MetS ≥ 4. Blood was drawn after 12 hours of fasting for measurement of biochemical variables and hsCRP levels, which were determined by immunoturbidimetric assay.

RESULTS

The groups with MetS risk factors presented higher serum hsCRP levels when compared with the CT group (p < 0.02). There were no differences in hsCRP levels among groups with MetS risk factors (p > 0.05). The best linear regression model to explain the association between MetS risk factors and hsCRP levels included waist circumference and HDL cholesterol (r = 0.40, p < 0.01). Women with MetS risk factors presented higher hsCRP levels when compared with men (p sex < 0.01).

CONCLUSIONS

Despite the absence of overt diseases and pharmacological treatment, subjects with MetS risk factors already presented increased hsCRP levels, which were significantly higher in women than men at similar conditions.

Adolescent-Onset Depression: Are Obesity and Inflammation Developmental Mechanisms or Outcomes?

Depression often has its first onset during adolescence and is associated with obesity. Furthermore, inflammatory processes have been implicated in both depression and obesity, although research amongst adolescents is limited. This review explores associations between depression and obesity, depression and inflammation, and obesity and inflammation from a developmental perspective. The temporal relations between these factors are examined to explore whether obesity and elevated inflammation act as either risk factors for, or outcomes of, adolescent-onset depression. Sex differences in these processes are also summarized. We propose a model whereby increases in sex hormones during puberty increase risk for depression for females, which can lead to obesity, which in turn increases levels of inflammation. Importantly, this model suggests that inflammation and obesity are outcomes of adolescent depression, rather than initial contributing causes. Further research on biological and psychosocial effects of sex hormones is needed, as is longitudinal research with children and adolescents.

Association of HIV, hepatitis C virus and liver fibrosis severity with interleukin-6 and C-reactive protein levels

BACKGROUND

Hepatitis C virus (HCV) infection is associated with chronic inflammation; yet studies show greater interleukin (IL)-6, but lower C-reactive protein (CRP) levels. We determined whether liver fibrosis severity and HCV replication affect the ability of IL-6 to stimulate the production of CRP from the liver.

METHODS

We used multivariable generalized linear regression to examine the association of HIV, HCV and transient elastography-measured liver stiffness with IL-6 and CRP in participants (164 HIV-monoinfected; 10 HCV-monoinfected; 73 HIV/HCV-coinfected; 59 neither infection) of the Women's Interagency HIV Study. Significant fibrosis was defined as liver stiffness greater than 7.1 kPa.

RESULTS

IL-6 was positively correlated with CRP levels in all women, but CRP levels were lower in HCV-infected women (with and without HIV infection) at all levels of IL-6. HCV-infected women with fibrosis had nearly 2.7-fold higher IL-6 levels compared to controls [95% confidence interval (CI 146%, 447%]; HCV-infected women without fibrosis had IL-6 levels that were similar to controls. By contrast, CRP was 28% lower in HCV-infected women with fibrosis (95% CI -55%, 15%) and 47% lower in HCV-infected women without fibrosis (95% CI -68%, -12%). Among the HCV-infected women, higher HCV-RNA levels were associated with 9% lower CRP levels per doubling (95% CI -18%, 0%).

CONCLUSION

Liver fibrosis severity is associated with greater IL-6 levels, but the stimulatory effect of IL-6 on CRP appears to be blunted by HCV replication rather than by liver fibrosis severity. Investigation of the potential CRP rebound after HCV-RNA eradication and persistent liver fibrosis on organ injury is needed.

Association of C-Reactive Protein and Metabolic Disorder in a Chinese Population

Objective: To assess the high-sensitivity C-reactive protein (hs-CRP) levels and explore the risk factors for an elevated hs-CRP level. We also provide the clinical utility of CRP to identify subjects with metabolic syndrome (MetS). Methods: Data were drawn from a cross-sectional survey in China. Subjects were divided into three subgroups: hs-CRP ≤ 1 mg/L, 1 mg/L < hs-CRP ≤ 3 mg/L and hs-CRP > 3 mg/L. Multiple linear regressions and logistic regression models were used. Results: In the Chinese population, 50.43% subjects had a low hs-CRP level, 30.21% subjects had an intermediate hs-CRP level and 19.36% subjects had an elevated hs-CRP level. Age, physical inactivity, abdominal obesity, a low LDL level, an elevated fasting glucose level, uric acid and urinary albumin to creatinine ratio (ACR) were correlated with log-CRP. In multivariate analysis, relative risks of an elevated CRP level were 2.40 (95% CI 1.44–3.99, p = 0.001), 3.63 (95% CI 2.20–5.98, p < 0.001), 4.23 (95% CI 2.51–7.11, p < 0.001) and 6.23 (95% CI 3.45–11.26, p < 0.001) for subjects with 1, 2, 3, or more than 3 MetS components, respectively. The accurate estimates of the area under the receiver operating characteristic of hs-CRP for MetS was 0.6954 (95% CI, 0.67–0.72). Conclusion: Age, physical inactivity, abdominal obesity, a low LDL level, an elevated fasting glucose level, uric acid and ACR are correlated with log-CRP. The number of MetS components is a significant determinant of elevated CRP levels after adjusted for other potential confounders.

Association of high sensitivity C-reactive protein with the components of metabolic syndrome in diabetic and non-diabetic individuals

BACKGROUND AND OBJECTIVES

High sensitivity C-reactive protein (hsCRP) has been associated with metabolic syndrome (MetS) and its components. Several studies have suggested hsCRP to be used as a marker for the primary prevention of cardiovascular diseases. So, we aimed to evaluate the association between hsCRP levels and the components of MetS in diabetic and non-diabetic population.

MATERIALS AND METHODS

Type II diabetic patients (T2DM) (n= 121) and healthy controls (n= 121) were enrolled for the study. Anthropometric measurements were taken along with blood pressure from the arm. Ten ml of blood was collected after overnight fasting for the measurement of lipid profile, hsCRP, C-peptide and glucose levels. Insulin resistance (HOMA2-IR) was estimated by HOMA2 calculator utilizing glucose and C-peptide values. All participants were classified into two groups on the basis of the presence or absence of MetS. Data were analysed through SPSS 14 software.

RESULTS

hsCRP, C-peptide and HOMA2-IR were significantly higher in T2DM subjects when compared with controls. As the number of the components of MetS increased, there was a linear increase in hsCRP levels in whole study population (p trend <.001), diabetic subjects (p trend <.001), as well as in controls (p trend <.001). HOMA2-IR and hsCRP levels were found to be better than LDL cholesterol and waist circumference for predicting the presence of MetS.

CONCLUSION

hsCRP was found to be better than LDL cholesterol and waist circumference for the prediction of MetS. Hence, hsCRP could be used as a defining marker of MetS in the near future.

Inflammation, haemostatic disturbance, and obesity: possible link to pathogenesis of diabetic retinopathy in type 2 diabetes

PURPOSE

The pathogenesis of diabetic retinopathy (DR) is insufficiently understood but may possibly involve chronic, low-grade inflammation. The aim of this cross-sectional study was to investigate the relationship between inflammatory and haemostatic markers, other markers of endothelial dysfunction and anthropometric parameters, and their association with DR in patients with type 2 diabetes.

METHODS

According to the DR status patients were divided into three groups: no retinopathy, mild/moderate nonproliferative (NPDR), and severe NPDR/proliferative retinopathy (PDR).

RESULTS

The groups did not differ in the levels of inflammatory and haemostatic markers, other markers of endothelial dysfunction, and anthropometric parameters. After dividing the patients according to the level of obesity (defined by BMI, WC, and WHR) into three groups ANOVA showed the differences in C-reactive protein according to the WC (P = 0.0265) and in fibrinogen according to the WHR (P = 0.0102) as well as in total cholesterol (P = 0.0109) and triglycerides (P = 0.0133) according to the BMI. Logistic regression analyses showed that diabetes duration and prolonged poor glycemic control are the main predictors of retinopathy in patients with type 2 diabetes.

CONCLUSION

Interrelations between obesity, inflammation, haemostatic disturbance, and other risk factors may possibly play an important additional role in endothelial dysfunction involved in the pathogenesis of diabetic retinopathy.

Obesity and C-reactive protein in various populations: a systematic review and meta-analysis

Obesity has been associated with elevated levels of C-reactive protein (CRP), a marker of inflammation and predictor of cardiovascular risk. The objective of this systematic review and meta-analysis was to estimate the associations between obesity and CRP according to sex, ethnicity and age. MEDLINE and EMBASE databases were searched through October 2011. Data from 51 cross-sectional studies that used body mass index (BMI), waist circumference (WC) or waist-to-hip ratio (WHR) as measure of obesity were independently extracted by two reviewers and aggregated using random-effects models. The Pearson correlation (r) for BMI and ln(CRP) was 0.36 (95% confidence interval [CI], 0.30-0.42) in adults and 0.37 (CI, 0.31-0.43) in children. In adults, r for BMI and ln(CRP) was greater in women than men by 0.24 (CI, 0.09-0.37), and greater in North Americans/Europeans than Asians by 0.15 (CI, 0-0.28), on average. In North American/European children, the sex difference in r for BMI and ln(CRP) was 0.01 (CI, -0.08 to 0.06). Although limited to anthropometric measures, we found similar results when WC and WHR were used in the analyses. Obesity is associated with elevated levels of CRP and the association is stronger in women and North Americans/Europeans. The sex difference only emerges in adulthood.

Advances in the surgical treatment of morbid obesity

Due to the rapidly expanding prevalence of obesity, bariatric surgery is becoming an increasingly popular treatment option. Bariatric surgeries including Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) produce long-term weight loss and metabolic improvement, reducing mortality. This review discusses the important benefits and risks of RYGB and VSG, highlighting hypothesized mechanisms for these effects. We present data suggesting that VSG, albeit a newer procedure, may be as effective as RYGB with fewer adverse effects including less surgical risk, reduced nutritional deficiency, and less incidence of dumping syndrome. This may position VSG as an increasingly important procedure, particularly for the treatment of pediatric obesity.

Association of high-sensitivity C-reactive protein with cardiometabolic risk factors and micronutrient deficiencies in adults of Ouagadougou, Burkina Faso

Increasing evidence suggests that high-sensitivity C-reactive protein (hs-CRP) is associated with cardiometabolic risk factors (CMRF) while being also related to micronutrient deficiencies. As part of a project on the double burden of under- and overnutrition in sub-Saharan Africa, we assessed the relationship between hs-CRP and both CMRF and micronutrient deficiencies in a population-based cross-sectional study carried out in the Northern district of Ouagadougou, the capital city of Burkina Faso. We randomly selected 330 households stratified by income tertile. In each income stratum, 110 individuals aged 25-60 years and having lived in Ouagadougou for at least 6 months were randomly selected, and underwent anthropometric measurements and blood sample collection. The prevalence of high hs-CRP was 39.4 %, with no sex difference. Vitamin A-deficient subjects (12.7 %) exhibited significant risk of elevated hs-CRP (OR 2.5; P= 0.015). Serum ferritin was positively correlated with log hs-CRP (r 0.194; P= 0.002). The risk of elevated hs-CRP was significant in subjects with BMI ≥ 25 kg/m² (OR 6.9; 95 % CI 3.6, 13.3), abdominal obesity (OR 4.6; 95 % CI 2.2, 7.3) and high body fat (OR 10.2; 95 % CI 5.1, 20.3) (P< 0.001, respectively). Independent predictors of hs-CRP in linear regression models were waist circumference (β = 0.306; P= 0.018) and serum TAG (β = 0.158; P= 0.027). In this sub-Saharan population, hs-CRP was consistently associated with adiposity. Assuming that plasma hs-CRP reflects future risk of cardiovascular events, intervention which reduces CRP, or chronic and acute nutrition conditions associated with it, could be effective in preventing their occurrence particularly in sub-Saharan Africa.

Relationship of C-reactive protein with components of the metabolic syndrome in a Tunisian population

BACKGROUND

C-reactive protein (CRP) is an independent risk factor of diabetes and cardiovascular disease and it is proposed as a component of metabolic syndrome (MS). This study was undertaken to investigate the relationship between CRP and various characteristics of the MS in a sample of the Tunisian population

METHODS

One hundred and forty nine patients with MS and 152 controls, aged 35-70 years were recruited. Waist circumference (WC), blood pressure, HDL-cholesterol (HDL-C), triglycerides (TG), glucose, insulin and CRP were measured. Insulin resistance was assessed by homeostasis model assessment of insulin resistance (HOMA-IR). MS was defined by NCEP-ATPIII report

RESULTS

CRP levels were significantly higher in MS group (4.41±3.73 mg/L vs. 2.68±2.59 mg/L, p<0.001) compared to without MS group. For both sexes, CRP increased as the number of MS components increased (p=0.015 for men and p<0.001) after adjustment for age, smoking, alcohol intake and, for women, menopause. There were statistically significant positive correlations for log CRP with WC, log TG, and log HOMA-IR in both sexes adjusted for confounding factors listed above. A significant negative correlation was found between HDL-C and log CRP only in women. In both sexes, WC was identified, by multiple linear regression models, as significant independent predictor of CRP level variability. HDL-C showed also a significant contribution only in women

CONCLUSIONS

The present study provides evidence that CRP levels are elevated in MS subjects. In addition, WC and HDL-C are significant predictors of the CRP elevation.

Central obesity and smoking are key modifiable risk factors for elevated C-reactive protein in Asian individuals who are not eligible for statin therapy

Objective:

Statin therapy reduces coronary heart disease (CHD) and mortality in individuals with elevated C-reactive protein (CRP) but low-density lipoprotein cholesterol below the threshold at which statin therapy is recommended. We determined the proportion of individuals with elevated CRP in whom statin therapy was not indicated, and examined predictors for elevated CRP in a multi-ethnic Asian population.

Design:

We studied 3404 participants (Chinese, Malays and Asian-Indians) without a history of hypercholesterolemia living in Singapore (mean age±s.d.: 48.9±11.2 years). Eligibility for statin therapy was determined based on the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III (ATPIII)) guideline. CRP was measured by high-sensitivity enzyme-linked immunosorbent assay method. CRP level greater than 2 mg l⁻¹ was considered as elevated.

Results:

Elevated CRP was found in 29.3% participants who were not eligible for statin therapy (n=2974). Elevated CRP was more common in females and amongst those of Malay or Asian-Indian ethnicity. Compared with participants with low CRP, those with elevated CRP were shown to have higher levels of obesity, blood pressure, triglyceride and insulin resistance (IR), but lower high-density lipoprotein cholesterol levels (all Ps<0.001). After multivariate analysis, gender (odds ratio (OR) 3.34 for females), ethnicity (Malay OR 1.57, 95% confidence interval (CI) 1.25–1.96; Asian-Indian OR 1.97, 95% CI 1.55–2.50), waist circumference (OR 1.06, 95% CI 1.05–1.07), smoking (OR 1.49, 95% CI 1.08–2.05) and IR (OR 1.14, 95% CI 1.07–1.22) were significant predictors of CRP (all Ps--values<0.05).

Conclusion:

Routine measurement of CRP identifies a substantial number of Asian individuals at risk of CHD in whom statin therapy is not currently indicated, particularly in women and certain ethnic groups (Malays and Asian Indians). Weight loss and smoking cessation are important measures to reduce the proportion of individuals with elevated CRP.

The trends of metabolic syndrome in normal-weight Tehranian adults

BACKGROUND

In recent decades, more attention has been directed to the clustering of cardiometabolic risk factors in normal-weight adults. This study investigates trends of the prevalence of metabolic syndrome (MetS) in a normal-weight Tehranian adult population during 6.6 years of follow-up.

METHODS

In this population-based cohort study of 5,269 participants aged ≥ 20 years during the 3 phases (1999-2001, 2002-2005 and 2005-2008) of the Tehran Lipid and Glucose Study, we selected 390 males and 358 females with a normal body mass index (18.5-24.9) during all 3 periods of follow-up. MetS was defined according to the International Diabetes Federation criteria, and waist circumference (WC) cut points were ≥ 89 cm for males and ≥ 91 cm for females.

RESULTS

The overall prevalence of MetS increased from 2.3 and 4.0% in phases I and II to 9.6% in phase III. This trend was significant in males (p < 0.001) but not in females (p = 0.6). No significant changes in components of MetS were seen, except in WC among males. In the 3 study phases, prevalence of abdominal obesity was 3.1, 18.5 and 36.2% in males, respectively.

CONCLUSIONS

There was a dramatic 4-fold increase in the prevalence of MetS in the Tehranian normal-weight adult population, highlighting the importance of MetS components, especially of WC, in normal-weight adult males.

Metabolic syndrome, insulin resistance and systemic inflammation as risk factors for reduced lung function in Korean nonsmoking males

The aim of this study was done to assess the association of lung function with insulin resistance (IR), systemic inflammation, and metabolic syndrome (MetS). In 9,581 apparently healthy non-smoking male adults, pulmonary function, fasting glucose, insulin, lipid profiles and serum high-sensitivity C-reactive protein (hs-CRP) levels were measured, and homeostatic model assessment (HOMA) was used to assess IR. The presence of MetS was defined according to the AHA/NHLBI criteria. The prevalence of MetS was 19.3%. The odds ratio of MetS for restrictive ventilatory pattern was 1.55 (95% confidence interval, 1.12-2.14), and that for obstructive ventilatory pattern was 1.39 (0.66-2.94) after adjustment for confounders. When subjects were divided in 4 groups according to quartiles of FVC or FEV(1) (% predicted [pred]), HOMA-IR significantly increased as the FVC or FEV(1) (% predicted [pred]) decreased. Individuals in the lowest FVC or FEV(1) quartile had the highest hs-CRP level. Prevalence of MetS increased as FVC or FEV(1) (% predicted [pred]) quartiles decreased. The abdominal obesity, hs-CRP and HOMA-IR were the independent predictors for the lowest FVC and FEV(1) (% predicted [pred]) even after adjustment for confounders. These results indicate that MetS, IR, and systemic inflammation are important risk factors for reduced lung function in nonsmoking Korean males.

Obesity, coffee consumption and CRP levels in postmenopausal overweight/obese women: importance of hormone replacement therapy use

Background/Objective

Obesity is associated with an inflammatory state that is often characterized by elevated plasma C-reactive protein (CRP) levels. Although coffee is broadly consumed in Western societies, few studies have examined the relationship between obesity, coffee consumption and CRP levels. The objective of the present study was to assess the relationship between obesity, coffee consumption and variation in CRP in postmenopausal, overweight/obese women with or without hormone replacement therapy (HRT) use.

Subjects/Methods

Cross-sectional analyses of 344 healthy sedentary, overweight/obese postmenopausal women (mean age=57.1±6.4 years and mean body mass index [BMI]=36.1±3.9 kg/m²). Plasma CRP levels were measured by a highly sensitive immunoassay that used monoclonal antibodies coated with polystyrene particles. Diet was assessed using the Food Intake and Analysis System semi-quantitative food frequency questionnaire.

Results

Plasma CRP was positively associated with BMI (p<0.001) and negatively associated with coffee consumption (p≤0.05). In women using HRT, plasma CRP was positively associated BMI in women consuming less than one cup of coffee per month (r²=0.15 [p<0.001]), one cup per day (0.14 [p=0.02]) and more than one cup per day (0.12 [p=0.03]). In women who did not use HRT, CRP was associated BMI only in women consuming less than one cup of coffee per day (r²=0.16 [p<0.001]) but not in women consuming one cup per day (0.06 [p=0.10]) or more than one daily cup of coffee (0.03 [p=0.27]).

Conclusion

Among overweight/obese postmenopausal women coffee consumption is negatively associated with CRP. Coffee consumption appears to attenuate the association between BMI and CRP, but only in women not using HRT.

Lung function impairment and metabolic syndrome: the critical role of abdominal obesity

RATIONALE

Increased risk for cardiovascular morbidity and mortality has been related to both lung function impairment and metabolic syndrome. Data on the relationship between lung function and metabolic syndrome are sparse.

OBJECTIVES

To investigate risk for lung function impairment according to metabolic syndrome traits.

METHODS

This cross-sectional population-based study included 121,965 men and women examined at the Paris Investigations Préventives et Cliniques Center between 1999 and 2006. The lower limit of normal was used to define lung function impairment (FEV(1) or FVC < lower limit of normal). Metabolic syndrome was assessed according to the American Heart Association/National Heart, Lung, and Blood Institute statement.

MEASUREMENTS AND MAIN RESULTS

We used a logistic regression model and principal component analysis to investigate the differential associations between lung function impairment and specific components of metabolic syndrome. Lung function impairment was associated with metabolic syndrome (prevalence = 15.0%) independently of age, sex, smoking status, alcohol consumption, educational level, body mass index, leisure-time physical activity, and cardiovascular disease history (odds ratio [OR] [95% confidence interval], 1.28 [1.20-1.37] and OR, 1.41 [1.31-1.51] for FEV(1) and FVC, respectively). Three factors were identified from factor analysis: "lipids" (low high-density lipoprotein cholesterol, high triglycerides), "glucose-blood pressure" (high fasting glycemia, high blood pressure), and "abdominal obesity" (large waist circumference). All factors were inversely related to lung function, but abdominal obesity was the strongest predictor of lung function impairment (OR, 1.94 [1.80-2.09] and OR, 2.11 [1.95-2.29], for FEV(1) and FVC, respectively). Similar results were obtained for women and men.

CONCLUSIONS

We found a positive independent relationship between lung function impairment and metabolic syndrome in both sexes, predominantly due to abdominal obesity. Further studies are required to clarify the underlying mechanisms.

The metabolic syndrome as a concept of adipose tissue disease

The metabolic syndrome is a constellation of interrelated metabolic risk factors that appear to directly promote the development of diabetes and cardiovascular disease. However, in 2005, the American Diabetes Association and the European Association for the Study of Diabetes jointly stated that no existing definition of the metabolic syndrome meets the criteria of a syndrome, and there have been endless debates on the pros and cons of using the concept of this syndrome. The controversy may stem from confusion between the syndrome and obesity. Obesity is an epidemic, essentially contagious disease caused by an environment of excess nutritional energy and reinforced by deeply rooted social norms. The epidemic of obesity should be prevented or controlled by social and political means, similar to the approaches now being taken to combat global warming. The diagnosis of metabolic syndrome is useless for this public purpose. The purpose of establishing criteria for diagnosing metabolic syndrome is to find individuals who are at increased risk of diabetes and cardiovascular disease and who require specific therapy including diet and exercise. The syndrome may be an adipose tissue disease different from obesity; in that case, it would be characterized by inflammation clinically detected through systemic inflammatory markers such as high-sensitivity C-reactive protein and insulin resistance reflecting histological changes in adipose tissue. However, many problems in defining the optimal diagnostic criteria remain unresolved.