Elevated C-reactive protein levels in overweight and obese adults

Institute for Research in Extramural Medicine, Faculty of Medicine, Vrije Universiteit, Amsterdam, The Netherlands.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 01/2000; 282(22):2131-5.
Source: PubMed


Human adipose tissue expresses and releases the proinflammatory cytokine interleukin 6, potentially inducing low-grade systemic inflammation in persons with excess body fat.
To test whether overweight and obesity are associated with low-grade systemic inflammation as measured by serum C-reactive protein (CRP) level.
The Third National Health and Nutrition Examination Survey, representative of the US population from 1988 to 1994.
A total of 16616 men and nonpregnant women aged 17 years or older.
Elevated CRP level of 0.22 mg/dL or more and a more stringent clinically raised CRP level of more than 1.00 mg/dL.
Elevated CRP levels and clinically raised CRP levels were present in 27.6% and 6.7% of the population, respectively. Both overweight (body mass index [BMI], 25-29.9 kg/m2) and obese (BMI, > or =30 kg/m2) persons were more likely to have elevated CRP levels than their normal-weight counterparts (BMI, <25 kg/m2). After adjustment for potential confounders, including smoking and health status, the odds ratio (OR) for elevated CRP was 2.13 (95% confidence interval [CI], 1.56-2.91) for obese men and 6.21 (95% CI, 4.94-7.81) for obese women. In addition, BMI was associated with clinically raised CRP levels in women, with an OR of 4.76 (95% CI, 3.42-6.61) for obese women. Waist-to-hip ratio was positively associated with both elevated and clinically raised CRP levels, independent of BMI. Restricting the analyses to young adults (aged 17-39 years) and excluding smokers, persons with inflammatory disease, cardiovascular disease, or diabetes mellitus and estrogen users did not change the main findings.
Higher BMI is associated with higher CRP concentrations, even among young adults aged 17 to 39 years. These findings suggest a state of low-grade systemic inflammation in overweight and obese persons.

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Available from: Lex Bouter, Jul 01, 2014
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    • "High-sensitivity C-reactive protein (hs-CRP), an acute phase reactant and a marker for systemic inflammation, has been found to be associated with future cardiovascular disease (CVD) events and mortality (Buckley et al., 2009; Kengne et al., 2012; Libby et al., 2002; Ridker, 2003; Ridker et al., 2000; Strandberg and Tilvis, 2000) as well as with single CVD risk factors (RFs), including obesity or body mass index (BMI) (Arena et al., 2006; Ganguli et al., 2011; Ishii et al., 2012; Khoo et al., 2011; Strandberg and Tilvis, 2000; Visser et al., 1999), smoking (Khoo et al., 2011; Strandberg and Tilvis, 2000), blood pressure (Khoo et al., 2011; Lakoski et al., 2005), serum cholesterol (Chiu et al., 2012; Ganguli et al., 2011), and diabetes (Chiu et al., 2012). However, no data are available on the associations between having a favorable level of all CVD RFs (i.e., low risk — LR) at younger ages and hs-CRP levels at older ages. "
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    ABSTRACT: Objectives: Examine associations of favorable levels of all cardiovascular disease (CVD) risk factors (RFs) [i.e., low risk (LR)] at younger ages with high sensitivity C-reactive protein (hs-CRP) at older ages. Methods: There were 1,324 participants ages 65-84 years with hs-CRP ≤ 10mg/l from the Chicago Healthy Aging Study (2007-2010), CVD RFs assessed at baseline (1967-73) and 39 years later. LR was defined as untreated blood pressure (BP) ≤120/≤80 mmHg, untreated serum total cholesterol <200 mg/dL, body mass index (BMI) <25 kg/m(2), not smoking, no diabetes. Hs-CRP was natural log-transformed or dichotomized as elevated (≥3 mg/l or ≥2 mg/l) vs. otherwise. Results: With multivariable adjustment, the odds ratios (95% confidence intervals) for follow-up hs-CRP ≥3 mg/ in participants with baseline 0RF, 1RF and 2+RFs compared to those with baseline LR were 1.35 (0.89-2.03), 1.61(1.08-2.40) and 1.69(1.04-2.75), respectively. There was also a graded, direct association across four categories of RF groups with follow-up hs-CRP levels (β coefficient/P-trend = 0.18/0.014). Associations were mainly due to baseline smoking and BMI, independent of 39-year change in BMI levels. Similar trends were observed in gender-specific analyses. Conclusions: Favorable levels of all CVD RFs in younger age are associated with lower hs-CRP level in older age.
    12/2015; 2:235-240. DOI:10.1016/j.pmedr.2015.03.012
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    • "The observed increase in CRP levels reported in patients with morbid obesity is consistent with the studies of Hofso et al. (2009), van Dielen et al. (2001), and Solá et al. (2009). In patients with morbid obesity there was a positive correlation between the concentration of CRP and BMI before the BT, which is in line with the results reported by Visser et al. (1999). These outcomes confirm the presence of low-grade inflammation and tissue damage in those patients. "
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    ABSTRACT: The aim of this study was to evaluate the concentrations of C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and the degree of homeostasis model assessment-insulin resistance (HOMA-IR) in patients with morbid obesity exposed to a three-week low-calorie diet and balneotherapy. The study included 33 patients (25 females and 8 males; mean age 46 years) with body mass index (BMI) values of >40 kg/m(2). Evaluations of CRP, IL-6, TNF-α, lipid profile, HOMA-IR, and fasting glucose were carried out before (baseline data) and three weeks after the treatment. The control group consisted of 20 healthy volunteers (15 females and 5 males) with a mean age of 39 years and BMI values of ≤24.9 kg/m(2). In the blood of patients with morbid obesity we found significantly elevated levels of CRP, TNF-α, triglycerides, HOMA-IR and fasting glucose, but a decreased level of high density lipoprotein (HDL)-cholesterol, compared with the healthy individuals. The treatment resulted in about a 9.4% reduction in body weight from 122.5 to 111.0 kg and a significant decrease in the concentration of CRP, but no change in TNF-α or IL-6. HOMA-IR was significantly reduced. The decrease in CRP level without changes in TNF-α or IL-6 concentrations after the low-calorie diet and balneological treatment, suggests that an essential amount of adipose tissue must be removed before proper adipocyte function is restored. The decrease in HOMA-IR indicates an improvement in insulin sensitivity, which is beneficial in obese patients.
    Journal of Zhejiang University SCIENCE B 05/2015; 16(5):404-411. DOI:10.1631/jzus.B1400219 · 1.28 Impact Factor
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    • "PCOS to demonstrate a relation with exercise between reductions in circulating leukocytes and improvements in insulin sensitivity. Chronic, low-grade inflammation is a characteristic of many metabolic diseases, including obesity, metabolic syndrome and Type 2 Diabetes [7] [8] [16]. Given the metabolic derangement in women with PCOS, this syndrome has also been hypothesized to be associated with increased levels of low grade inflammation [12]. "
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    ABSTRACT: Polycystic ovary syndrome (PCOS) is characterized by insulin resistance, elevated circulating leukocytes, and hypothesized to have higher adipose tissue inflammation. Aerobic exercise reduces circulating leukocytes and improves insulin sensitivity in obese individuals, but the effect of exercise on inflammation in PCOS is not known. We investigated circulating leukocytes, insulin sensitivity by euglycemic-hyperinsulinemic clamp, serum pro- and anti-inflammatory markers (hsCRP, TNF-α, total and high molecular weight adiponectin), and abdominal subcutaneous adipose tissue (SAT) gene expression of proinflammatory markers in 8 PCOS women and 8 obese control females matched for BMI. Additionally, in a prospective study, the 8 women with PCOS underwent a 16-week aerobic exercise regimen with the same measures performed post-intervention. Compared to controls, white blood cell counts (WBC) were 30% higher (p = 0.04) and circulating total adiponectin levels were 150% lower (p = 0.03) in women with PCOS at baseline/pre-exercise conditions. SAT gene expression of macrophage migration inhibitory factor (MIF, p < 0.01) and interleukin-6 (IL-6, p < 0.05) were also lower in women with PCOS. In response to 16 weeks of aerobic exercise, insulin sensitivity improved (p < 0.01) and WBC counts decreased (p = 0.02). The exercise-induced change in WBC and circulating neutrophils correlated inversely with changes in glucose disposal rate (r = −0.73, p = 0.03; and r = −0.82, p = 0.01, respectively). Aerobic exercise reduced serum leptin (p < 0.05) after 4 weeks, trended to reduce the ratio of leptin-to-high molecular weight adiponectin (p < 0.1) by the 8th week, and significantly increased serum dehydroepiandrosterone sulfate (DHEA-S, p < 0.001) after 16 weeks. In conclusion, women with PCOS have higher circulating leukocytes compared to controls, which can be reversed by aerobic exercise and is associated with improvements in insulin sensitivity.
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