The association between inflammatory markers and obesity-related factors in Tehranian adults: Tehran lipid and glucose study

Document Type : Original Article


1 1 Cellular and Molecular Research Center, Obesity Research Center, Research Institute for Endocrine Sciences Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran


Objective(s):Obesity considered being a low-grade inflammatory disease. The objective of this study was to examine the association between inflammatory markers (IM) including C-reactive protein (hs-CRP), Interleukin-6 (IL-6), and homocystein (Hcy) and obesity[F1] -related factors (e.g. BMI, waist, hip) in adult participants of Tehran lipid and glucose study (TLGS).
Materials and Methods: In this cross-sectional study, 352 individuals (132 men and 220 women), age ≥19 years, were randomly recruited from participants of TLGS population[F2] . The serum levels of hs-CRP, IL-6, Hcy were determined using the enzyme linked immunosorbent assay (ELISA) method[F3] . Variables were compared by sample t-test. Bivariate linear correlation was estimated using Pearson’s correlation coefficient. Linear regression analysis was applied to investigate the association between IMs and anthropometric and biochemical variables.
Results: The mean age of participants was 46.1±16.1 years. abdominal obesity was present in 199(56.5%) individuals. levels of hs-CRP and IL-6 increased in the abdominally obese group (1507±3.3 vs. 577.8±4.3 ng/ml P<0.001) (3.6±3.3 vs. 1.9±3.8 pg/ml P< 0.001), and in the same group, the best predictors for hs-CRP, IL-6 and Hcy were waist (WC), waist to height ratio (WHtR) and wrist respectively; hip and WHtR were the best predictors for Hcy and hs-CRP in the normal group. A linear augmentation in hs-CRP and IL-6 levels was observed in association with obesity categorizes.
Conclusion: This study provides evidence that abdominally obese individuals had higher levels of IMs. Wrist, waist and WHtR were the best predictors for Hcy, hs-CRP and IL-6 respectively in this group.



1. Klein J, Perwitz N, Kraus D, Fasshauer M. Adipose tissue as source and target for novel therapies. Trends Endocrinol Metab 2006; 17:26-32.
2. Organization WH. Obesity: Preventing and managing the global epidemic. WHO Consultation 2004; ISBN: 9241208945
3. Ronti T, Lupattelli G, Mannarino E. The endocrine function of adipose tissue: an update. Clin Endocrinol (Oxf) 2006; 64:355-365.
4. Fantuzzi G. Adipose tissue, adipokines, and inflammation. J Allergy Clin Immunol 2005; 115:911-919.
5. Greenberg AS, Obin MS. Obesity and the role of adipose tissue in inflammation and metabolism. Am J Clin Nutr 2006; 83:461S-465S.
6. Trayhurn P, Wood IS. Adipokines: inflammation and the pleiotropic role of white adipose tissue. Br J Nutr 2004; 92:347-355.
7. Bermudez EA, Rifai N, Buring J, Manson JE, Ridker PM. Interrelationships among circulating interleukin-6, C-reactive protein, and traditional cardiovascular risk factors in women. Arterioscler Thromb Vasc Biol 2002; 22:1668-1673.
8. Anty R, Bekri S, Luciani N, Saint-Paul MC, Dahman M, Iannelli A, et al. The inflammatory C-reactive protein is increased in both liver and adipose tissue in severely obese patients independently from metabolic syndrome, Type 2 diabetes, and NASH. Am J Gastroenterol 2006; 101:1824-1833.
9. Bisoendial RJ, Birjmohun RS, Akdim F, van 't Veer C, Spek CA, Hartman D, et al. C-reactive protein elicits white blood cell activation in humans. Am J Med 2009; 122:582 e1-589.
10. Ridker PM. C-reactive protein and the prediction of cardiovascular events among those at intermediate risk: moving an inflammatory hypothesis toward consensus. J Am Coll Cardiol 2007; 49: 2129-2138.
11. Dudeja V, Misra A, Pandey RM, Devina G, Kumar G, Vikram NK. BMI does not accurately predict overweight in Asian Indians in Northern India. Br J Nutr 2001; 86:105-112.
12. Scott JM. Homocysteine and cardiovascular risk. Am J Clin Nutr 2000; 72:333-334.
13. Azizi F MM, Rahmani M, Emami H, Mirmiran P, Hajipour R. Tehran Lipid and Glucose Study. IJEM 2000; 2: 77-86.
14. Azizi F, Rahmani M, Emami H, Mirmiran P, Hajipour R, Madjid M, et al. Cardiovascular risk factors in an Iranian urban population: Tehran lipid and glucose study (phase 1). Soz Praventivmed 2002; 47:408-426.
15. Azizi F, Ghanbarian A, Momenan AA, Hadaegh F, Mirmiran P, Hedayati M, et al. Prevention of non-communicable disease in a population in nutrition transition: Tehran Lipid and Glucose Study phase II. Trials 2009; 10:5.
16. Delavari A, Forouzanfar MH, Alikhani S, Sharifian A, Kelishadi R. First nationwide study of the prevalence of the metabolic syndrome and optimal cutoff points of waist circumference in the Middle East: the national survey of risk factors for noncommunicable diseases of Iran. Diabetes Care 2009; 32:1092-1097.
17. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972; 18:499-502.
18. Belfki H, Ben Ali S, Bougatef S, Ben Ahmed D, Haddad N, Jmal A, et al. Relationship of C-reactive protein with components of the metabolic syndrome in a Tunisian population. Eur J Intern Med 2012; 23:e5-9.
19. Stelzer I, Zelzer S, Raggam RB, Prüller F, Truschnig-Wilders M, Meinitzer A, et al. Link between leptin and interleukin-6 levels in the initial phase of obesity related inflammation. Translat Res 2012; 159:118-124.
20. Hsieh SD, Yoshinaga H, Muto T, Sakurai Y, Kosaka K. Health risks among Japanese men with moderate body mass index. Int J Obes Relat Metab Disord 2000; 24:358-362.
21. Cox BD, Whichelow M. Ratio of waist circumference to height is better predictor of death than body mass index. BMJ 1996; 313:1487.
22. Nakamura H, Ito H, Egami Y, Kaji Y, Maruyama T, Koike G, et al. Waist circumference is the main determinant of elevated C-reactive protein in metabolic syndrome. Diabetes Res Clin Pract 2008; 79: 330-336.
23. Saijo Y, Kiyota N, Kawasaki Y, Miyazaki Y, Kashimura J, Fukuda M, et al. Relationship between C-reactive protein and visceral adipose tissue in healthy Japanese subjects. Diabetes Obes Metab 2004; 6: 249-258.
24. You T, Ryan AS, Nicklas BJ. The metabolic syndrome in obese postmenopausal women: relationship to body composition, visceral fat, and inflammation. J Clin Endocrinol Metab 2004; 89:5517-5522.
25. 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; 19:972-978.
26. Mohamed-Ali V, Goodrick S, Rawesh A, Katz DR, Miles JM, Yudkin JS, et al. Subcutaneous adipose tissue releases interleukin-6, but not tumor necrosis factor-alpha, in vivo. J Clin Endocrinol Metab 1997; 82:4196-4200.
27. O'Brien KD, Brehm BJ, Seeley RJ, Bean J, Wener MH, Daniels S, et al. Diet-induced weight loss is associated with decreases in plasma serum amyloid a and C-reactive protein independent of dietary macronutrient composition in obese subjects. J Clin Endocrinol Metab 2005; 90:2244-2249.
28. Ryan AS, Nicklas BJ. Reductions in plasma cytokine levels with weight loss improve insulin sensitivity in overweight and obese postmenopausal women. Diabetes Care 2004; 27:1699-1705.
29. Nishida M, Moriyama T, Sugita Y, Yamauchi-Takihara K. Abdominal obesity exhibits distinct effect on inflammatory and anti-inflammatory proteins in apparently healthy Japanese men. Cardiovasc Diabetol 2007; 6:27.
30. Vaya A, Rivera L, Hernandez-Mijares A, de la Fuente M, Sola E, Romagnoli M, et al. Homocysteine levels in morbidly obese patients: its association with waist circumference and insulin resistance. Clin Hemorheol Microcirc 2012; 52:49-56.