Adiposity, Inflammation, and Risk for Death in Black and White Men and Women in the United States: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

ArticleinThe Journal of Clinical Endocrinology and Metabolism 96(6):1805-14 · March 2011with10 Reads
DOI: 10.1210/jc.2010-3055 · Source: PubMed
It has been proposed that adiposity is a protective response to excess caloric supply, but it is cardiometabolically harmful once adipocytes become inflamed. The objective of the study was to assess whether elevated C-reactive protein (CRP), a measure of systemic inflammation, can differentiate individuals at higher mortality risk due to excess adiposity. We conducted an observational study of 16,486 white and 11,168 black men and women in the Reasons for Geographic and Racial Differences in Stroke study, a U.S. national cohort. The main outcome was all-cause mortality. The mean age of the cohort was 64 ± 9 yr. Over a 6-yr period, 927 whites and 669 blacks died. The absolute risk of death was highest among underweight whites and blacks (9.2 and 14%, respectively), not the obese (4.7% whites; 4.0% blacks) or severely obese (5.9% whites; and 4.6% blacks). Among those with elevated CRP (≥3 vs. <1 mg/liter), underweight [hazard ratio (HR) 2.08, 95% confidence interval (CI) 1.03-4.21] and normal-weight (HR 2.62, 95% CI 1.87-3.67) whites were at significantly higher mortality risk but not severely obese whites (HR 1.55, 95% CI 0.77-2.96), resulting in a statistical interaction (P = 0.01). Similar results were also seen for blacks, although a higher mortality risk among severely obese blacks with CRP 3 or greater vs. less than 1 mg/liter was also demonstrated (HR 2.58, 95% CI 1.04-6.41). Among whites and black women, higher waist circumference was associated with an increased mortality risk, although this relationship was not modified by CRP levels (P = 0.47 for whites and P = 0.25 for blacks). Among middle-aged and older adults, the addition of CRP was most informative among underweight and normal-weight individuals, not the obese. This negated our hypothesis that increased levels of CRP would differentiate individuals at higher mortality risk due to excess adiposity.
    • "Higher plasma concentrations of inflammatory factors such as IL-6 and TNF-α have been associated with lower grip strength and gait speed in older adults, demonstrating the interconnection between immune and functional status in the elderly [40]. CRP has been related to all-cause and specific causes of mortality and IL-6 was found to be a strong predictor of mortality [41][42][43]. Measurement of inflammatory markers has been conducted in centenarians. Centenarians demonstrate fewer signs of inflammaging [11,12]. "
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    • "Thresholds at which BMI confers mortality risk may also vary significantly by race. Several studies have reported a weaker association between higher BMI categories and mortality in black women than in white women, with thresholds for elevated mortality risk as high as BMI of 403536373839404142; although the association between BMI and mortality was similar in black and white women in the Black Women's Health Study and in the Multiethnic Cohort Study [43, 44] . The majority of participants in the WIHS cohort are black women, in whom the association between BMI and mortality has been reported to be weaker than in white women. "
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    • "y SAHS) Atlantis et al, 64 2010 Lawlor et al , 58 2006( Renfrew / Paisley women ) Ferrie et al , 50 2009 ( men) Wändell et al , 56 2009 ( women) Cabrera et al , 65 2005 Lang et al , 23 2008 ( women) Lakoski et al , 51 2011 ( women) McTigue et al , 68 2006 ( egy for PubMed yielded 4142 articles , of which 128 met our criteria . A second PubMed search yielded 2892 additional articles , of which 13 met our criteria . "
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