BACKGROUND AND AIMS: This study was designed to elucidate the role of C-reactive protein (CRP) as an inflammatory marker in the development of the metabolic syndrome (MS). METHODS AND RESULTS: A total of 333 women without current medication attended an obesity-screening programme held in Yun-Lin, Taiwan. Anthropometric measurements were obtained; biochemical profiles, lipid profiles and high-sensitivity CRP (hsCRP) were measured. A structural equation model (SEM) was constructed to demonstrate that obesity might initiate the sequential pathway that leads to a pro-inflammatory state and other metabolic derangements. The results of SEM in the Taiwanese women showed that obesity was positively associated with elevated CRP (B=0.69, p<0.001). The pro-inflammatory state could result in insulin resistance (B=0.57, p<0.001), which in turn could lead to dyslipidaemia (B=0.46, p<0.01). The association between obesity and hypertension was positive and direct (B=0.43, p<0.01) without the intermediation of inflammation or insulin resistance. The implications could be reproduced when the same model was applied to the metabolic profiles of the Caucasian participants in the National Health and Nutrition Examination Survey 1999-2002. CONCLUSION: Our study has demonstrated that obesity plays the central role in leading to hypertension and a pro-inflammatory state, insulin resistance and dyslipidaemia. The SEM has provided a comprehensive view to illustrate the complex interplay of the main components in the development of the MS, and this approach can be generalized to different populations.
BACKGROUND AND AIMS: This study was designed to elucidate the role of C-reactive protein (CRP) as an inflammatory marker in the development of the metabolic syndrome (MS). METHODS AND RESULTS: A total of 333 women without current medication attended an obesity-screening programme held in Yun-Lin, Taiwan. Anthropometric measurements were obtained; biochemical profiles, lipid profiles and high-sensitivity CRP (hsCRP) were measured. A structural equation model (SEM) was constructed to demonstrate that obesity might initiate the sequential pathway that leads to a pro-inflammatory state and other metabolic derangements. The results of SEM in the Taiwanese women showed that obesity was positively associated with elevated CRP (B=0.69, p<0.001). The pro-inflammatory state could result in insulin resistance (B=0.57, p<0.001), which in turn could lead to dyslipidaemia (B=0.46, p<0.01). The association between obesity and hypertension was positive and direct (B=0.43, p<0.01) without the intermediation of inflammation or insulin resistance. The implications could be reproduced when the same model was applied to the metabolic profiles of the Caucasian participants in the National Health and Nutrition Examination Survey 1999-2002. CONCLUSION: Our study has demonstrated that obesity plays the central role in leading to hypertension and a pro-inflammatory state, insulin resistance and dyslipidaemia. The SEM has provided a comprehensive view to illustrate the complex interplay of the main components in the development of the MS, and this approach can be generalized to different populations.
Authors: Jennifer L St Sauver; Aruna V Sarma; Debra J Jacobson; Michaela E McGree; Michael M Lieber; Cynthia J Girman; Ajay Nehra; Steven J Jacobsen Journal: Am J Epidemiol Date: 2009-04-24 Impact factor: 4.897