Probiotic mixtures appear to be effective against a wide range of end points. Based on a limited number of studies, multi-strain probiotics appear to show greater efficacy than single strains, including strains that are components of the mixtures themselves. However, whether this is due to synergistic interactions between strains or a consequence of the higher probiotic dose used in some studies is at present unclear.

Objective-Activated innate immunity is thought to be involved in the pathogenesis of metabolic syndrome and type 2 diabetes. Interleukin-18 (IL-18) is a pleiotropic proinflammatory cytokine with important regulatory functions in the innate immune response. We sought to determine whether an elevated IL-18 concentration was a risk predictor for metabolic syndrome in a community population independent of obesity and hyperinsulinemia. Methods and Results-A representative general population, aged 27 to 77 years, without clinical diabetes was studied for clinical and biochemical risk factors for metabolic syndrome. Serum IL-18 concentration measured in 955 subjects correlated with metabolic syndrome traits including body mass index (BMI), waist circumference, triglyceride, high-density lipoprotein (inversely), and fasting glucose and insulin levels (all PϽ0.001). Mean IL-18 levels rose progressively with the increasing number of metabolic risk factors (ANOVA PϽ0.001). After adjusting for age, gender, BMI, and insulin levels, increasing IL-18 tertiles were associated with an odds ratio for metabolic syndrome of 1.0, 1.42, and 2.28, respectively (P trendϭ0.007). The graded risk relation was even stronger in nonobese subjects and not attenuated when adjusted for C-reactive protein and IL-6 levels. Key Words: IL-18 Ⅲ metabolic syndrome Ⅲ obesity Ⅲ insulin resistance Ⅲ inflammatory mediators M etabolic syndrome is a heterogeneous condition characterized by visceral adiposity, dyslipidemia, hypertension, and insulin resistance. 1,2 The metabolic syndrome with its clustering of metabolic and atherosclerotic risk factors is a strong determinant of type 2 diabetes and cardiovascular disease (CVD). [3][4][5] Obesity and insulin resistance are considered central to the pathophysiology of this metabolic and cardiovascular syndrome. 6,7 Recently, activated innate immunity and chronic inflammation have also been causally implicated and may represent a potential link between metabolic syndrome, diabetes, and atherosclerosis. 8 -10 Several cross-sectional studies have shown that acutephase reactants such as C-reactive protein (CRP) and cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-␣ associate with features of the metabolic syndrome such as body mass index (BMI)/waist circumference, measures of insulin resistance/plasma insulin concentration, hypertension, and dyslipidemia. [11][12][13][14][15][16] However, it is uncertain whether the association of inflammatory markers with metabolic syndrome is independent of measures of obesity and insulin resistance when they are included in a risk prediction model. [17][18][19] IL-18, a recently described member of the IL-1 cytokine superfamily, is now recognized as an important regulator of innate and acquired immune responses. 20,21 It is a potent proinflammatory cytokine, and a role in plaque destabilization has been suggested. 22 Prospective studies have shown an association of circulating IL-18 levels with cardiovascular death in patients with coronary artery disease and...

Background and Purpose-Systemic inflammatory markers have been shown to predict future cardiovascular events, but whether they are associated with early atherosclerosis is uncertain. We investigated the relationship of inflammatory markers interleukin-6 (IL-6), high-sensitive C-reactive protein (hs-CRP), fibrinogen, monocyte count, and white cell count (WCC) with subclinical carotid atherosclerosis in a healthy community population. Methods-B-mode carotid ultrasound was performed on 1111 randomly selected male and female subjects aged 27 to 77 years. Serum IL-6, hs-CRP, plasma fibrinogen, monocyte count, and WCC were measured on all subjects, along with conventional cardiovascular risk factors. Results-Multivariate analysis showed that IL-6 (PϽ0.0001), fibrinogen (Pϭ0.007), and monocyte count (Pϭ0.001) were associated with carotid plaque formation in the whole population. Monocyte count remained associated independently with carotid plaque formation when adjusted further for conventional risk factors (odds ratio per SD increase in monocyte count 1.4; 95% CI, 1.13 to 1.73; Pϭ0.002). IL-6 (PϽ0.0001), fibrinogen (PϽ0.0001), and monocyte count (Pϭ0.04) were also associated with carotid intima-medial thickness (IMT) in the whole population. However, when adjusted further for conventional risk factors, none remained independently predictive of carotid IMT. Further analysis showed an age-monocyte interaction (Pϭ0.03), with monocyte count being an independent predictor of carotid IMT in the older age group only (Ͼ53 years; Pϭ0.003). Conclusion-In a healthy community population, monocyte count is a better independent predictor of common carotid IMT and plaque formation than IL-6, hs-CRP, fibrinogen, and WCC. Monocyte count may represent an inexpensive, easy-to-measure risk marker for subclinical carotid atherosclerosis.