High sensitivity C-reactive protein is associated with the metabolic syndrome independent to viral and bacterial pathogen burden

The Use of Machine Learning Techniques to Determine the Predictive Value of Inflammatory Biomarkers in the Development of Type 2 Diabetes Mellitus

Background: Certain inflammatory biomarkers, such as interleukin-6, interleukin-1, C-reactive protein (CRP), and fibrinogen, are prototypical acute-phase parameters that can also be predictors of cardiovascular disease. However, this inflammatory response can also be linked to the development of type 2 diabetes mellitus (T2DM). Methods: We performed a cross-sectional, retrospective study of hypertensive patients in an outpatient setting. Demographic, clinical, and laboratory parameters, such as the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), CRP, and fibrinogen, were recorded. The outcome was progression to overt T2DM over the 12-year observation period. Results: A total of 3,472 hypertensive patients were screened, but 1,576 individuals without T2DM were ultimately included in the analyses. Patients with elevated fibrinogen, CRP, and insulin resistance had a significantly greater incidence of progression to T2DM. During follow-up, 199 patients progressed to T2DM. Multivariate logistic regression analyses showed that body mass index [odds ratio (OR) 1.04, 95% confidence interval (CI): 1.01-1.07], HOMA-IR (OR 1.13, 95% CI: 1.08-1.16), age (OR 1.05, 95% CI: 1.03-1.07), log(CRP) (OR 1.37, 95% CI: 1.14-1.55), and fibrinogen (OR 1.44, 95% CI: 1.23-1.66) were the most important predictors of progression to T2DM. The area under the receiver operating characteristic curve (AUC) of this model was 0.76. Using machine learning methods, we built a model that included HOMA-IR, fibrinogen, and log(CRP) that was more accurate than the logistic regression model, with an AUC of 0.9. Conclusion: Our results suggest that inflammatory biomarkers and HOMA-IR have a strong prognostic value in predicting progression to T2DM. Machine learning methods can provide more accurate results to better understand the implications of these features in terms of progression to T2DM. A successful therapeutic approach based on these features can avoid progression to T2DM and thus improve long-term survival.

Viral and parasitic pathogen burden and the association with stroke in a population-based cohort

Background Higher cumulative burden of viral and bacterial pathogens may increase the risk of stroke, but the contribution of parasitic infections in relation to cumulative pathogen burden and risk of stroke has rarely been examined. Aim To estimate the association of multiple persistent viral and parasitic infections with stroke in a representative sample of adults in the United States. Methods Serological evidence of prior infection was categorized as positive for 0-1, 2, 3, or 4-5 infections based on immunoglobulin G seropositivity to cytomegalovirus, hepatitis A virus, hepatitis B virus, Toxoplasma gondii, and Toxocara spp. in 13,904 respondents from the National Health and Nutrition Examination Survey III. Regression analysis was used to estimate the cross-sectional association between serological evidence of prior infection and history of stroke adjusting for demographic risk factors, and potential mediators of stroke. Results Age-adjusted models that included serological evidence of prior infection to cytomegalovirus, hepatitis A virus, hepatitis B virus, Toxoplasma gondii, and Toxocara spp. showed that adults in the highest serological evidence of prior infection category (4-5 infections) had a higher prevalence of stroke (5.50%, 95% confidence interval 2.44-10.46%) than those in the lowest serological evidence of prior infection categories (1.49%, 95% confidence interval 1.01-2.11%), and a trend test suggested a graded association between serological evidence of prior infection and stroke ( p = 0.02). In multivariable logistic regression models, the positive association of serological evidence of prior infection with stroke prevalence remained significant after adjustment for other significant risk factors (odds ratio = 1.4, p = 0.01) but was only significant among those aged 20-59 (odds ratio = 2.0, p = 0.005) and not among those aged 60-69 ( p = 0.78) or 70 and older ( p = 0.43). Conclusion We found support for a connection between serological evidence of prior infection to cytomegalovirus, hepatitis A virus, hepatitis B virus, Toxoplasma gondii, and Toxocara spp. and stroke among those aged 20-59. There may be a need to consider common parasitic infections in addition to viral and bacterial pathogens when calculating serological evidence of prior infection in relation to cerebrovascular disease.

Effect of periodontal treatment on glycemic control of patients with diabetes: A systematic review and meta-analysis

AIMS/INTRODUCTION

The aim of the present study was to investigate whether non-surgical periodontal treatment reduces glycated hemoglobin (HbA1c) and fasting plasma glucose (FPG) levels in diabetic patients.

MATERIALS AND METHODS

An electronic search was carried out on MEDLINE (through PubMed interface), EMBASE and the Cochrane Central Register of Controlled Trials. Randomized controlled trials with a minimum of 3 months follow up were included. The risk of bias was assessed for each study. A meta-analysis was carried out to evaluate the effect of non-surgical periodontal treatment on HbA1c and FPG levels. The effect of the adjunctive use of antimicrobials was also assessed.

RESULTS

A total of 15 studies were included. A reduction of -0.38% (95% confidence interval [CI] -0.23 to -0.53) after 3-4 months (P < 0.001) and of -0.31% (95% CI 0.11 to -0.74) after 6 months (P = 0.15) of follow-up was found for HbA1c, favoring the treatment group. Similarly, in treated patients, a significantly greater decrease in FPG was observed in respect to control participants. Such difference amounted to -9.01 mg/dL (95% CI -2.24 to -15.78) after 3-4 months (P = 0.009) and -13.62 mg/dL (95% CI 0.45 to -27.69) after 6 months (P = 0.06) from treatment, respectively. In participants treated with adjunctive antimicrobials, a non-significant increase of HbA1c was observed 3 months after treatment, whereas FPG decreased by 0.27 mg/dL (95% CI 39.56 to -40.11; P = 0.99).

CONCLUSIONS

The meta-analysis showed that non-surgical periodontal treatment improves metabolic control in patients with both periodontitis and diabetes.

Population-based study of high plasma C-reactive protein concentrations among the Inuit of Nunavik

Background

The shift away from traditional lifestyle in the Inuit population over the past few decades has been associated with an increased prevalence of coronary heart disease (CHD) risk factors such as obesity, high blood pressure (BP) and diabetes. However, the impact of this transition on the pro-inflammatory marker high-sensitivity C-reactive protein (hs-CRP) has not been documented.

Objectives

To examine the prevalence of elevated plasma hs-CRP concentrations in Inuit from Nunavik in the province of Quebec (Canada) and identify anthropometric, biochemical and lifestyle risk factors associated with elevated hs-CRP.

Design

A population-representative sample of 801 Inuit residents from 14 villages of Nunavik, aged between 18 and 74 years, was included in the analyses. Subjects participated in a clinical session and completed questionnaires on lifestyle. Multivariate logistic regression was used to determine risk factors for elevated hs-CRP.

Results

Elevated plasma hs-CRP concentrations (≥2 mg/L) were present in 32.7% (95% confidence interval (CI) 29.5–35.8) of the Inuit adult population and were more prevalent among women than among men (36.7% vs. 29.0%, p=0.007). Multivariate logistic regression analysis indicated that every 1 mmHg increase in systolic BP was associated with a 3% increase in the odds of having hs-CRP concentrations ≥2 mg/L in the Inuit population (95% CI 1.01–1.04). The combination of older age (≥50 vs. <30 years) and elevated waist circumference (gender-specific cut-off values) in a multivariate logistic model was also associated with a 13.3-fold increase in the odds of having plasma hs-CRP concentrations ≥2 mg/L (95% CI 5.8–30.9).

Conclusions

These data indicate that elevated hs-CRP is relatively prevalent among Inuit with values that are similar to those seen in Canadian Caucasian populations. Sex, age, waist circumference and systolic BP are major factors that increase the risk of this inflammatory phenotype among Inuit from Nunavik, despite their different lifestyle background compared with Caucasians.

The association between Helicobacter pylori infection and insulin resistance: a systematic review

BACKGROUND

Helicobacter pylori infection has been associated with diverse extradigestive morbidity, including insulin resistance (IR) syndrome. The aim of this systematic review was to summarize the epidemiologic evidence concerning the association between H. pylori infection and IR quantitative indexes.

MATERIALS AND METHODS

A computerized literature search in PubMed electronic databases and Cochrane Central Register of Controlled Trials was performed.

RESULTS

Nine studies reporting data on 2120 participants were finally eligible for this systematic review. Seven of them were cross-sectional studies and two were nonrandomized, open-label, controlled trials investigating the effect of H. pylori eradication on IR. Homeostatic model of assessment insulin resistance (HOMA-IR) was used in all studies to quantify IR. There seems to be a trend toward a positive association between H. pylori infection and HOMA-IR, strengthened by regression analysis in one study. However, there was significant heterogeneity between studies regarding the method(s) of H. pylori infection diagnosis based on and the study populations. The studies for the effect of H. pylori eradication on HOMA-IR revealed conflicting results.

CONCLUSIONS

Although data seem to indicate a potential association between H. pylori infection and IR, further studies are needed to strengthen this association and to clarify whether there is a causative link between them. If a causal link is confirmed in the future, this may have a major impact on the pathophysiology and management of IR syndrome, including type 2 diabetes mellitus and nonalcoholic fatty liver disease.