Abdominal obesity, chronic inflammation and the risk of non-alcoholic fatty liver disease.

INTRODUCTION AND OBJECTIVES: The purpose of this study was to evaluate the effect of abdominal obesity and chronic inflammation on risk of non-alcoholic fatty liver disease (NAFLD) among Chinese population. MATERIALS AND METHODS: Overall, 50776 staff from the Kailuan Group who participated in and finished physical examinations between 2006 and 2007 were included in the cohort study. Their medical information was collected and they were followed after examination. The correlations of waist-to-height ratio (WHtR) or serum high-sensitivity C-reactive protein (hs-crp) with NAFLD were analyzed. Then, we categorized all participants into four groups: non-abdominal obesity and non-chronic inflammation group, abdominal obesity and non-chronic inflammation group, non-abdominal obesity and chronic inflammation group, abdominal obesity and chronic inflammation group, and non-abdominal obesity and non-chronic inflammation group was used as a control group. The combined effects of abdominal obesity and chronic inflammation with NAFLD were analyzed using the Cox proportional hazard regression model. RESULTS: After a mean follow-up of 5.59±1.79 years, a total of 15451 NAFLD cases occurred. We found the WHtR and hs-crp increase the risk for NAFLD, respectively. Compared with the non-abdominal obesity and non-chronic inflammation group, the risk of NAFLD was significantly increased in the abdominal obesity and non-chronic inflammation group (HR 1.21, 95%CI 1.11-1.32), non-abdominal obesity and chronic inflammation group (HR 1.32, 95%CI 1.27-1.38), abdominal obesity and chronic inflammation group (HR 1.60, 95% CI 1.52-1.70). And, a significant interaction effect was found of abdominal obesity and chronic inflammation on NAFLD. CONCLUSIONS: In this study, it was demonstrated in the Chinese population that both abdominal obesity and chronic inflammation increase the risk of NAFLD, and there is an interaction between the two factors in the incidence of NAFLD.

Relationship of inflammatory and metabolic parameters in adolescents with PCOS: BMI matched case-control study.

Objective: Polycystic ovary syndrome (PCOS) begins in adolescence and has cardiovascular and metabolic components in later years. Cystatin C and high-sensitivity C-reactive protein (hs-CRP) levels and neutrophil-lymphocyte and platelet-lymphocyte ratios are associated with metabolic and inflammatory events. Here, we evaluated inflammatory and metabolic parameters in normal and overweight adolescents with PCOS. Materials and methods: This prospective case-control study enrolled 90 adolescents with PCOS and 100 matched by age and BMI healthy adolescents classified as either normal weight (NW) and overweight (OW). Groups were compared based on inflammatory and metabolic parameters (serum cystatin C, hs-CRP, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), lipids, fasting blood glucose-insulin (FBG-FI), HOMA-IR levels, waist circumference [WC], and waist-hip ratio [WHR]). The relationship between the parameters were compared and predictive abilities were evaluated. Results: Cystatin C, hs-CRP, NLR, triglyceride (TG), FBG-FI, HOMA-IR, WC, and WHR were significantly higher in those with PCOS. The NW PCOS group had significantly higher TG, cystatin C, hs-CRP, and NLR versus OW controls. The highest HOMA-IR values were observed in OW PCOS (p < .05). Cystatin C and hs-CRP sensitivity and specificity were significant (p < 0.05). Cystatin C and hs-CRP were positively correlated with other metabolic parameters. Conclusion: Independent of BMI, inflammatory and metabolic parameters are significantly higher in adolescents with PCOS compared to controls and even worse in those who are also OW. Therefore, adolescents with PCOS should be encouraged to maintain healthy lifestyles and weights to avoid metabolic risks. Hs-CRP and cystatin C could be promising markers to predictive of future metabolic risks.

Relationship of inflammatory and metabolic parameters in adolescents with PCOS: BMI matched case-control study

ABSTRACT Objective: Polycystic ovary syndrome (PCOS) begins in adolescence and has cardiovascular and metabolic components in later years. Cystatin C and high-sensitivity C-reactive protein (hs-CRP) levels and neutrophil-lymphocyte and platelet-lymphocyte ratios are associated with metabolic and inflammatory events. Here, we evaluated inflammatory and metabolic parameters in normal and overweight adolescents with PCOS. Materials and methods: This prospective case-control study enrolled 90 adolescents with PCOS and 100 matched by age and BMI healthy adolescents classified as either normal weight (NW) and overweight (OW). Groups were compared based on inflammatory and metabolic parameters (serum cystatin C, hs-CRP, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), lipids, fasting blood glucose-insulin (FBG-FI), HOMA-IR levels, waist circumference [WC], and waist-hip ratio [WHR]). The relationship between the parameters were compared and predictive abilities were evaluated. Results: Cystatin C, hs-CRP, NLR, triglyceride (TG), FBG-FI, HOMA-IR, WC, and WHR were significantly higher in those with PCOS. The NW PCOS group had significantly higher TG, cystatin C, hs-CRP, and NLR versus OW controls. The highest HOMA-IR values were observed in OW PCOS (p < .05). Cystatin C and hs-CRP sensitivity and specificity were significant (p < 0.05). Cystatin C and hs-CRP were positively correlated with other metabolic parameters. Conclusion: Independent of BMI, inflammatory and metabolic parameters are significantly higher in adolescents with PCOS compared to controls and even worse in those who are also OW. Therefore, adolescents with PCOS should be encouraged to maintain healthy lifestyles and weights to avoid metabolic risks. Hs-CRP and cystatin C could be promising markers to predictive of future metabolic risks.

Association of Netrin 1 with hsCRP in Subjects with Obesity and Recent Diagnosis of Type 2 Diabetes.

Netrin 1 (Ntn1) is a cell migration protein with an anti-inflammatory effect, which may play a key role in the pathological development of type 2 diabetes (T2D). In this study, we evaluate the relationships between the serum concentrations of Ntn1, glucose, and high-sensitivity C-reactive Protein (hsCRP). We carried out a cross-sectional study including 90 individuals divided into three groups (n = 30): healthy subjects, individuals with obesity without glucose alterations, and individuals with newly diagnosed T2D. Serum concentrations of Ntn1 and hs-CRP were determined by enzyme-linked immunosorbent assay (ELISA). The serum concentration of Ntn1 was higher in individuals with newly diagnosed T2D (0.33 ± 0.22 ng/mL), in comparison to healthy subjects and individuals with obesity (0.13 ± 0.06 and 0.15 ± 0.07 ng/mL, respectively). In addition, we observed a positive association between the levels of Ntn1 and hsCRP (rho = 0.443; p < 0.001) as well as with serum glucose (rho = −0.110; p = 0.05). The serum concentration of Ntn1 was higher in individuals with T2D, in comparison with the other groups in this study, and presented a positive correlation with hsCRP. Therefore, Ntn1 can be considered a promising risk biomarker and a potential therapeutic target for T2D.

Complement component 7 is associated with total- and cardiac death in chest-pain patients with suspected acute coronary syndrome.

BACKGROUND: Complement activation has been associated with atherosclerosis, atherosclerotic plaque destabilization and increased risk of cardiovascular events. Complement component 7 (CC7) binds to the C5bC6 complex which is part of the terminal complement complex (TCC/C5b-9). High-sensitivity C-reactive protein (hsCRP) is a sensitive marker of systemic inflammation and may reflect the increased inflammatory state associated with cardiovascular disease. AIM: To evaluate the associations between CC7 and total- and cardiac mortality in patients hospitalized with chest-pain of suspected coronary origin, and whether combining CC7 with hsCRP adds prognostic information. METHODS: Baseline levels of CC7 were related to 60-months survival in a prospective, observational study of 982 patients hospitalized with a suspected acute coronary syndrome (ACS) at 9 hospitals in Salta, Argentina. A cox regression model, adjusting for conventional cardiovascular risk factors, was fitted with all-cause mortality, cardiac death and sudden cardiac death (SCD) as the dependent variables. A similar Norwegian population of 871 patients was applied to test the reproducibility of results in relation to total death. RESULTS: At follow-up, 173 patients (17.7%) in the Argentinean cohort had died, of these 92 (9.4%) were classified as cardiac death and 59 (6.0%) as SCD. In the Norwegian population, a total of 254 patients (30%) died. In multivariable analysis, CC7 was significantly associated with 60-months all-cause mortality [hazard ratio (HR) 1.26 (95% confidence interval (CI), 1.07-1.47) and cardiac death [HR 1.28 (95% CI 1.02-1.60)], but not with SCD. CC7 was only weakly correlated with hsCRP (r = 0.10, p = 0.002), and there was no statistically significant interaction between the two biomarkers in relation to outcome. The significant association of CC7 with total death was reproduced in the Norwegian population. CONCLUSIONS: CC7 was significantly associated with all-cause mortality and cardiac death at 60-months follow-up in chest-pain patients with suspected ACS. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01377402, NCT00521976.

Cardiovascular Risk Is Increased in Miner's Chronic Intermittent Hypobaric Hypoxia Exposure From 0 to 2,500 m?

Over the past 40 years, mining activities in Chile have relocated miners who normally live at sea level to work at high altitudes. This results in a form of chronic intermittent hypobaric hypoxia (CIHH) characterized by alternating periods of work at high altitude and rest periods at sea level. Previous studies performed in our laboratory showed that aerobic capacity is reduced at 3,800 m, even when oxygen content is maintained. Our study aimed to determine the corporal composition, food intake, maximum oxygen uptake, and concentration of high sensitivity C reactive protein (hsCRP) in an acclimatized miner population that work from 0 to 2,500 m with CIHH exposure over 4 years. All miners recruited for our study were operators of heavy trucks with CIHH for over 4 years (shiftwork 7*7 days), and our experimental population was composed of 54 miners at sea level, 61 at 1,600 m, and 38 at 2,500 m. All evaluations were performed on the 3rd or 4th day of diurnal shiftwork. To determine corporal composition, we measured weight and height (to calculate body mass index, BMI), skinfolds (to calculate body fatty, BF), and waist circumference (WC); maximal aerobic capacity was evaluated using a ramp-incremental cycling to exhaustion protocol and a venous blood sample before the exercise test to measure (hsCRP) via an ELISA test. We found higher values of BMI, BF, and WC, in the miners' population but observed no significant difference between populations. We found a decrease in VO2 of 11.6% at 1,600 m and 25.9% at 2,500 m compared to miners at sea level. An increase in (hsCRP) at 1,600 and 2,500 m regards sea level. We observed a high prevalence of overweight and obese subjects, which was related to the ad libitum availability of food and low physical activity (sedentarism). We found that work capacity was maintained despite a decreased VO2 max at moderate altitude. However, overweight and obesity support an increased risk of cardiometabolic disease in miner's which is unrelated to altitude. In contrast, an increased hsCRP level could be associated with increased inflammatory mechanisms at 1,600 and 2,500 m.

Effects of Incretin - based Therapy on High - sensitivity C - reactive Protein in Patients with Type 2 Diabetes: A Systematic Review and Meta - Analysis

ABSTRACT Background: Recently, studies had shown that incretin-based therapies could reduce the levels of pro-inflammatory markers. The data on the effects of incretin-based therapies on serum high-sensitivity C-reactive protein (hs-CRP) in type 2 diabetes (T2DM) were inconsistent. Objective: The objective of the study was to assess the effects of incretin-based therapies on hs-CRP in patients with T2DM by meta-analysis. Methods: We searched PubMed, EMBASE, the Cochrane Collaboration Library, and Web of Science to identify the eligible randomized clinical trials until August 2019. The pooled standard mean differences (SMD) were calculated by random-effects model using STATA 11.0. Results: Twenty-five studies with 28 randomized controlled trials were finally included into the meta-analysis. Meta-analysis revealed a significant reduction in hs-CRP following treatment with incretin-based regimens compared to controls (SMD = −0.452, p < 0.001). Subgroup analysis of different class of incretin-based drugs showed that therapy with both dipeptidyl peptidase 4 inhibitors (DPP-4Is, SMD = −0.338, p = 0.026) and glucagon-like peptide 1 receptor agonists (GLP-1 RAs, SMD = −0.544, p = 0.003) caused significant reductions in hs-CRP. Besides, there was a significant reduction in hs-CRP with an intervention duration more than 24 weeks (SMD = −0.465, p = 0.001), while no significant difference with <24 weeks. Meta-regression analyses showed that better glycemic control and more body mass index (BMI) decline were associated with hs-CRP reduction after incretin-based therapies. Conclusions: This meta-analysis suggests that incretin-based therapies, both GLP-1 RAs and DPP-4Is, can cause a significant reduction in hs-CRP in patients with T2DM, which is related to long intervention duration, better glycemic control, and more BMI decline.

Serum Magnesium and High-sensitive C-reactive Proteins in Hypertensive, Obese Female School Learners

ABSTRACT Objective: To examine the relationship of serum magnesium and high-sensitive C-reactive proteins (hsCRPs) with overweight/obesity, and its association with hypertension in lean versus overweight/obese (O/O), female, adolescent school learners living in Mthatha, Eastern Cape, South Africa. Methods: A case-control study was conducted involving age-matched, non-pregnant and nonlactating lean and O/O females aged 13-17 years. Relevant data on demography, anthropometry (height, weight, and waist and hip circumferences), blood pressure and venous blood samples were collected. Results: A significant inverse correlation was observed between serum magnesium and waist circumference (WC) (r = −0.3153; 95% CI = −3.843, −0.8681; p = 0.0022). Serum hsCRP levels were significantly higher in O/O participants. Participants with a WC > 80 cm had significantly higher mean systolic blood pressure and mean diastolic blood pressure (MDBP). A hip circumference (HC) > 94 cm was associated with higher mean systolic blood pressure (MSBP) and MDBP (120 ± 2 vs 113 ± 2, p = 0.009 and 73 ± 2 vs 68 ± 1, p = 0.003). Both WC and HC were found to be positively correlated with both MSBP (r = 0.2691; 95% CI = 0.042, 0.457; p = 0.018 and r = 0.2758; 95% CI = 0.03184, 0.3001; p = 0.0159) and MDBP (r = 0.2686; 95% CI = 0.0286, 0.320; p = 0.19 and r = 0.2836; 95% CI = 0.05382, 0.4455; p = 0.013), respectively. Conclusion: In our study, low-grade inflammation and early-onset hypertension in O/O adolescent females were consistent with evidence that support the beneficial effect of maintaining lean body habitus. There is an urgent need to prevent overweight/obesity among adolescents.

Obesity, dyslipidemia, and high blood pressure are associated with cardiovascular risk, determined using high-sensitivity C-reactive protein concentration, in young adults.

OBJECTIVE: Few studies have investigated the relationships between high-sensitivity C-reactive protein (hs-CRP) concentration and conventional cardiometabolic markers in young adults. The aim of this study was to characterize the cardiometabolic profile of young adults who are at high cardiovascular risk, according to hs-CRP concentration. METHODS: A cross-sectional study was conducted in 300 young adults (18 to 30 years old) from southern Mexico (n = 150 normal-weight and n = 150 obese). Their circulating lipid and glucose concentrations were measured using colorimetric enzymatic assays, and their hs-CRP, ApoA, and ApoB concentrations were measured using turbidimetric assays. RESULTS: The most prevalent abnormalities in the participants with high cardiovascular risk, determined using an hs-CRP >28.57 nmol/L, were high waist circumference (85.7%), obesity (83.9%), high low-density lipoprotein-cholesterol (64.3%), low high-density lipoprotein-cholesterol (50%), Apo B in the highest tertile (39.3%), hypertriglyceridemia (35.7%), and high blood pressure (30.4%). In addition, there were strong associations between hs-CRP >28.57 nmol/L and obesity (odds ratio [OR] = 13.9), high waist circumference (OR = 8.0), hypertriglyceridemia (OR = 4.0), high blood pressure (OR = 3.4), hypercholesterolemia (OR = 2.8), and Apo B in the highest tertile (OR = 2.4). CONCLUSION: The principal cardiometabolic alterations associated with high cardiovascular risk, determined using hs-CRP, are obesity, dyslipidemia, and high blood pressure in young adults.

Preschoolers with recurrent wheezing have a high prevalence of sleep disordered breathing.

Objective: Sleep-disordered breathing (SDB) is highly prevalent in school children with poorly-controlled asthma. However, this association has not been assessed in preschoolers with recurrent wheeze, nor in those at risk for asthma. We hypothesized that preschoolers with asthma risk (positive asthma predictive index [API]) have a higher prevalence of SDB and higher inflammatory biomarkers (blood-hsCRP and urinary-LTE4) levels than those with negative API.Method: Children 2 to 5 years of age with recurrent wheezing were classified as positive or negative API. SDB was determined by the pediatric sleep questionnaire (PSQ) and its subscale (PSQSub6). Demographic characteristics, spirometry, blood hsCRP and urinary LTE4 were assessed.Results: We enrolled 101 preschoolers: 70 completed all measurements, 55.4% were males, mean age 4.07 ± 0.87 years, 45% overweight or obese, 70% had positive API, 87.5% had rhinitis. The prevalence of SDB measured by PSQ was 40.8% and by PSQSub6 was 29.6%. However, the proportion of SDB was similar between positive and negative API groups. The hsCRP (mean ± SD) was higher in the positive than in negative API (3.58 ± 0.58 and 1.32 ± 0.36 mg/L, p = 0.69, respectively); moreover, no differences in urinary LTE4 were found between groups. No correlation of PSQ (+) or PSQSub6 (+) with hsCRP and uLTE4 was found. However, preschoolers with positive API had significantly more post-bronchodilator percentage change in FEF25-75 than negative API (24.14 ± 28.1 vs. 4.13 ± 21.8, respectively, p = 0.01).Conclusions: In preschoolers with recurrent wheezing, we should be investigating for the coexistence of SDB, using early screening methods for detecting those conditions.

Prediction of gestational diabetes mellitus in the first trimester: comparison of maternal fetuin-A, N-terminal proatrial natriuretic peptide, high-sensitivity C-reactive protein, and fasting glucose levels

ABSTRACT Objective We investigated the utility of maternal fetuin-A, N-terminal proatrial natriuretic peptide (pro-ANP), high-sensitivity C-reactive protein (hs-CRP), and fasting glucose levels at 11-14 gestation weeks for predicting pregnancies complicated by gestational diabetes mellitus (GDM). Subjects and methods This prospective cohort study included 327 low-risk pregnant women who completed antenatal follow-up at a tertiary research hospital between January and April 2014. Maternal blood samples were collected between 11-14 gestational weeks in the first trimester of pregnancy and then stored at -80 °C until further analyses. During follow-up, 29 (8.8%) women developed GDM. The study population was compared 1:2 with age- and body mass index-matched pregnant women who did not develop GDM (n = 59). Fasting plasma glucose (FPG) levels and serum fetuin-A, pro-ANP, and hs-CRP levels were measured using automated immunoassay systems. Results There was a significant negative correlation between fetuin-A and hs-CRP (CC = -0.21, p = 0.047) and a positive correlation between FPG and hs-CRP (CC = 0.251, p = 0.018). The areas under the receiver operating characteristic curve for diagnosing GDM were 0.337 (p = 0.013), 0.702 (p = 0.002), and 0.738 (p < 0.001) for fetuin-A, hs-CRP, and FPG, respectively. The optimal cut-off values were > 4.65, < 166, and > 88.5 mg/dL for maternal hs-CRP, fetuin-A, and FPG, respectively. Conclusion Reduced fetuin-A, elevated hs-CRP, and FPG levels in women in the first trimester can be used for the early detection of GDM. Further research is needed before accepting these biomarkers as valid screening tests for GDM.

Composite acute phase glycoproteins with coronary artery calcification depends on metabolic syndrome presence - The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

BACKGROUND: Inflammation has been weakly associated with coronary artery calcium (CAC) in the overall population. However, it is currently unknown whether this varies according to the cardio-metabolic profile. We evaluated the association between GlycA, a unique composite biomarker of pro-inflammatory acute phase glycoproteins, high sensitivity C-reactive protein (hsCRP), uric acid, and their composite values (composite inflammation) in the overall population and strata according to cardiovascular risk. METHODS: This is a cross-sectional study of 3753 Sao Paulo site participants of the ELSA-Brasil cohort that were free of cardiovascular/chronic inflammatory disease and not taking statins or allopurinol. We measured GlycA by nuclear magnetic resonance spectroscopy. For each biomarker quartile (Qs), we ran adjusted logistic and linear regression for CAC>0 and CAC score. RESULTS: In the overall analysis, the 4th vs. 1st GlycA Q odds ratio (OR) for CAC>0 was 1.53 (95% CI: 1.18, 1.98, p trend<0.001) adjusted for demographics and lifestyle, but null after adding metabolic syndrome (MS) components, OR 1.14 (95% CI: 0.86, 1.51, p trend=0.140). Likewise, for continuous CAC values there was no difference across GlycA Qs in the fully adjusted analysis. Similarly, hsCRP, uric acid, and composite inflammation were not associated with CAC>0 or CAC score. In stratified analysis, GlycA was associated with CAC>0 in No-MS individuals, standardized (SD) OR 1.23 (95% CI: 1.08, 1.40); but not in MS individuals, SD OR 1.01 (95% CI: 0.89, 1.15) (p interaction 0.037). We found similar interaction in stratified analysis for continuous CAC on composite inflammation. CONCLUSIONS: GlycA and composite inflammation are associated with CAC among low cardiovascular risk individuals (No-MS), but not otherwise. GlycA and composite biomarkers may better represent sources of inflammation apart from visceral obesity and traditional cardiovascular risk factors, which may have relevant effect on CAC accumulation in low cardiovascular risk individuals.

Effect of Bifidobacterium lactis HN019 on inflammatory markers and oxidative stress in subjects with and without the metabolic syndrome.

Beneficial effects of probiotics have been reported on body weight, lipid and carbohydrate metabolism, inflammatory state and oxidative stress in healthy subjects and in many metabolic and inflammatory diseases. The aim of this study was to evaluate the effects of Bifidobacterium lactis HN019 on inflammatory state and nitro-oxidative stress in patients with and without the metabolic syndrome (MetS). The usual diets of the thirty-three subjects were supplemented with probiotic milk for 90 d. Inflammatory markers and oxidative measurements were performed. In relation to the baseline values, subjects in both groups showed a decrease in homocysteine (P=0·02 and P=0·03, respectively), hydroperoxides (P=0·02 and P=0·01, respectively) and IL-6 levels (P=0·02). Increases in adiponectin (P=0·04) and nitric oxide metabolites (NOx, P=0·001) levels were only seen in the group with the MetS in relation to the baseline values, whereas only the individuals without the MetS had increases in total radical-trapping antioxidant parameter levels (P=0·002). In conclusion, B. lactis HN019 have several beneficial effects on inflammatory and oxidative biomarkers in healthy subjects and the MetS patients. Patients with the MetS showed a specific improvement in adiponectin and NOx levels, whereas a specific favourable effect was shown in the antioxidant defenses in healthy subjects. If the results obtained in the present study are confirmed, supplementation of fermented milk with probiotics in healthy subjects and patients with the MetS must be further discussed.

Beyond the Definition of Metabolic Syndrome: Uric Acid, High Sensitivity C Reactive Protein and Global Cardiovascular Risk / Más allá de la definición de síndrome metabólico: ácido úrico, proteína c reactiva de alta sensibilidad y riesgo cardiovascular global

Introduction: the metabolic syndrome is becoming one of the main problems in public health.Objective: to evaluate the relation between metabolic syndrome and uric acid, high sensitivity c reactive protein, total cardiovascular risk and cardiovascular events.Methods: a study of cases controls nested in a dynamic cohort was carried out in Velasco Teaching Polyclinic from 2010 to 2015, the cases were 67 patients that developed metabolic syndrome during the period and the control group were 67 patients matched by sex and age ± 5 years. The participants underwent a physical examination, anthropometry, laboratory test; all the study participants were under continuous surveillance during 4.5 years for development of cardiovascular events.Results: the waist circumference (p = 0.000), systolic (p= 0.0042) and diastolic blood pressure (p= 0.0298), high sensitivity c reactive protein (p= 0.0039) and uric acid (p= 0.0283) were significantly associate in both groups. The body mass index was higher than 30 kg/m2 (OR 7.54; CI95%:3.35-16.9), LDL cholesterol greater than 4.16 mmol/l (OR 3.49; CI 95%:1.58-7.70) and hs CRP higher than 1 mg/dl (OR 3.59; CI 95%:1.51-8.51) showed statistically significant differences according to groups of studies. Global cardiovascular risk greater 20%, it was 3.84 times higher in the group with metabolic syndrome (CI 95%:1.67-8.82), 13.4% of the patients with metabolic syndrome developed a cardiovascular event during the period in comparison with the 2.9% in the group without metabolic syndrome (OR= 5.04; CI 95%: 1.04-24.3).Conclusions: metabolic syndrome was significantly associated with mean level of uric acid, high sensitivity c reactive protein, total cardiovascular risk and cardiovascular events.(AU)

Introducción: el síndrome metabólico se está convirtiendo en uno de los principales problemas de salud públicaObjetivo: evaluar la relación entre el síndrome metabólico y el ácido úrico, la proteína c reactiva de alta sensibilidad, el riesgo cardiovascular global y la incidencia de eventos cardiovasculares.Métodos: se realizó un estudio de casos controles anidados en una cohorte dinámica en el Policlínico Docente de Velasco desde 2010 a 2015, los casos fueron 67 pacientes que desarrollaron síndrome metabólico en el periodo y 67 controles que fueron apareados por sexo y edad de ± 5 años en relación con los casos, los participantes fueron sometidos a un examen físico, determinaciones antropométricas y de laboratorio, fueron sometidos a seguimiento durante 4,5 años para la aparición de eventos cardiovasculares.Resultados: mostraron que la circunferencia abdominal (p 0,000), la presión arterial sistólica (p 0,0042) y diastólica (p 0,0298), la proteína c reactiva de alta sensibilidad (p 0,0039) y el ácido úrico (p 0,0283) mostraron asociación estadísticamente significativa en ambos grupos. El índice de masa corporal mayor de 30 kg/m2 (OR 7,54; IC 95%: 3,35-16,9), LDL colesterol mayor de 4,16 mmol/l (OR 3,49; IC 95%:1,58-7,70) y proteína c reactiva de alta sensibilidad mayor de 1 mg/dl (OR=3,59; IC 95%:1,51-8,51) mostraron asociación estadísticamente significativa de acuerdo con los grupos de estudio. El riesgo cardiovascular global mayor de 20% fue 3,84 veces mayor en el grupo con síndrome metabólico (IC 95 %: 1,67-8,82), el 13,4% de los pacientes con síndrome metabólico desarrollaron un evento cardiovascular durante el periodo de seguimiento en comparación con el 2,9% en el grupo sin síndrome metabólico (OR= 5,04; IC 95%: 1,04-24,3).Conclusiones: el síndrome metabólico se asoció significativamente con la concentración media de ácido úrico, con la proteína c reactiva de alta sensibilidad, el riesgo cardiovascular global

The relationship between circulating irisin, retinol binding protein-4, adiponectin and inflammatory mediators in patients with metabolic syndrome

ABSTRACT Objective We wanted to investigate whether there is a relationship between circulating irisin, retinol binding protein-4 (RBP-4), adiponectin and proinflammatory mediators implicated in the development of insulin resistance (IR) in metabolic syndrome (MetS). Subjects and methods In 180 individuals, including controls and patients with MetS, we measured fasting plasma insulin, high sensitivity C-reactive protein (hsCRP), pentraxin-3 (PTX-3), interleukin-33 (IL-33), irisin, RBP-4, and adiponectin using ELISA kits. Results While fasting plasma hsCRP, PTX-3, IL-33, irisin, RBP-4 concentrations were higher, adiponectin levels were lower in patients with MetS than in controls. A correlation analysis revealed that plasma irisin levels were positively associated with MetS components such as waist circumference and waist-hip ratio, low density lipoprotein (LDL) and markers of systemic inflammation such as PTX-3, hsCRP, uric acid, and RBP-4. Adiponectin levels were negatively associated with waist circumference, waist-hip ratio, PTX-3 and LDL. Conclusions Although the precise mechanisms are still unclear, irisin, RBP-4, adiponectin and PTX-3 are hallmarks of the MetS, which is related to low-grade inflammation. It is conceivable that irisin and adiponectin might contribute to the development of MetS and may also represent novel MetS components. Future clinical studies are needed to confirm and extend these data.

Waist-to-height ratio and sedentary lifestyle as predictors of metabolic syndrome in children in Ecuador.

OBJECTIVE: To determine the predictors and prevalence of metabolic syndrome (MS) and the presence of vascular inflammation in apparently-normal children (10-15 years) of both sexes in Guayaquil, Ecuador. STUDY DESIGN AND METHODS: We included 395 apparently-healthy students from a middle-income school in a cross-sectional survey. Informed consent was obtained from students and parents. Anthropometric measurements including blood pressure (BP), body mass index (BMI) and waist-to-height ratio (WHtR), and blood tests were recorded. Vascular inflammation parameters were assessed. Percentiles of the different parameters were used, and MS was defined according to National Cholesterol Education Program Adult Treatment Panel III criteria (NCEP-ATPIII). Waist circumference>P 75, blood pressure>P 90, glucose>100mg/dl, triglycerides>100mg/dl, HDL<45mg/dl. If 3 of the 5 criteria were present, this was considered MS. RESULTS: The mean age was 12 years (186 boys, 209 girls). The overall prevalence of MS was 9.37% (6.33% in girls, 3.04% in boys). Sustained hypertension was detected in 6.6% of children and pre-hypertension in 7.1%. Obesity was found in 1.8% of subjects, and overweight in 15.2%. Triglycerides has a RR 2.34 (1.97-2.76); HOMA index has a RR 1.97(1.62-2.40); HDL cholesterol has a RR 1.84(1.58-2.13); Insulin level has a RR 1.53(1.40-1.67) and interleukin 6 has RR 1.83(1.20-2.79). Serum glucose, total cholesterol and LDL-Cholesterol had no association with the metabolic syndrome. HDL-Cholesterol<45mg/dl and triglyceride>100mg/dl were present in 70% of subjects with MS. The WHtR threshold≥0.5 was 100% sensitive in both sexes (67% specificity in boys and 69% in girls). There were significant associations between the WHtR and pre-hypertension and sedentary lifestyle (P<0.001 and P<0.003 respectively). A WHtR value of ≥0.50 indicated a 2.2-fold increased risk of MS compared with normal WHtR, and normal weight. CONCLUSIONS: A WHtR≥0.5 was 100% sensitive in detecting MS in 10-15 year-old boys and girls in the normal or overweight range of the BMI. This assessment is a simple and practical tool for use in population-based studies of cardiovascular risk. When combined with pre-hypertension and a sedentary lifestyle, the WHtR is highly sensitive in predicting MS.

Adiposity as a full mediator of the influence of cardiorespiratory fitness and inflammation in schoolchildren: The FUPRECOL Study.

BACKGROUND AND AIMS: Studies in the paediatric population have shown inconsistent associations between cardiorespiratory fitness and inflammation independently of adiposity. The purpose of this study was (i) to analyse the combined association of cardiorespiratory fitness and adiposity with high-sensitivity C-reactive protein (hs-CRP), and (ii) to determine whether adiposity acts as a mediator on the association between cardiorespiratory fitness and hs-CRP in children and adolescents. METHODS AND RESULTS: This cross-sectional study included 935 (54.7% girls) healthy children and adolescents from Bogotá, Colombia. The 20 m shuttle run test was used to estimate cardiorespiratory fitness. We assessed the following adiposity parameters: body mass index, waist circumference, and fat mass index and the sum of subscapular and triceps skinfold thickness. High sensitivity assays were used to obtain hs-CRP. Linear regression models were fitted for mediation analyses examined whether the association between cardiorespiratory fitness and hs-CRP was mediated by each of adiposity parameters according to Baron and Kenny procedures. Lower levels of hs-CRP were associated with the best schoolchildren profiles (high cardiorespiratory fitness + low adiposity) (p for trend <0.001 in the four adiposity parameters), compared with unfit and overweight (low cardiorespiratory fitness + high adiposity) counterparts. Linear regression models suggest a full mediation of adiposity on the association between cardiorespiratory fitness and hs-CRP levels. CONCLUSIONS: Our findings seem to emphasize the importance of obesity prevention in childhood, suggesting that having high levels of cardiorespiratory fitness may not counteract the negative consequences ascribed to adiposity on hs-CRP.

Associations between dietary patterns and serum lipids, apo and C-reactive protein in an adult population: evidence from a multi-city cohort in South America.

Several previous epidemiological studies from developed countries have shown that an unhealthy dietary pattern affects plasma lipid levels and inflammation biomarkers. We assessed the cross-sectional associations between dietary patterns and cardiovascular risk factors among 961 adults from a multi-city cohort in South America. We conducted a principal component analysis to derive dietary patterns. As outcomes, we examined plasma levels of apo A-I, apo B, high-sensitivity C-reactive protein (hs-CRP), LDL-, HDL- and serum total cholesterol and TAG. The crude and adjusted changes in each outcome were estimated for quartiles of dietary patterns using multivariable linear regression models. The prudent pattern (PP) characterised by higher intake of fruits, vegetables, fish, seafood, whole cereal and low-fat dairy products was associated with reduced plasma concentrations of apo B (-8·5 mg/l), total cholesterol (-18·8 mg/dl) and LDL-cholesterol (-16·5 mg/dl) and hs-CRP (-1·6 mg/l) in men. In women also reduced plasma concentrations of apo B (-6·6 mg/l), total (-12·0 mg/dl) and LDL (-9·3 mg/dl). The 'Western-like' pattern characterised by higher intake of eggs, pastry and cakes, pizza, snacks, refined grains, red meat, vegetable oils and poultry was not significantly associated with any of the selected serum lipid or inflammatory biomarkers. The explained variances were 10·3 and 7·4 %, respectively. The PP was associated with better lipid profile, mainly lower atherogenic particles (apo B) and LDL-cholesterol and serum total cholesterol. This study provides possible evidence of a prudent diet in South American populations to help reduce the burden of CVD.

Beyond the Definition of Metabolic Syndrome: Uric Acid, High Sensitivity C Reactive Protein and Global Cardiovascular Risk / Más allá de la definición de síndrome metabólico: ácido úrico, proteína c reactiva de alta sensibilidad y riesgo cardiovascular global

Introduction: the metabolic syndrome is becoming one of the main problems in public health. Objective: to evaluate the relation between metabolic syndrome and uric acid, high sensitivity c reactive protein, total cardiovascular risk and cardiovascular events. Methods: a study of cases controls nested in a dynamic cohort was carried out in Velasco Teaching Polyclinic from 2010 to 2015, the cases were 67 patients that developed metabolic syndrome during the period and the control group were 67 patients matched by sex and age ± 5 years. The participants underwent a physical examination, anthropometry, laboratory test; all the study participants were under continuous surveillance during 4.5 years for development of cardiovascular events. Results: the waist circumference (p = 0.000), systolic (p= 0.0042) and diastolic blood pressure (p= 0.0298), high sensitivity c reactive protein (p= 0.0039) and uric acid (p= 0.0283) were significantly associate in both groups. The body mass index was higher than 30 kg/m2 (OR 7.54; CI95%:3.35-16.9), LDL cholesterol greater than 4.16 mmol/l (OR 3.49; CI 95%:1.58-7.70) and hs CRP higher than 1 mg/dl (OR 3.59; CI 95%:1.51-8.51) showed statistically significant differences according to groups of studies. Global cardiovascular risk greater 20%, it was 3.84 times higher in the group with metabolic syndrome (CI 95%:1.67-8.82), 13.4% of the patients with metabolic syndrome developed a cardiovascular event during the period in comparison with the 2.9% in the group without metabolic syndrome (OR= 5.04; CI 95%: 1.04-24.3). Conclusions: metabolic syndrome was significantly associated with mean level of uric acid, high sensitivity c reactive protein, total cardiovascular risk and cardiovascular events.

Introducción: el síndrome metabólico se está convirtiendo en uno de los principales problemas de salud pública Objetivo: evaluar la relación entre el síndrome metabólico y el ácido úrico, la proteína c reactiva de alta sensibilidad, el riesgo cardiovascular global y la incidencia de eventos cardiovasculares. Métodos: se realizó un estudio de casos controles anidados en una cohorte dinámica en el Policlínico Docente de Velasco desde 2010 a 2015, los casos fueron 67 pacientes que desarrollaron síndrome metabólico en el periodo y 67 controles que fueron apareados por sexo y edad de ± 5 años en relación con los casos, los participantes fueron sometidos a un examen físico, determinaciones antropométricas y de laboratorio, fueron sometidos a seguimiento durante 4,5 años para la aparición de eventos cardiovasculares. Resultados: mostraron que la circunferencia abdominal (p 0,000), la presión arterial sistólica (p 0,0042) y diastólica (p 0,0298), la proteína c reactiva de alta sensibilidad (p 0,0039) y el ácido úrico (p 0,0283) mostraron asociación estadísticamente significativa en ambos grupos. El índice de masa corporal mayor de 30 kg/m2 (OR 7,54; IC 95%: 3,35-16,9), LDL colesterol mayor de 4,16 mmol/l (OR 3,49; IC 95%:1,58-7,70) y proteína c reactiva de alta sensibilidad mayor de 1 mg/dl (OR=3,59; IC 95%:1,51-8,51) mostraron asociación estadísticamente significativa de acuerdo con los grupos de estudio. El riesgo cardiovascular global mayor de 20% fue 3,84 veces mayor en el grupo con síndrome metabólico (IC 95 %: 1,67-8,82), el 13,4% de los pacientes con síndrome metabólico desarrollaron un evento cardiovascular durante el periodo de seguimiento en comparación con el 2,9% en el grupo sin síndrome metabólico (OR= 5,04; IC 95%: 1,04-24,3). Conclusiones: el síndrome metabólico se asoció significativamente con la concentración media de ácido úrico, con la proteína c reactiva de alta sensibilidad, el riesgo cardiovascular global y el desarrollo de eventos cardiovasculares.

La resistina se asocia con la proteína C reactiva y marcadores de riesgo cardiovascular en niños obesos / Resistin is associated with C reactive protein and cardiovascular risk markers in obese children / A resistina associa-se à proteína C reativa e aos marcadores de risco cardiovascular em crianças obesas

El objetivo del trabajo fue evaluar los niveles de resistina sérica y su asociación con la proteína C reactiva (PCR-hs), óxido nítrico (NO) y lípidos plasmáticos (LP) en sujetos de edad pediátrica. Participaron 366 niños y adolescentes (10-16 años), agrupados en eutróficos (n=162) y obesos (n=204). Se les estudió peso, talla, circunferencia de la cintura, resistina sérica, glucosa e insulina basal, LP, NO, PCR-hs, malondialdehído y tensión arterial. Se calculó el IMC, el índice cintura-talla (IC/T) y el HOMA-IR. Se utilizaron las pruebas t de Student, ANOVA, U de Mann y Whitney o Kruskal- Wallis para comparar entre grupos y la correlación de Spearman para determinar asociación entre variables. Los obesos masculinos presentaron niveles superiores de resistina (p<0,05). El género femenino presentó valores más altos de resistina en eutróficos (p=0,012) y con IC/T normal (p=0,011). A mayor concentración de resistina los eutróficos presentaron niveles más altos de triacilglicéridos, pero los obesos mostraron niveles más bajos de triacilglicéridos, HDLc y NO, más altos de PCR-hs y mayor IMC. Los resultados sugieren que la resistina podría ser un factor de riesgo para la enfermedad cardiovascular por su asociación positiva con la PCR-hs e inversa con el NO y la HDLc, parámetros involucrados en la inflamación y la disfunción endotelial.

The aim of this study was to evaluate seric levels of resitin and their association with high-sensitivity C Reactive Protein (hs-CRP), nitric oxide (NO) and plasmatic lipids (PL) in a pediatric age population. A total of 366 children and adolescents (between 10-16 years old) participated, and were grouped into eutrophic (n=162) and obese (n=204). Weight, height, waist circumference, resistin, fasting blood glucose and insulin levels, PL, hs-CRP, NO, malondialdehyde and blood pressure were measured. BMI, waist to height ratio (W/HR) and HOMA-IR were calculated. T-student, ANOVA, Mann-Whitney U-value or Kruskal-Wallis were used to compare between groups and Spearman correlation was used to determine association among variables. Male obese subjects showed higher resistin levels (p<0.05). Female subjects showed higher resistin values in the eutrophic group (p=0.012) and in the normal W/HR (p=0.011). At higher levels of resistin, the eutrophic group showed higher levels of triacylglycerides, but the obese group showed lower triacylglycerides, HDLc and NO levels and higher hs-CRP levels and BMI. These results suggest that resistin could be a risk factor for cardiovascular disease because of its positive association with hs-CRP and inverse association with NO and HDLc, parameters involved in inflammation and endothelial dysfunction.

O objetivo da pesquisa foi avaliar os níveis séricos de resistina sérica e sua associação com a proteína C-reativa (PCR-hs), óxido nítrico (NO) e lipídios plasmáticos (LP) em crianças e adolescentes. O estudo envolveu 366 crianças e adolescentes (10-16 anos), agrupados em eutróficos (n=162) e obesos (n=204). Os sujeitos foram estudados em relação ao peso, altura, circunferência da cintura, resistina sérica, glicose e insulina basal, LP, NO, PCR-hs, malondialdeído e pressão arterial. Os IMC, índice cintura-altura (IC/A) e HOMA-IR foram calculados. Foram utilizados os Testes t de Student, ANOVA, U de Mann e Whitney ou Kruskal-Wallis para comparar entre os grupos e a correlação de Spearman para verificar a associação entre variáveis. Os obesos masculinos mostraram níveis mais elevados de resistina (p<0,05). O sexo feminino apresentou valores mais altos de resistina em eutróficos (p=0,012) e com IC/T normal (p=0,011). À maior concentração de resistina, os eutróficos apresentaram maiores níveis de triacilglicerídeos, mas os obesos apresentaram níveis mais baixos de triacilglicerídeos, HDLc e NO, mais altos de PCR-hs e maior IMC. Os resultados sugerem que a resistina poderia ser um fator de risco para a doença cardiovascular devido à sua associação positiva com a PCR-hs e inversa com o NO e a HDLc, parâmetros envolvidos na inflamação e disfunção endotelial.