Differentiation Between Obesity and Insulin Resistance in the Association With C-Reactive Protein

McLaughlin, Tracey; Abbasi, Fahim; Lamendola, Cindy; Liang, Lynn; Reaven, Gerald M.; Schaaf, Patricia; Reaven, Peter D.

doi:10.1161/01.cir.0000041046.32962.86

Cited by 321 publications

(237 citation statements)

References 35 publications

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“…CRP (a strong predictor of cardiovascular disease) is lowered following improvements in insulin sensitivity. 38 Indeed, CRP was reduced by wk 16 in this study and the relatively low glycemic load of both diets may have augmented this reduction. 39 The modest improvements in liver function markers occurred despite subjects being within normal range at baseline.…”

Section: Discussionmentioning

confidence: 57%

Effect of calcium and dairy foods in high protein, energy-restricted diets on weight loss and metabolic parameters in overweight adults

2005

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OBJECTIVE:To compare the effects two high-protein (HP) diets that differ in dietary calcium and protein source on weight loss, body composition, glucose and lipid metabolism, markers of liver function, fibrinolysis and endothelial function and blood pressure. DESIGN: Randomized, parallel study (12 wk of energy restriction, 4 wk of energy balance) of high dairy protein/high-calcium (DP, 2400 mg Ca/d) and high mixed protein/moderate calcium (MP, 500 mg Ca/d) diets (5.5 MJ/d, 34% protein, 41% carbohydrate, 24% fat). SUBJECTS: In all, 50 healthy, overweight (age 25-64 y; body mass index 25-35 kg/m 2 ;) males (n ¼ 20) and females (n ¼ 30). RESULTS: Loss of total weight (À9.773.8 kg), fat mass (À8.370.4 kg) and lean mass (À1.670.3 kg) were independent of dietary group. Improvements in fasting insulin, lipids, systolic/diastolic blood pressure, and markers of liver function, fibrinolysis and endothelial function were independent of dietary intervention. CONCLUSIONS: Increased dietary calcium/dairy foods in an energy-restricted, HP diet does not affect weight loss or body composition. Weight reduction following increased protein diets is associated with beneficial metabolic outcomes that are not affected by protein source.

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Section: Discussionmentioning

confidence: 57%

Effect of calcium and dairy foods in high protein, energy-restricted diets on weight loss and metabolic parameters in overweight adults

2005

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“…3,10,19,[36][37][38] A study of healthy premenopausal women who completed a 1-y weight loss programme achieved a minimum 10% loss of weight and a decrease in cytokine (IL-6 and TNF-a) produc- CRP reduction following gastric bypass surgery C Holdstock et al tion. 34 Medical treatment with sibutramine or orlistat for 6 months achieved a reduction in CRP despite less weight loss (2-5.4%).…”

Section: Discussionmentioning

confidence: 99%

“…9 In contrast, in a study of obese women in which CRP was measured before and after 3 months of reduced energy intake, the relation between CRP concentrations and insulin resistance appeared independent of obesity. 10 The medical treatment of obesity, in particular morbid obesity (BMI Z40 kg/m 2 ), is unsatisfactory and has led to the increased use of surgery worldwide. 11 Roux-en-Y gastric bypass (RYGBP) causes a marked reduction in adipose tissue mass, 12 alters adipose tissue regulatory hormones 13 and reduces morbidity.…”

Section: Introductionmentioning

confidence: 99%

CRP reduction following gastric bypass surgery is most pronounced in insulin-sensitive subjects

et al. 2005

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OBJECTIVE: Obesity is frequently associated with insulin resistance, dyslipidemia, hypertension and an increased risk of cardiovascular disease, reflected in elevated markers of inflammation, in particular C-reactive protein (CRP). To what extent the insulin resistance or the obesity per se contributes to increased CRP levels is unclear. In morbidly obese patients, gastric bypass surgery causes marked changes in body weight and improves metabolism, thereby providing informative material for studies on the regulation of inflammatory markers. DESIGN: Prospective, surgical intervention study of inflammatory markers in morbidly obese subjects. SUBJECTS: In total, 66 obese subjects with mean age 39 y and mean body mass index (BMI) 45 kg/m 2 were studied prior to and 6 and 12 months following Roux-en-Y gastric bypass (RYGBP) surgery. MEASUREMENTS: Serum concentrations of high sensitivity CRP, serum amyloid A (SAA) and interleukin-6 (IL-6), as well as markers of glucose and lipid metabolism. RESULTS: Prior to surgery, CRP levels were elevated compared to the reference range of healthy, normal-weight subjects. CRP correlated with insulin sensitivity, as reflected by the homeostatic model assessment (HOMA) index, but not BMI, when corrected for age and gender. Surgery reduced BMI from 45 to 31 kg/m 2 and lowered CRP, SAA and IL-6 levels by 82, 57 and 50%, respectively, at 12 months. The reduction in CRP was inversely related to HOMA at baseline independently of the change in body weight (r ¼ À0.36, P ¼ 0.005). At 12 months, 140 and 40% reductions in CRP were seen in subjects with HOMA o 4 (insulin sensitive) and HOMA49 (insulin resistant) despite similar reductions in BMI. Reductions in SAA and IL-6 tended to parallel the changes in CRP, but were less informative. CONCLUSION: In morbidly obese subjects, gastric bypass surgery lowers energy intake, reduces inflammatory markers and improves insulin sensitivity. Despite a marked reduction in body weight, only a small effect on CRP levels was seen in insulinresistant patients, indicating that flexibility of circulating CRP levels is primarily dependent upon insulin sensitivity rather than energy supply.

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“…1,2 It has been shown that not all obese subjects have high levels of C-reactive protein (CRP), but only those who are insulin resistant, 3 suggesting a strong link between insulin resistance and inflammation.…”

Section: Introductionmentioning

confidence: 99%

Adiponectin gene expression and adipocyte NF-κB transcriptional activity in elderly overweight and obese women: inter-relationships with fat distribution, hs-CRP, leptin and insulin resistance

et al. 2007

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Objective: The regulatory processes that modulate adiponectin production and the mechanisms involved in nuclear factor kB (NF-kB) transcriptional activity in human adipocytes are not yet fully known. The aim of our study was to evaluate the interrelationships between body fat, fat distribution, systemic inflammation, insulin resistance, leptin and the serum and subcutaneous adipose tissue gene expression levels of tumor necrosis factor-alpha (TNF-a), adiponectin and the inhibitor kappa B-alpha (IkB-a), in subjects with a wide range of body mass index (BMI). We also wanted to determine which of these variables was most closely related to adiponectin gene expression and adipocyte NF-kB transcriptional power. Methods: A total of 27 women aged between 50 and 80 years, with BMI ranging from 22.1 to 53.3 kg/m 2 , were studied. In all subjects BMI, waist circumference, body composition by dual X-ray absorptometry, triglycerides, cholesterol, high-density lipoprotein cholesterol (HDL-Ch), glucose, insulin, homeostasis model assessment of insulin resistance (HOMA), high-sensitive C-reactive protein (hs-CRP), serum adiponectin, leptin and TNF-a were evaluated. Subcutaneous adipose tissue biopsies were taken from the abdomen of all subjects and the mRNA levels of adiponectin, TNF-a and IkB-a were determined. Results: BMI and waist circumference were associated positively with leptin, HOMA, and hs-CRP, and negatively with HDL-Ch; waist was also associated with adiponectin and IkB-a mRNA. HOMA was negatively associated with serum adiponectin and adiponectin mRNA. Hs-CRP was negatively associated with IkB-a mRNA, and was positively associated with HOMA.Step-down multiple regression analysis was performed to determine the joint effects of BMI, waist circumference, triglycerides, HDL-Ch, HOMA, hs-CRP, leptin, serum and TNF-a mRNA on adiponectin gene expression: waist circumference and leptin were both included in the best fitting regression equation for predicting adiponectin gene expression (R 2 ¼ 0.403, P ¼ 0.006). Stepwise multiple regression analysis was performed, considering IkB-a mRNA as a dependent variable and BMI, waist, HDL-Ch, HOMA, hs-CRP and adiponectin mRNA as independent variables. Adiponectin mRNA was the only variable to enter the regression (R 2 ¼ 0.406, Po0.001). Conclusion: Our results suggest that abdominal adiposity and leptin are independent predictors of adiponectin gene expression and that in human adipocytes, adiponectin gene expression is strongly related to IkB-a mRNA.

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Differentiation Between Obesity and Insulin Resistance in the Association With C-Reactive Protein

Cited by 321 publications

References 35 publications

Effect of calcium and dairy foods in high protein, energy-restricted diets on weight loss and metabolic parameters in overweight adults

Effect of calcium and dairy foods in high protein, energy-restricted diets on weight loss and metabolic parameters in overweight adults

CRP reduction following gastric bypass surgery is most pronounced in insulin-sensitive subjects

Adiponectin gene expression and adipocyte NF-κB transcriptional activity in elderly overweight and obese women: inter-relationships with fat distribution, hs-CRP, leptin and insulin resistance

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