Changes in Inflammatory Biomarkers Across Weight Classes in a Representative US Population: A Link Between Obesity and Inflammation
Tóm tắt
Obesity has been linked with a chronic state of inflammation which may be involved in the development of metabolic syndrome, cardiovascular disease, non-alcoholic steatohepatitis, and even cancer. The objective of this study was to examine the association between obesity class and levels of inflammatory biomarkers from men and women who participated in the 1999–2004 National Health and Nutrition Examination Survey (NHANES). Serum concentrations of C-reactive protein (CRP) and fibrinogen were measured among US participants of the 1999–2004 NHANES. We examined biomarker levels across different weight classes with normal weight, overweight, and obesity classes 1, 2, and 3 were defined as BMI of <25.0, 25.0–29.9, 30.0–34.9, 35.0–39.9, and ≥40.0, respectively. With CRP levels for normal weight individuals as a reference, CRP levels nearly doubled with each increase in weight class: +0.11 mg/dl (95% CI, 0.06–0.16) for overweight, +0.21 mg/dl (95% CI, 0.16–0.27) for obesity class 1, +0.43 mg/dl (95% CI, 0.26–0.61) for obesity class 2, and +0.73 mg/dl (95% CI, 0.55–0.90) for obesity class 3. With normal weight individuals as a reference, fibrinogen levels increase with increasing weight class and were highest for obesity class 3 individuals, +93.5 mg/dl (95% CI, 72.9–114.1). Individuals with hypertension or diabetes have higher levels of CRP and fibrinogen levels compared to individuals without hypertension or diabetes, even when stratified according to BMI. There is a direct association between increasing obesity class and the presence of obesity-related comorbidities such as diabetes and hypertension with high levels of inflammatory biomarkers.
Tài liệu tham khảo
Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 2006;295(13):1549–1555. doi:10.1001/jama.295.13.1549.
Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, Marks JS. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 2003;289:76–79. doi:10.1001/jama.289.1.76.
Solá E, Vayá A, Simó M, Hernández-Mijares A, Morillas C, España F, Estellés A, Corella D. Fibrinogen, plasma viscosity and blood viscosity in obesity. Relationship with insulin resistance. Clin Hemorheol Microcirc. 2007;37(4):309–318.
Must A, Spadano J, Coakley EH, et al. The disease burden associated with overweight and obesity. JAMA 1999;282:1523–1529. doi:10.1001/jama.282.16.1523.
Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the Third National Health and Nutrition Examination Survey. JAMA 2002;287:356–359. doi:10.1001/jama.287.3.356.
Crummy F, Piper AJ, Naughton MT. Obesity and the lung: 2. Obesity and sleep-disordered breathing. Thorax 2008;63(8):738–746. doi:10.1136/thx.2007.086843.
Wilson PW, D’Agostino RB, Sullivan L, Parise H, Kannel WB. Overweight and obesity as determinants of cardiovascular risk: the Framingham experience. Arch Intern Med. 2002;162:1867–1872. doi:10.1001/archinte.162.16.1867.
Messier SP. Obesity and osteoarthritis: disease genesis and nonpharmacological weight management. Rheum Dis Clin North Am. 2008;34(3):713–729. doi:10.1016/j.rdc.2008.04.007.
Kung HC, Hoyert DL, Xu JQ, Murphy SL. Deaths: Final Data for 2005. National Vital Statistics Reports; vol 56 no 10. Hyattsville: National Center for Health Statistics, 2008.
Vgontzas AN. Does obesity play a major role in the pathogenesis of sleep apnoea and its associated manifestations via inflammation, visceral adiposity, and insulin resistance. Arch Physiol Biochem. 2008;114(4):211–223. doi:10.1080/13813450802364627.
Calabro P, Yeh ET. Intra-abdominal adiposity, inflammation, and cardiovascular risk: new insight into global cardiometabolic risk. Curr Hypertens Rep Reb. 2008;10(1):32–38.
Engstrom G, Hedblad B, Stavenow L, Jonsson S, Lind P, Janzon L, et al. Incidence of obesity-associated cardiovascular disease is related to inflammation-sensitive plasma proteins: a population-based cohort study. Arterioscler Thromb Vasc Biol. 2004;24:1498–1502. doi:10.1161/01.ATV.0000134293.31512.be.
Hotamisligil GS. Inflammation and metabolic disorders. Nature 2006;444:860–867. doi:10.1038/nature05485.
Kannel WB, D’Agostino RB, Wilson PW, Belanger AJ, Gagnon DR. Diabetes, fibrinogen, and risk of cardiovascular disease: the Framingham experience. Am Heart J. 1990;120(3):672–676. doi:10.1016/0002-8703(90)90026-T.
Fibrinogen Studies Collaboration. Plasma fibrinogen level and the risk of major cardiovascular diseases and nonvascular mortality: an individual participant meta-analysis. JAMA 2005;294(14):1799–1809. doi:10.1001/jama.294.14.1799.
Pepys MB. The acute phase response and C-reactive protein. Oxford Textbook of Medicine. In Weatherall DJ, Ledingham JGG, Warrell DA, eds. New York: Oxford University Press, 1996, pp. 1527–1533.
Bisoendial RJ, Kastelein JJ, Stroes ES. C-reactive protein and atherogenesis: from fatty streak to clinical event. Atherosclerosis 2007;195(2):e10–18. doi:10.1016/j.atherosclerosis.2007.04.053.
Rifai N, Ridker PM. Inflammatory markers and coronary heart disease. Curr Opin Lipidol. 2002;13(4):383–389. doi:10.1097/00041433-200208000-00005.
Danesh J, Collins R, Appleby P, Peto R. Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: meta-analyses of prospective studies. JAMA 1998;279(18):1477–1482. doi:10.1001/jama.279.18.1477.
Ford ES. Body mass index, diabetes, and C-reactive protein among U.S. adults. Diabetes Care 1999;22(12):1971–1977. doi:10.2337/diacare.22.12.1971.
Visser M, Bouter LM, McQuillan GM, Wener MH, Harris TB. Elevated C-reactive protein levels in overweight and obese adults. JAMA 1999;282:2131–2135. doi:10.1001/jama.282.22.2131.
Ernst E. Fibrinogen as a cardiovascular risk factor—interrelationship with infections and inflammation. Eur Heart J. 1993;14(Suppl K):82–87.
Kakafika AI, Liberopoulos EN, Mikhailidis DP. Fibrinogen: a predictor of vascular disease. Curr Pharm Des. 2007;13(16):1647–1659. doi:10.2174/138161207780831310.
Solá E, Vayá A, Simó M, Hernández-Mijares A, Morillas C, España F, Estellés A, Corella D. Fibrinogen, plasma viscosity and blood viscosity in obesity. Relationship with insulin resistance. Clin Hemorheol Microcirc. 2007;37(4):309–318.
National Center for Health Statistics. NHANES 1999–2000 Public Data Release File Documentation. Available online from: http://www.cdc.gov/nchs/data/nhanes/gendoc.pdf [Accessed April 2008]. 2008.
National Center for Health Statistics. NHANES 2001–2002 Public Data Release File Documentation. Available online from: http://www.cdc.gov/nchs/data/nhanes/nhanes_01_02/general_data_release_doc.pdf [Accessed April 2008]. 2008.
National Center for Health Statistics. NHANES 2003–2004 Public Data Release File Documentation. Available online from: http://www.cdc.gov/nchs/data/nhanes/nhanes_03_04/general_data_release_doc_03-04.pdf [Accessed April 2008]. 2008.
Blood pressure levels. In: Heart and stroke encyclopedia: A-Z guide. Dallas, TX: American Heart Association, Available online from: http:www.americanheart.org/Heart_and_Stroke_A_Z_Guide/bplev.html 2000.
Centers for Disease Control and Prevention. NHANES Laboratory/Medical Technologists Procedures Manual. Atlanta, GA: Centers for Disease Control and Prevention, April 2001. Available online from: www.cdc.gov/nchs/data/nhanes/lab1-6.pdf [Accessed April 2008].
National Health and Nutrition Examination Survey Laboratory Protocol for CRP and fibrinogen. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Available online from: http://www.cdc.gov/nchs/data/nhanes/frequency/lab11doc.pdf [Accessed April 2008]. 2008.
Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey Data. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 1999–2004. http://www.cdc.gov/nchs/nhanes.htm
Hoffman R, Benz EJ Jr, Shattil SJ, et al, eds. Hematology: Basic Principles and Practice. 4th ed. Philadelphia: Churchill Livingstone, 2005:2097.
McPherson RA, Pincus MR. Henry’s Clinical Diagnosis and Management by Laboratory Methods, 21st ed. Philadelphia: Saunders, 2007, p 239.
Theuma P, Fonseca VA. Inflammation, insulin resistance, and atherosclerosis. Metab Syndr Relat Disord. 2004;2(2):105–113. doi:10.1089/met.2004.2.105.
Bastard JP, Maachi M, Lagathu C, Kim MJ, Caron M, Vidal H, Capeau J, Feve B. Recent advances in the relationship between obesity, inflammation, and insulin resistance. Eur Cytokine Netw. 2006;17(1):4–12.
Yudkin JS, Stehouwer CD, Emeis JJ, Coppack SW. C-reactive protein in healthy subjects: associations with obesity, insulin resistance, and endothelial dysfunction: a potential role for cytokines originating from adipose tissue. Arterioscler Thromb Vasc Biol. 1999;19:972–8.
Madsen EL, Rissanen A, Bruun JM, Skogstrand K, Tonstad S, Hougaard DM, Richelsen B. Weight loss larger than 10% is needed for general improvement of levels of circulating adiponectin and markers of inflammation in obese subjects: a 3-year weight loss study. Eur J Endocrinol. 2008;158(2):179–187. doi:10.1530/EJE-07-0721.
Selvin E, Paynter NP, Erlinger TP. The effect of weight loss on C-reactive protein: a systematic review. Arch Intern Med. 2007;167(1):31–39. doi:10.1001/archinte.167.1.31.