Obesity is the major determinant of elevated C-reactive protein in subjects with the metabolic syndrome

Aronson, Doron; Bartha, Peter; Zinder, Oren; Kerner, Arthur; Markiewicz, Walter; Avizohar, Ophir; Brook, Gerald J.; Levy, Yishai

doi:10.1038/sj.ijo.0802609

Cited by 263 publications

(205 citation statements)

References 34 publications

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“…All models found a positive association between elevated levels of CRP and Obesity and this relationship varied across gender and race. The findings in this study with regard to the association between the ln(CRP)-BMI association and estimate curves are matched with the findings of previous studies [15][16][17][18][19][20][21]. However, The FP method provided a better model fit compared to other statistical models (linear, quadratic, and categorical).…”

Section: Discussionsupporting

confidence: 78%

Examining the association between C-Reactive protein and obesity by using the fractional polynomial approach; applying on NHANES dataset from 2001 to 2010

Abo-Zaid¹,

Morrissey²

2017

J Med Stat Inform

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Objective: This study uses a flexible nonlinear approach, Fractional polynomial models (FPs), to examine the association between obesity and C-reactive protein to select the best fitted model within 44 potentially FP models. Methods: Data for 5 years (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010) of the National Health Interview Survey (NHANES) was used. All respondents aged between 17 and 74 were included in the analysis. CRP was transformed to ln(CRP) to eliminate skewness and missing values were removed from the analysis. A fractional polynomial approach was applied to measure the relationship between elevated levels of CRP and obesity. A closed test was used to select the best model among the 44 models. Results: The best fitted fractional polynomial regression model contained the powers -2 and -2 for BMI. The association between the ln(CRP) and BMI when estimated using the FP approach exhibited a J-shaped pattern for women and men. Women have a higher risk of elevated CRP level compared to men. A deviance difference test yielded a significant improvement in model fit of -2 and -2 compared to other BMI functions. Conclusion:The fractional polynomial regression model is the most robust estimator of BMI compared to other linear or nonlinear models. Keywords: Categorization, C-reactive protein, fractional polynomial model, linear model, obesity © 2017 Abo-Zaid et al; licensee Herbert Publications Ltd. This is an Open Access article distributed under the terms of Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0). This permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. IntroductionC-reactive protein (CRP) is an acute-phase protein of the family of the pentraxins and is widely used in clinical settings to monitor chronic and acute inflammatory conditions. Recent research has found that the increase of BMI is associated with elevated CRP concentrations regardless of sex, age, and ethnicity [1,2].Various models are available to analyze the relationship between CRP and BMI. However, the choice between linear and non-linear analysis is controversial in applied fields such as medicine, clinical trials, and epidemiology. A few studies show that categorizing the continuous data is preferable , especially if the association between two variables is nonlinear. (Wang et al., 2016). However, [3]. Reported many pitfalls for this approach such as the loss of information and decrease the power of the model [3][4][5][6][7], while debate over the appropriate cut-off points for normal, overweight and obese further complicate the categorization of BMI.A number of studies have used BMI as a continuous variable. However, estimating the association between BMI and a set of covariates using a continuous scale is challenging because the relationship may be nonlinear, and the BMI distribution is often right skewed. Furthermore, linear models require many assumptions including data normality and the absence of multico...

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Section: Discussionsupporting

confidence: 78%

Examining the association between C-Reactive protein and obesity by using the fractional polynomial approach; applying on NHANES dataset from 2001 to 2010

Abo-Zaid¹,

Morrissey²

2017

J Med Stat Inform

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“…Acquired immunity is also affected by obesity, because T cell-and B cell-mediated immune responses are impaired in obese ob/ob (16) and diabetic db/db mice (17). Obesity is further characterized by an imbalance of the cytokine network, resulting in a low-grade systemic inflammatory status (18). The inflammatory cytokines IL-6, IL-1, and TNF-␣, abnormally elevated in obesity, mostly originate from the activated macrophages infiltrating the white adipose tissue (12,19).…”

Section: Impairment Of Dendritic Cell Functionality and Steady-statementioning

confidence: 99%

Impairment of Dendritic Cell Functionality and Steady-State Number in Obese Mice

Macia

Delacre

Abboud

et al. 2006

The Journal of Immunology

122

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There is a finely tuned interplay between immune and neuroendocrine systems. Metabolic disturbances like obesity will have serious consequences on immunity both at the cellular and at the cytokine expression levels. Our in vivo results confirm the immune deficiency of ob/ob mice, leptin deficient and massively obese, characterized by a reduced Ag-specific T cell proliferation after keyhole limpet hemocyanin immunization. In this report, we show that dendritic cells (DCs), major APCs involved in T lymphocyte priming, are affected in obese mice. Both their function and their steady-state number are disturbed. We demonstrate that DCs from ob/ob mice are less potent in stimulation of allogenic T cells in vitro. This impaired functionality is not associated with altered expression of phenotypic markers but with the secretion of immunosuppressive cytokines such as TGF-β. Moreover, we show increased in vivo steady-state number of epidermal DCs in ob/ob mice, which is not due to a migratory defect. The ob/ob mice are characterized by the absence of functional leptin, a key adipokine linking nutrition, metabolism, and immune functions. Interestingly, intradermal injection of leptin is able to restore epidermal DC number in obese mice. Thus, DCs might be directly sensitive to metabolic disturbances, providing a partial explanation of the immunodeficiency associated with obesity.

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“…Others have shown no significant relation between CRP and adiponectin [33][34][35]. Furthermore, recent studies have shown that CRP is associated with obesity rather than insulin resistance or metabolic syndrome [36][37][38]. These results indicate a possibility of some different aspects between low-grade inflammation and insulin resistance, and suggest a synergistic effect of these two factors on atherosclerosis.…”

mentioning

confidence: 54%

“…Moreover, Matsushita et al have reported that adiponectin showed a stronger correlation with metabolic syndrome than CRP in Japanese men [42], consistent with our finding that HMW-adiponectin rather than CRP was associated with the components of metabolic syndrome. Furthermore, recent studies have shown that CRP is associated with obesity rather than insulin resistance or metabolic syndrome [37,38], and emerging evidence suggests a hypothesis that CRP has no causal association with metabolic syndrome [36]. Although there is little doubt about the fact that CRP and adiponectin reflect some common pathway between inflammation and insulin resistance [32], this and recent studies also suggest some different aspects between CRP and adiponectin.…”

Section: Discussionmentioning

confidence: 99%

Combination of C-reactive Protein and High Molecular Weight (HMW)-Adiponectin Reflects Further Metabolic Abnormalities Compared with Each of Them Alone in Japanese Type 2 Diabetic Subjects

et al. 2008

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Abstract. Objective: Serum C-reactive protein (CRP) and adiponectin levels predict atherosclerosis and coronary heart disease. However, the efficacy of the combination of both markers remains unknown. In the present study, we investigated whether the combination of CRP and adiponectin is associated with further metabolic abnormalities compared to each of them alone. Research design and methods: Eighty-three Japanese type 2 diabetic outpatients participated in this study. We measured serum high-sensitive CRP and high molecular weight (HMW)-adiponectin, and investigated their relationship with various metabolic parameters. Results: In univariate analysis, CRP was significantly correlated with diastolic blood pressure and HDL-cholesterol. On the other hand, HMW-adiponectin was significantly correlated with systolic (SBP) and diastolic blood pressure, plasma glucose, HDL-cholesterol, triglycerides and HOMA-IR, but not with CRP. We then classified the subjects into three groups: low CRP and high HMW-adiponectin levels (low risk group, 19%), high CRP and low HMW-adiponectin levels (high risk group, 22%), and others. In Spearman rank correlation coefficient analysis, this classification was significantly associated with a larger number of metabolic risk factors: SBP, glucose, HbA1c, LDL-cholesterol, HDL-cholesterol, triglycerides and HOMA-IR, compared with classification by CRP or HMW-adiponectin alone. Conclusion: These results suggest that combination of CRP and HMW-adiponectin reflects further metabolic abnormalities compared with each of them in type 2 diabetic subjects. The combined measurement of both markers may be useful to detect cardiovascular high risk patients.Key words: C-reactive protein, Adiponectin, Coronary risk factor, Type 2 diabetes mellitus (Endocrine Journal 55: 331-338, 2008) BOTH type 2 diabetes and atherosclerosis are characterized by low-grade inflammation and insulin resistance [1,2]. Patients with type 2 diabetes show a 2-to 5-fold increase in coronary heart disease (CHD)-related death [3], thus it is very important to precisely evaluate the risk of CHD in diabetic patients in clinical settings. Serum CRP and adiponectin reflect low-grade inflammation and insulin resistance, respectively, and are known as the important markers of atherosclerosis and CHD [4,5]. Serum CRP level is increased in obese [6] and diabetic [7-9] subjects, and predicts the onset of cardiovascular disease [4,[10][11][12]. On the other hand, serum adiponectin level is negatively associated with visceral fat [13] and insulin resistance [13][14][15]. It has been reported that adiponectin level is decreased in obese [16] and diabetic subjects [17] and subjects with cardiovas-

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Obesity is the major determinant of elevated C-reactive protein in subjects with the metabolic syndrome

Cited by 263 publications

References 34 publications

Examining the association between C-Reactive protein and obesity by using the fractional polynomial approach; applying on NHANES dataset from 2001 to 2010

Examining the association between C-Reactive protein and obesity by using the fractional polynomial approach; applying on NHANES dataset from 2001 to 2010

Impairment of Dendritic Cell Functionality and Steady-State Number in Obese Mice

Combination of C-reactive Protein and High Molecular Weight (HMW)-Adiponectin Reflects Further Metabolic Abnormalities Compared with Each of Them Alone in Japanese Type 2 Diabetic Subjects

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