Sex difference in the association of metabolic syndrome with high sensitivity C-reactive protein in a Taiwanese population

Nutritional Approaches to Modulate Cardiovascular Disease Risk in Systemic Lupus Erythematosus: A Literature Review

Systemic lupus erythematosus (SLE) is a chronic pathology characterized by a bimodal mortality pattern attributed to clinical disease activity and cardiovascular disease (CVD). A complex interaction between traditional CVD risk factors such as obesity, dyslipidemia, smoking, insulin resistance, metabolic syndrome, and hypertension, as well as the presence of non-traditional CVD risk factors such as hyperhomocysteinemia, pro-inflammatory cytokines, and C-reactive protein levels, has been suggested as a cause of the high prevalence of CVD in SLE patients. On the other hand, environmental factors, such as nutritional status, could influence the disease's prognosis; several nutrients have immunomodulators, antioxidants, and anti-cardiometabolic risk properties which could reduce SLE severity and organ damage by decreasing the development of traditional and non-traditional CVD risk factors. Therefore, this critical literature review discusses the therapeutic potential of nutritional approaches that could modulate the development of the main comorbidities related to CVD risk in SLE patients.

Decoding the link associated with areca nut chewing and cardiovascular disease using hsCRP as a biomarker

Background

Chewing of areca nut is associated with various oral and systemic ill effects. The deleterious oral effects of areca nut have been widely documented to range from reactive lesions, periodontal health compromise to oral pre-cancer and cancerous states and have been described widely in the literature. The reported systemic effects of areca nut chewing are relatively less documented but reported in literature. Areca nut chewing may predispose to cardiovascular disease due to a systemic inflammatory response from the elevated levels of circulating inflammatory mediators. High-sensitivity C-reactive protein (hsCRP) is a systemic inflammatory biomarker to assess the risk of cardiovascular disease.

Materials and Methods

This cross-sectional, observational study was conducted among areca nut chewers (n = 50) and non-chewers (n = 50). Areca nut chewers were considered as chewers/cases. Blood samples were collected from the participants and hsCRP levels were studied. The data were analysed using SPSS software, version 21 for statistical significance. Chi-square test was used to compare categorical variables. Mann-Whitney U test was done to analyse continuous variables. The level of statistical significance was set at P value < 0.05.

Results

hsCRP mean was higher among the chewers (2.3 ± 3.7) compared to non-chewers (0.9 ± 1.3). The difference in hsCRP levels between the study group was statistically significant (P = 0.002).

Conclusion

This study demonstrates the link between areca nut and cardiovascular disease using hsCRP as biomarker.

Association between metabolic syndrome, C-reactive protein, and the risk of primary liver cancer: a large prospective study

Background and aims

High-sensitivity C-reactive protein (hs-CRP) levels and metabolic syndrome (MetS) are known to be associated with an increased incidence of different cancers. We aimed to evaluate the effect of MetS combined with high hs-CRP levels on the risk of primary liver cancer (PLC).

Methods

Participants were recruited from the Kailuan cohort study and were classified into four groups according to the presence or absence of MetS and inflammation (hs-CRP ≥ 3 or < 3 mg/L). The associations of MetS and inflammation with the risk of PLC were assessed using Cox proportional hazards models.

Results

This study included 92,770 participants. The mean age was 51.4 years old. Over a median follow-up of 13.02 years, 395 participants were diagnosed as PLC. Compared to the control participants without inflammation (hs-CRP < 3 mg/L) and MetS (n = 69,413), participants with high hs-CRP levels combined with MetS (n = 2,269) had a higher risk of PLC [hazard ratios (HR) 2.91; 95% confidence interval (CI), 1.77–4.81], and participants with high hs-CRP levels and without MetS (n = 14,576) had the same trend (HR, 1.36; 95%CI, 1.05–1.75). However, participants with low hs-CRP levels and MetS (n = 6,512) had no significant association with an elevated risk of PLC (HR, 1.18; 95%CI, 0.76–1.82). After excluding participants who had cancer during the first year of follow-up, sensitivity analysis showed the same trend. In addition, co-occurrence of MetS and high hs-CRP levels had significant interactive effects on the risk of PLC between the sexes (P < 0.001) and the patients with HBV infection (P = 0.012).

Conclusions

Participants with co-occurrence of MetS and high hs-CRP levels have an elevated risk of PLC.

Trial registration

Kailuan study, ChiCTR–TNRC–11001489. Registered 24 August, 2011-Retrospectively registered, http://www.chictr.org.cn/showprojen.aspx?proj=8050

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-022-09939-w.

Gender differences in Anxious-depressive symptomatology, Metabolic Syndrome and Colorectal Adenomas among outpatients undergoing colonoscopy: a cross-sectional study according to a PNEI perspective

BACKGROUND AND AIM OF THE WORK

To explore gender differences in patients suffering from anxious-depressive symptoms, Metabolic Syndrome (MetS) and Colorectal Adenomas (CRAs) in a sample of outpatients undergoing colonoscopy for screening purposes.

METHODS

Cross-sectional study. 126 consecutive outpatients of both sexes undergoing colonoscopy for non-specific abdominal symptoms between January 2015 and June 2021 at the Modena Policlinico General Hospital (Modena, Northern Italy) were enrolled. MetS was diagnosed according to ATPIII and IDF criteria. Anxiety and depression were assessed with the Hospital Anxiety and Depression Scale (HADS), while the Temperament and Character Inventory (TCI) was used to study personality. The SF-36 was also included as a measure of quality of life perception.

RESULTS

Among 126 outpatients (51.60% male) undergoing colonoscopy, 51 (44%) had CRAs, 54 (47%) MetS, 41 (41.40%) anxiety symptoms, 22 (22.20%) depressive symptoms and 13 (13.10%) combined anxious-depressive symptoms. HADS-Anxiety (t=2.68, p=0.01) and TCI Reward Dependence (TCI-RD) (t=3.01, p=0.00) mean scores were significantly higher in women; conversely, SF-36 Mental Component Summary scores were higher in men. CRAs were significantly prevalent in men (χ2=9.32, p=0.00) and were statistically significantly associated with male sex at the univariate logistic regression analysis (OR=3.27; p<0.01). At the multivariate logistic regression, diastolic hypertension (p<0.01) was positively associated with male sex, while TCI-RD (p=0.04) and HDL hypocholesterolemia (p=0.02) were inversely associated with male sex.

CONCLUSIONS

Several significant gender differences in anxious-depressive symptoms, MetS and CRAs were found. These preliminary data suggest the need to consider gender specificities while implementing therapeutic, diagnostic, and preventive strategies.

Can biomarkers be used to improve diagnosis and prediction of metabolic syndrome in childhood cancer survivors? A systematic review

Childhood cancer survivors (CCS) are at increased risk to develop metabolic syndrome (MetS), diabetes, and cardiovascular disease. Common criteria underestimate adiposity and possibly underdiagnose MetS, particularly after abdominal radiotherapy. A systematic literature review and meta-analysis on the diagnostic and predictive value of nine newer MetS related biomarkers (adiponectin, leptin, uric acid, hsCRP, TNF-alpha, IL-1, IL-6, apolipoprotein B (apoB), and lipoprotein(a) [lp(a)]) in survivors and adult non-cancer survivors was performed by searching PubMed and Embase. Evidence was summarized with GRADE after risk of bias evaluation (QUADAS-2/QUIPS). Eligible studies on promising biomarkers were pooled. We identified 175 general population and five CCS studies. In the general population, valuable predictive biomarkers are uric acid, adiponectin, hsCRP and apoB (high level of evidence), and leptin (moderate level of evidence). Valuable diagnostic biomarkers are hsCRP, adiponectin, uric acid, and leptin (low, low, moderate, and high level of evidence, respectively). Meta-analysis showed OR for hyperuricemia of 2.94 (age-/sex-adjusted), OR per unit uric acid increase of 1.086 (unadjusted), and AUC for hsCRP of 0.71 (unadjusted). Uric acid, adiponectin, hsCRP, leptin, and apoB can be alternative biomarkers in the screening setting for MetS in survivors, to enhance early identification of those at high risk of subsequent complications.

Relation between Inflammation, Oxidative Stress, and Macronutrient Intakes in Normal and Excessive Body Weight Adolescent Girls with Clinical Features of Polycystic Ovary Syndrome

The impact of diet on inflammation and oxidative stress (OS) in girls with polycystic ovary syndrome (PCOS) is unknown. Therefore, our study aimed to investigate, in PCOS girls, whether certain macronutrient intakes can be associated with these disturbances. For this purpose, 59 PCOS participants (aged 14-18 years) were recruited to this study and divided into two subgroups: overweight/obese-Ov/Ob group (n = 22) and normal weight-N group (n = 37). Nutrition was assessed using a 3-day food record. The studied markers were total antioxidant capacity (TAC), malondialdehyde (MDA), C-reactive protein (CRP), tumor necrosis factor α (TNF-α), and interleukins 1 and 6 (IL-1 and IL-6). We found plant protein intake inversely correlated with IL-6 (p = 0.007; r = -0.557), TNF-α (p = 0.006; r = -0.564), MDA (p = 0.01; r = -0.539) in the Ov/Ob group and with TAC (p = 0.021; r = -0.38) in the N group. Inverse correlations in the Ov/Ob group were observed between protein intake and IL-6 (p = 0.031; r = -0.461), TNF- α (p = 0.043; r = -0.435); carbohydrates and IL-6 (p = 0.037; r = -0.448), MDA (p = 0.045; r = -0.431); fiber and IL-6 (p = 0.025; r = -0.475). A positive relationship between cholesterol intake and CRP concentration (p = 0.038; r = 0.342) was also found in the N group. These findings revealed that inflammation and OS are increased in Ov/Ob girls with decreased plant protein intake and low carbohydrates in the diet. Moreover, inflammation may be increased by cholesterol intake in slim PCOS girls. On the other hand, decreased intake of fiber and total protein intake increased inflammation. ClinicalTrials.gov Identifier: NCT04738409.

Competing interplay between systemic and periodontal inflammation: obesity overrides the impact of oral periphery

Objectives

We aimed at investigating whether the interaction between the local inflammation, periodontitis, and obesity is independently associated with systemic inflammation.

Methods

From the population-based Study of Health in Pomerania, 3366 participants, without (2366) and with (1000) obesity, were studied for the association of periodontitis, measured as probing depth (PD) and plaque together with body mass index (BMI) on C-reactive protein (CRP). Quantile regression was used to evaluate the association between periodontal, anthropometric, and inflammatory variables (outcomes).

Results

The overall prevalence of obesity in this adult population was 31.4% in men and 28.1% in women. Both PD and plaque were positively associated with CRP, revealing an increasing impact across the CRP concentration distribution. Adjusting the regression of CRP or fibrinogen on PD for waist circumference attenuated but did not abolish the PD coefficients. Dental plaque was similarly associated with these interrelations. Association between PD and a dental plaque was different among participants with low-, medium-, or high-risk CRP concentrations.

Conclusion

Local and systemic sources of inflammation contribute to blood levels of inflammatory markers. The respective contributions depend on the relative rate in each of the inflammation-inducing risks and are dominated by adiposity.

Clinical relevance

Keeping systemic inflammation low in order to prevent age-related disease sequelae.

Electronic supplementary material

The online version of this article (10.1007/s00784-020-03514-y) contains supplementary material, which is available to authorized users.

Metabolic Syndrome for Cardiovascular Disease Morbidity and Mortality Among General Japanese People: A Mini Review

Background

The importance of management of metabolic syndrome (MetS) for risk reduction of cardiovascular disease (CVD) has been recognized worldwide. Because of the comparatively unique characteristics of bodily figure/obesity and incident CVD in Japan, the relevance of MetS on CVD can be still discussed among Japanese people. The present study aimed to review briefly the relationship of MetS with CVD morbidity/mortality among general Japanese people.

Methods

Population-based prospective cohort studies evaluating the predictive value of MetS on CVD morbidity/mortality via a PubMed search up to 2019 were summarized.

Results

We identified two studies on morbidity that reported MetS to predict CVD morbidity. We identified three studies on mortality, and these studies showed an increased direction of hazard ratio (HR) of CVD mortality, while one study reported an insignificant prediction of MetS for CVD mortality. In the meta-analysis method, MetS significantly predicted CVD morbidity (HR=1.71 [95% confidence interval=1.34–2.18] in men and HR=1.89 [95% confidence interval=1.45–2.46] in women) as well as CVD mortality (HR=1.68 [95% confidence interval=1.37–2.06] in men and HR=1.73 [95% confidence interval=1.39–2.15] in women).

Conclusion

Among general Japanese people, MetS can be a positive predictor of CVD morbidity/mortality. Since the studies are limited, more research is needed to establish the findings.

High-Sensitivity C-Reactive Protein Leads to Increased Incident Metabolic Syndrome in Women but Not in Men: A Five-Year Follow-Up Study in a Chinese Population

PURPOSE

Metabolic syndrome (MetS), characterized by a constellation of insulin resistance, central obesity, hypertension, and hyperlipidemia, is a global health threat. High-sensitivity C-reactive protein (hs-CRP) has been shown to be associated with type 2 diabetes and cardiovascular disease; however, its association with incident MetS is less known. Therefore, the aim of this study was to examine the prospective association between hs-CRP and MetS among a Chinese population in a 5-year follow-up study.

PATIENTS AND METHODS

The levels of hs-CRP were measured using serum samples collected at baseline recruitment in 2012 from 886 participants without MetS. Follow-up interviews were conducted in 2018, and MetS was diagnosed by 2017 criteria from the Chinese Diabetes Society. Multivariate logistic regression models were used to assess the overall and sex-specific associations between hs-CRP and incident MetS. The odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were computed with adjustment for demographic, socioeconomic, clinical, and lifestyle factors.

RESULTS

After a mean follow-up duration of 5.40 ± 0.56 years, 116 (13.3%) participants developed MetS. In the total study population, increased hs-CRP levels were associated with a higher risk of MetS (OR comparing extreme quartiles of hs-CRP: 4.06 [95% CI: 1.91-8.65]) in the fully-adjusted model. When stratified by sex, the positive association was only observed in women (OR: 4.82 [1.89-12.3]) but not in men (OR: 3.15 [0.82-12.1]; P-interaction = 0.039).

CONCLUSION

In this study of a Chinese population, a positive association between hs-CRP and incident MetS was found only in women and not in men. Sex-specific prediction and intervention of MetS using hs-CRP as a target should be further evaluated.

Temporal relationship between inflammation and insulin resistance and their joint effect on hyperglycemia: the Bogalusa Heart Study

BACKGROUND

Inflammation and insulin resistance play crucial roles in the development of type 2 diabetes mellitus (T2DM). We aim to examine the temporal relationship between high-sensitivity C-reactive protein (hsCRP) and insulin resistance in non-diabetic adults and their joint effect on the development of hyperglycemia.

METHODS

The longitudinal cohort from the Bogalusa Heart Study consisted of 509 non-diabetic adults (360 whites and 149 blacks, mean age = 42.8 years at follow-up) who had hsCRP, fasting glucose and insulin measured twice at baseline and follow-up over 6.8 years. Cross-lagged panel model was used to examine the temporal relationship between hsCRP and homeostasis model assessment for insulin resistance (HOMA-IR). Information on incident T2DM was collected in a survey in 6.1 years after the follow-up survey.

RESULTS

After adjusting for race, sex, age, body mass index, smoking, alcohol drinking and follow-up years, the path coefficient from baseline hsCRP to follow-up HOMA-IR (β2 = 0.105, p = 0.009) was significant and greater than the path from baseline HOMA-IR to follow-up hsCRP (β1 = 0.005, p = 0.903), with p = 0.011 for the difference between β1 and β2. This one-directional path from baseline hsCRP to follow-up HOMA-IR was significant in the hyperglycemia group but not in the normoglycemia group. In addition, participants with high levels of baseline hsCRP and follow-up HOMA-IR had greater risks of T2DM (odds ratio, OR = 2.38, p = 0.035), pre-T2DM (OR = 2.27, p = 0.006) and hyperglycemia (OR = 2.18, p = 0.003) than those with low-low levels.

CONCLUSIONS

These findings suggest that elevated hsCRP is associated with future insulin resistance in non-diabetic adults, and their joint effect is predictive of the development of T2DM.

Sex differences in the association of metabolic syndrome with low back pain among middle-aged Japanese adults: a large-scale cross-sectional study

BACKGROUND

Although some recent studies have indicated an association between metabolic syndrome (MetS) and musculoskeletal disease, little is known about the association of MetS with low back pain (LBP). The present study aimed to investigate sex differences in the association of MetS and the clustering of MetS components with LBP among middle-aged Japanese individuals.

METHODS

Study subjects were 45,192 adults (30,695 men, 14,497 women) aged 40-64 years who underwent annual health checkups conducted from April 2013 to March 2014. MetS was defined according to the criteria of the Examination Committee of Criteria for MetS in Japan as abdominal obesity plus at least two of dyslipidemia, high blood pressure, or high blood glucose. Information on LBP and health-related lifestyles were collected using a self-administered questionnaire. Logistic regression modeling was used to calculate the odds ratio (OR) and 95% confidence interval (CI) for LBP.

RESULTS

After adjusting for age and lifestyle factors, the OR of MetS for LBP was 1.15 (95% CI 0.95-1.40) in men and 2.16 (95% CI 1.32-3.53) in women. Compared to subjects without abdominal obesity, the presence of abdominal obesity significantly increased the OR for LBP among men (abdominal obesity only: OR 1.34, 95% CI 1.02-1.76; abdominal obesity plus one component: OR 1.24, 95% CI 1.01-1.52; abdominal obesity plus two or more components: OR 1.26, 95% CI 1.02-1.55). Among women, adding other components of MetS to abdominal obesity significantly increased ORs for LBP (abdominal obesity only: OR 1.70, 95% CI 0.94-3.08; abdominal obesity plus one component: OR 1.66, 95% CI 1.06-2.60; abdominal obesity plus two or more components: OR 2.30, 95% CI 1.41-3.78).

CONCLUSIONS

This large-scale cross-sectional study indicated that MetS was significantly associated with LBP among women only and that a sex-difference existed in the association between the clustering of MetS components and LBP. Clustering of MetS components by sex may need to be considered for the prevention of LBP, although further prospective studies are needed to clarify the causality.

On the Application of Clustering and Classification Techniques to Analyze Metabolic Syndrome Severity Distribution Area and Critical Factors

In recent years, metabolic syndrome has become one of the leading causes of death in Taiwan. This study proposes a classification and clustering method specific to the administrative regions of New Taipei City to explore the incidence and corresponding risk factors for metabolic syndrome in various geographic areas. We used integrated community health screening data and survey results obtained from people aged ≥40 years in each of the administrative regions of New Taipei City as study samples. Using a combination of Ward’s method, multivariate analysis of variance, and k-means, we identified administrative regions of New Taipei City with metabolic syndrome incidences of a similar nature. Classification and regression tree methods were used to discover the key causes of metabolic syndrome in each region based on lifestyles and dietary habits. The administrative regions were divided into four groups: high-risk, slightly high-risk, normal-risk, and low-risk. The results showed that the severity of metabolic syndrome varies by region and the risk factors for metabolic syndrome vary by region. It has also been found that regions with a higher incidence of metabolic syndrome have relatively fewer medical resources.

Association between C-Reactive Protein and Metabolic Syndrome in Korean Adults

Background

The prevalence of metabolic syndrome (MetS) is increasing, and obesity, insulin resistance, and inflammation are the known risk factors. However, results of previous studies regarding the relationship between MetS and inflammation have not been consistent. This study aimed to identify the associations between C-reactive protein (CRP) and MetS and its components in obese and non-obese men and women.

Methods

This was a cross-sectional study based on the 6th Korea National Health and Nutrition Examination Survey (2015), and a nationally representative sample of 3,013 Korean adults aged 40–78 years were included. Those with cardiovascular disease, cancer, CRP level >10 mg/L, white blood cell count >10,000/mm³ , chronic kidney disease, and lung/liver disease were excluded.

Results

Approximately 11.0%, 50.0%, 8.4%, and 48.8% of non-obese men, obese men, non-obese women, and obese women presented with MetS (P<0.001), respectively. In all four groups, those who presented with MetS or its components showed a higher high-sensitivity (hs-CRP) average than those without. Multivariate regression analysis showed the increased risk of developing MetS with higher quartiles of hs-CRP level in obese (3rd and 4th quartiles: odds ratios [ORs], 3.87 and 2.57, respectively) and non-obese women (4th quartile: OR, 2.63). The different components also showed increased ORs in the four groups. However, no statistically significant trend in the relationship was found in men.

Conclusion

Low-grade inflammation may increase the risk of MetS in Korean women independent of adiposity. However, due to the cross-sectional design of the present study, further studies must be conducted to identify the causal relationship between inflammation and metabolic disorders.

Association between Dietary Inflammatory Index, C-Reactive Protein and Metabolic Syndrome: A Cross-Sectional Study

Increased prevalence of metabolic syndrome (MetS) has become a global major public health problem. Chronic low-grade inflammation associated with diet was found to play an import role in the development of MetS, although further studies are needed. The main purpose of this study was to explore the association between the dietary inflammatory index (DII), C-reactive protein (CRP) as a sign of inflammation status, and MetS. A total of 1712 participants from eight cities in China were included. Sociodemographic and health-related information was collected by a self-administrated questionnaire. Anthropometric information and fasting blood samples were collected for identification of MetS. DII scores were computed based on one time 24-h dietary recall. No significant association between MetS and DII was observed except for the blood pressure component of MetS (OR _{T3 versus T1} = 1.40; 95% CI: 1.03 to 1.89). A significant increased prevalence for MetS was observed for higher CRP (OR = 1.66; 95% CI: 1.26 to 2.18), as well as four out of five of MetS components. In stratified analyses by sex, the associations between DII/CRP and MetS among women, but not men, are comparable to the whole sample. In addition, Both the 2nd and 3rd tertile of the DII had a higher CRP level (β-Coefficients _{T2 versus T1} = 0.086, 95% CI: 0.004 to 0.167; β-Coefficients _{T3 versus T1} = 0.145, 95% CI: 0.045 to 0.245) among subjects with MetS. Participants with higher DII scores reported a higher degree of “Shanghuo” (p = 0.007), which is a traditional concept characterized by “redness, swelling, fever and pain” in Chinese Medicine. This study suggested a close association between CRP and MetS, while the association between the DII and MetS was limited. DII was only specifically associated with CRP at a higher level among participants with MetS.

Association of serum high-sensitivity C-reactive protein with metabolic control and diabetic chronic vascular complications in patients with type 2 diabetes

AIMS

To determine an association between hs-CRP and metabolic control/diabetic chronic vascular complications (DCVCCxs) in the patients with type 2 diabetes (DM). In addition, the possibility of using hs-CRP levels to predict risk of DCVCCxs will also be validated.

METHODS

This cohort study randomly enrolled 608 patients with DM during the 2007-2008 study period. We also recorded basic laboratory findings at baseline and at one year, to include fasting plasma glucose, HbA1c, triglyceride, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and hs-CRP.

RESULTS

Logistic regressions of odds ratios between hs-CRP and DCVCCxs (coronary arterial disease, cerebrovascular disease, diabetic nephropathy, diabetic retinopathy, and diabetic peripheral neuropathy) showed significant correlations, except for cerebrovascular disease, as follows 0.2 (0.11-0.38), 0.09 (0.01-0.77), 0.06 (0.02-0.16), 0.31 (0.12-0.82), and 0.17 (0.07-0.43), respectively. Linear regression for changes in hs-CRP were significantly correlated with HbA1c (r=0.38), fasting plasma glucose (r=0.40), triglyceride (r=0.20), low-density lipoprotein cholesterol (r=0.12), and high-density lipoprotein cholesterol (r=-0.12). No correlation was found for total cholesterol (r=0.06). Based on receiver operating characteristic (ROC) analysis, the cut-off points for hs-CRP levels for prediction of DCVCCxs were 2.89, 2.25, 2.10, 2.25, and 2.82mg/L, for coronary arterial disease, cerebrovascular disease, diabetic nephropathy, diabetic retinopathy, and diabetic peripheral neuropathy, respectively.

CONCLUSIONS

Our data showed that DCVCCxs were associated with hs-CRP in patients with DM. The cut-off point for hs-CRP can be used to predict association with DCVCCxs. Well-controlled metabolic components in diabetic patients, especially HbA1c, fasting plasma glucose, and triglyceride may reduce the level of hs-CRP.

High-sensitive C-reactive protein and risk of incident type 2 diabetes: a case-control study nested within the Singapore Chinese Health Study

BACKGROUND

The liver-derived C-reactive protein (CRP) is a sensitive and systemic biomarker of inflammation, and has been associated with increased risk of developing type 2 diabetes in populations other than Chinese. Therefore, we prospectively examined the relation between plasma levels of CRP and risk of type 2 diabetes (T2D) among a Chinese population.

METHODS

Plasma high-sensitive CRP (hs-CRP) concentrations were assayed among 571 T2D cases and 571 controls nested in the prospective cohort of the Singapore Chinese Health Study. Both cases and controls were free of physician-diagnosed diabetes, cardiovascular disease and cancer at blood collections (1999-2004). Incident physician-diagnosed T2D cases were self-reported during the follow-up visits (2006-2010), and controls were matched for age (±3 years) and date (±6 months) of blood collection and gender. Multivariable logistic regression models were used to compute the odds ratio (OR) and the corresponding 95% confidence intervals (CIs).

RESULTS

The mean (SD) concentrations of hs-CRP were 2.79 (2.65) and 1.86 (2.03) mg/L, respectively, in cases and controls (P < 0.001). After multivariate adjustment for T2D risk factors such as lifestyle, body mass index, plasma triglycerides and HDL cholesterol, the OR comparing the extreme quartiles of hs-CRP was 1.74 [95% CI 1.12-2.70; P for trend = 0.016]. When the analysis was limited to 279 cases who had HbA1c ≥6.5% at the time of blood collection and their controls, the OR comparing the extreme quartiles of hs-CRP was 2.43 (95% CI 1.25-4.71; P for trend = 0.003). When confined to the other 292 subjects with HbA1c <6.5% and their controls, the corresponding OR was 1.24 (95% CI 0.64-2.39; P for trend = 0.93).

CONCLUSIONS

We found that CRP was not associated with increased risk of incident diabetes in this cohort of Chinese in Singapore. Previous positive findings from prospective studies might be partly due to undiagnosed T2D among the cases during blood collection.

A Prospective Study of Variability in Glycemic Control during Different Phases of the Menstrual Cycle in Type 2 Diabetic Women Using High Sensitivity C - Reactive Protein

INTRODUCTION

Diabetes mellitus (DM) is one of the metabolic syndromes prevalent worldwide, with more concentration in the Asian region. Many studies have been conducted in order to understand the complex pathogenesis of this disease. Yet, there exists a lacuna in our knowledge about DM. This study aims at establishing the reason for glycemic variation in menstruating Type-2 diabetic women by estimation of C-reactive protein, an inflammatory marker that exhibits significant association with changes in blood glucose levels.

METHODOLOGY

A prospective study was undertaken in Type-2 diabetic women of reproductive age group to assess the variability of glycemic control during different phases of menstrual cycle using high sensitivity C reactive protein (hs-CRP) as the biomarker. Fifty women were enrolled after satisfying a set of inclusion and exclusion criteria. The fasting blood glucose, hs-CRP concentration and endogenous female hormones were assayed in follicular and luteal phases of the cycle. The observed parameters were analyzed statistically for significant correlation. Observation and Result: The result showed that hs-CRP level significantly correlates with increasing levels of fasting blood glucose level in both the phases of menstrual cycle in Type-2 diabetic women. The significance is statistically stronger during luteal phase of the cycle (r = 0.807; p<0.05). The correlation observed between hs-CRP and Estrodiol in follicular phase (r = -0.311; p < 0.05) was not statistically significant. The hs-CRP level increased significantly with progesterone level during luteal phase (r = 0.826; p <0.05).

CONCLUSION

This study concludes that Type-2 diabetic women of reproductive age group encounter a period of poor glycemic control during luteal phase, as shown by statistically high hs-CRP level mediated by endogenous progesterone hormone. Therefore, this study advocates careful monitoring, life style adjustments and drug regime to reduce the fluctuation in glycemic level experienced by Type-2 diabetic premenopausal women in the luteal phase.

Gender differences in the association of insulin resistance and high-sensitivity c-reactive protein in obese adolescents

Background

Low-grade vascular inflammation is believed to initiate early atherosclerotic process by inducing insulin resistance (IR), with significant gender differences in adults. We evaluated the relationship between surrogate measures of inflammation and IR in obese adolescents.

Methods

The association among markers of inflammation [high-sensitivity c-reactive protein (hs-CRP)] and IR, cardiometabolic risk factors and body composition was retrospectively examined in 199 obese adolescents [(111 F/88 M), aged 15.5 ± 1.2 years]. Insulin resistance was assessed using homeostatic model assessment for insulin resistance (HOMA-IR).

Results

Males had higher body mass index SD-score (BMI-SDS), fat mass (FM), glucose, insulin, HOMA-IR, HbA_1c, hs-CRP, triglycerides: HDL-C (TG:HDL-C) ratio than females (p < 0.05), whereas females had higher c-peptide: insulin ratio than males (p < 0.05). Also, 50.8% of subjects were identified with metabolic syndrome with similar gender distribution (M: 57.9% vs. F: 45.1%, p = 0.32). Hs-CRP was correlated with HOMA-IR in the cohort, even when controlling for FM (r = 0.26; p < 0.0001). However, hs-CRP and HOMA-IR displayed a significant correlation only in females (r = 0.37; p < 0.0001) when adjusting for FM and pubertal status. Also, c-peptide: insulin ratio was inversely correlated with hs-CRP (r = −0.32; p < 0.001) and HOMA-IR (r = −0.62; p < 0.0001) and partially mediated the relationship between these biomarkers only among females (β = 0.36, p < 0.001 to β = 0.18, p < 0.05; Sobel Test: p < 0.01).

Conclusions

A positive association between hs-CRP and HOMA-IR was observed only in adolescent girls which was influenced by altered hepatic insulin clearance. This implies that obese adolescent girls may be at greatest risk of developing early atherosclerosis and diabetes.

Markers of Systemic Inflammation and Apo-AI Containing HDL Subpopulations in Women with and without Diabetes

Background. Besides their role in reverse cholesterol transport, HDL particles may affect the atherosclerotic process through the modulation of subclinical inflammation. HDL particles differ in size, composition, and, probably, anti-inflammatory properties. This hypothesis has never been explored in diabetic women, frequently having dysfunctional HDL. The potential relationship between lipid profile, Apo-AI containing HDL subclasses distribution, and common inflammatory markers (hsCRP, IL-6) was examined in 160 coronary heart disease- (CHD-) free women with and without type 2 diabetes. Results. Compared to controls, diabetic women showed lower levels of the atheroprotective large α-1, α-2, and pre-α-1 and higher concentration of the small, lipid-poor α-3 HDL particles (P < 0.05 all); diabetic women also had higher hsCRP and IL-6 serum levels (age- and BMI-adjusted P < 0.001). Overall, HDL subclasses significantly correlated with inflammatory markers: hsCRP inversely correlated with α-1 (P = 0.01) and pre-α-1 (P = 0.003); IL-6 inversely correlated with α-1 (P = 0.003), α-2 (P = 0.004), and pre-α-1 (P = 0.002) and positively with α-3 HDL (P = 0.03). Similar correlations were confirmed at univariate regression analysis. Conclusions. More atheroprotective HDL subclasses are associated with lower levels of inflammatory markers, especially in diabetic women. These data suggest that different HDL subclasses may influence CHD risk also through the modulation of inflammation.

Metabolic syndrome: comparison of prevalence in young adults at 3 land-grant universities

OBJECTIVE

The study examines metabolic syndrome (MetS) among college students at 3 geographically distinct US campuses.

PARTICIPANTS

Undergraduates (N = 360; 68% women), 18 to 24 years of age, were recruited at each public university in January and February 2011. MetS prevalence was evaluated in 83% (n = 299) participants.

METHODS

Anthropometric, biochemical, and clinical measures were collected in the fasted state.

RESULTS

Twelve percent of college men and 6% of college women met the clinical definition of MetS. Males were more likely to have ≥ 2 individual MetS criteria than females (33% vs 16%; p < .05). Prevalence and individual criteria of MetS differed between the 3 regions. Obese and overweight students met significantly more MetS criteria and had higher C-reactive protein levels than normal-weight students (both p < .05).

CONCLUSION

Findings suggest that MetS prevalence among college students differs by sex, weight status, and region. Further research is needed to identify effective, targeted interventions that are regionally appropriate for this population.

Abdominal obesity is associated with albuminuria in women: the 2011 Korea National Health and Nutrition Examination Survey

BACKGROUND

The effects of obesity on the kidney, apart from diabetes or hypertension, have not drawn much attention. Moreover, only a few studies have reported the relationship between obesity status and albuminuria in Asian countries, including South Korea. Therefore, this study aimed to investigate the association between obesity status and albuminuria in Korean adults.

METHODS

We analyzed data from the 2011 Korea National Health and Nutrition Examination Survey. Of the 4,979 subjects included in the general-population group, 3,274 were sorted into a nondiabetic and nonhypertensive population group. Obesity status was measured by body mass index and waist circumference. Albuminuria was defined as a urine albumin-to-creatinine ratio ≥30 mg/g.

RESULTS

Abdominally obese women were at higher risk for albuminuria than were women without abdominal obesity both in the general population (odds ratio [OR], 95% confidence interval [CI]: 2.08 [1.04-4.16]) and in the nondiabetic and nonhypertensive population (OR [95% CI]: 6.96 [2.34-20.64]) after further adjustment for confounders. Among generally nonobese women, abdominally obese women were at higher risk for albuminuria than were women without abdominal obesity both in the general population (OR [95% CI]: 2.82 [1.51-5.29]) and in the nondiabetic and nonhypertensive population (OR [95% CI]: 5.32 [1.47-19.22]).

CONCLUSION

Abdominal obesity is associated with an increased risk for albuminuria in Korean women, independently of diabetes or hypertension. Screening for abdominal obesity, especially in women, may therefore provide earlier identification of individuals at risk for developing renal disease and cardiovascular disease, even those who are nondiabetic and nonhypertensive.

C-reactive protein + 1059 G>C polymorphism in type 2 diabetes and coronary artery disease patients

Human C-reactive protein (CRP) is an acute phase reactant involved in chronic and acute inflammation. CRP is associated with metabolic syndrome, obesity, atherosclerosis, unstable angina, insulin resistance and diabetes. The present study evaluates the association of + 1059 G>C silent polymorphism in exon 2 of CRP gene in 581 cases [CAD (206), T2D (266), T2D with CAD (109)] and 235 controls in the population of Punjab (North-West India). The frequency of + 1059 G allele is highest in CAD (98.3%) followed by T2D (98.1%), T2D + CAD cases (97.7%) and controls (94.7%). G-allele is associated with increased risk of T2D [P = 0.003, OR = 2.93 (1.39–6.17)] and CAD [P = 0.004, OR = 3.25 (1.39–7.60)] in comparison to controls. Recessive model shows that GG genotype increases the risk of CAD by 4 fold (P = 0.003, OR = 4.19, 1.62–10.80), T2D by 3 fold (P = 0.008, OR = 3.23, 1.36–7.60) and T2D + CAD by 3.5 fold (P = 0.029, OR = 3.64, 1.14–11.66). Factor analyses show that BMI, WC, and WHR are core predictors for CAD and T2D, whereas CHO, TG and VLDL for T2D + CAD. The present study concludes that GG genotype of CRP + 1059 G>C polymorphism and clustering of obesity and dyslipidemia underlie the risk towards CAD, T2D and T2D + CAD in the North-West Indian population of Punjab.

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CRP + 1059 G>C SNP analyzed in 266 T2D, 109 T2D with CAD, 206 CAD, and 235 controls

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GG genotype increases the risk towards T2D, CAD, and T2D + CAD in population of Punjab.

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GC genotype provides protection towards T2D, CAD, and T2D + CAD in population of Punjab.

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Clustering of obesity and dyslipidemia underlies the risk towards T2D, CAD, and T2D + CAD.

Circulating microRNAs have a sex-specific association with metabolic syndrome

Background

The microRNAs let-7 g and miR-221 have been demonstrated to be related to the glucose metabolism. This study assessed the serum levels of these two microRNAs in subjects with and without metabolic syndrome (MetS).

Results

The serum microRNA levels were detected in 102 subjects aged 40 to 80 years who were recruited from the general population. The status of MetS was defined by the Adult Treatment Panel III (ATP III) criteria modified for Asians. Subjects with histories of cardiovascular diseases or who were receiving treatment with hypoglycemic or lipid-lowering agents were excluded. The levels of both circulating microRNAs (let-7 g and miR-221) were higher in subjects with MetS (p = 0.004 and p = 0.01, respectively). The sex-specific analysis showed that the difference was more prominent in women (for both miRNAs, p < 0.05 in women and p > 0.1 in men). In the female subjects, increased expression of both microRNAs was associated with an increased number of MetS risk components (p = 0.002 for let-7 g and p = 0.022 for miR-221). Moreover, the elevation of serum let-7 g was significantly associated with a low level of high-density lipoprotein cholesterol (p = 0.022) and high blood pressure (p = 0.023). In contrast, the miR-221 level was not associated with any individual MetS risk component.

Conclusions

The circulating levels of let-7 g and miR-221 displayed a female-specific elevation in individuals with metabolic syndrome.

Central obesity and albuminuria: both cross-sectional and longitudinal studies in Chinese

Background

Albuminuria is recognized as a marker of vascular dysfunction. Central obesity increases the risk of cardiovascular disease. Little is known about the association between albuminuria and central obesity in Chinese. We aimed to assess the association between central obesity and prevalence and incidence of albuminuria in a middle-aged population-based cohort study.

Methods

This is a cross-sectional and longitudinal cohort study. A total of 2350 subjects aged ≥40 years were recruited in 2004 in Taiwan for cross-sectional analysis. Longitudinal analysis included 1432 baseline normoalbuminuria subjects with a mean 2.8 years follow-up, 67 of whom exhibited incident albuminuria. Albuminuria was defined as urinary albumin-to-creatinine ratio ≥30 mg/g creatinine. Multiple logistic regression analyses were used to evaluate the relationship between central obesity and prevalence and incidence of albuminuria after adjustment for age, gender, body mass index, blood pressure, renal function, glucose, high sensitivity c-reactive protein, smoking, betel nut chewing, alcohol drinking, and physical activity.

Results

At baseline, albuminuria is significantly associated with central obesity. The adjusted odds ratio of having albuminuria among subjects with central obesity was 1.73(95% confidence interval (CI): 1.04–2.85), compared to the subjects without central obesity. In multivariable models, participants with central obesity at baseline had a 112% increase in risk of incident albuminuria (adjusted incidence rate ratio (95% CI): 2.12(1.01–4.44)) compared with participants with non-central obesity.

Conclusions

Abdominal adiposity was independently associated with increased prevalence and incidence of albuminuria in Chinese. The mechanisms linking adiposity and albuminuria need to be addressed.

Metabolic syndrome and quality of life in the elderly: age and gender differences

PURPOSE

The metabolic syndrome (MetS) is highly prevalent in Western older populations. MetS is an intriguing entity, because it includes potentially reversible risk factors. Some studies have suggested an inverse correlation between MetS and health-related quality of life (HRQoL), but data regarding older subjects are scanty and conflicting. The aim of this study was to assess the association between HRQoL and MetS in older, unselected community-dwelling subjects.

METHODS

We analyzed data of 356 subjects aged 75+ living in Tuscania (Italy). HRQoL was assessed using the Health Utilities Index, Mark 3. Diagnosis of MetS was defined according to the National Cholesterol Education Program's ATP-III criteria.

RESULTS

MetS was reported by 137 (38%) participants. According to linear regression analysis, MetS was associated with significantly better HRQoL in men (B = 0.19 95% CI = 0.06-0.32; p = 0.006), but not in women. Also, when the regression model was analyzed in men, MetS was associated with better HRQoL (B = 0.17, 95% CI = 0.01-0.32; p = 0.035) only among participants aged 80+. No significant associations were found in men between HRQoL and any of the single components of MetS.

CONCLUSIONS

MetS is not associated with worse HRQoL among community-dwelling elderly; it is associated with significantly better HRQoL among the oldest men.