The implication of obesity and central fat on markers of chronic inflammation: The ATTICA study

doi:10.1016/j.atherosclerosis.2005.03.010

Atherosclerosis

Volume 183, Issue 2, December 2005, Pages 308-315

https://doi.org/10.1016/j.atherosclerosis.2005.03.010 Get rights and content

Abstract

Objective

We evaluated the association of obesity with various markers of chronic inflammation, in a population-based sample of 3042 adults.

Methods

During 2001–2002, we randomly enrolled 1514 men (18–87 years old) and 1528 women (18–89 years old), from the Attica area, Greece; the sampling was stratified by the age–sex distribution of the region (census 2001). Among several variables, we also measured various inflammatory markers (C-reactive protein, tumor necrosis factor α, amyloid A, white blood cells and interleukin-6) and anthropometric variables (weight, height, waist and hip circumferences). Central fat was defined as waist-to-hip ratio ≥ 0.95 in men and ≥ 0.8 in women, while obesity as body mass index (BMI) > 29.9 kg/m².

Results

Central fat prevailed in 36% of men and 43% of women (p < 0.001), while obesity prevailed in 20% of men and 15% of women, respectively. Compared to participants with normal body fat distribution, those with central fat exhibited 53% higher C-reactive protein levels, 30% higher tumor necrosis factor, α levels, 26% higher amyloid A levels, 17% higher white blood cell counts and 42% higher interleukin-6 levels (all p < 0.05). We observed that all inflammation markers were related to BMI (index for obesity), waist and to waist-to-hip ratio (indices for central fat), in both genders. Moreover, the models that included waist or waist-to-hip ratio as independent variable had higher explanatory ability (i.e. R²) than the models included BMI, especially in women, even after adjusting for age and various other potential confounders.

Conclusion

Our results suggest a relationship between central adiposity and inflammation process, irrespective of age and other potential confounders. This association was more prominent than the relationship between total obesity and inflammation. It could be hypothesized that a disproportionate accumulation of visceral fat mass could be partially associated with increased coronary risk, through inflammation process.

Introduction

Obesity in its various manifestations is now considered as a very serious health problem, affecting a significant proportion of people of all ages. During the past years, high body mass has been positively associated with incidence of coronary heart disease [1], mainly due to its effect on the prevalence of hypertension, dyslipidemia, hyperinsulenemia and type-2 diabetes among obese people [2]. Central fat (i.e. an increase in abdominal visceral fat), has also been associated with increased cardiovascular risk [2], mainly, through the development of many metabolic disorders characterized by insulin resistance, including type-2 diabetes and hypertension, as well as alterations in homeostasis, fibrinolysis and, in part, inflammation [3], [4]. Moreover, growing data suggest that inflammation is strongly involved in atherogenesis [5]. However, the link between obesity and cardiovascular disease or factors related to the disease is not fully understood and, especially, the contribution of inflammation has not fully appreciated.

In this work, we sought to evaluate the association between various markers of chronic inflammation and the prevalence of obesity and central fat, in a population-based sample of Greek adults, without any clinical evidence of cardiovascular disease.

Section snippets

Population of the study

The “ATTICA” study has been carried out in the province of Attica (including 78% urban and 22% rural areas), where Athens, is a major metropolis. The sampling was random, multistage (by city) and it was based on the age–sex distribution of the province of Attica provided by the National Statistical Service (census of 2001). From May 2001 to December 2002, 4056 inhabitants from the above area and without any clinical evidence for cardiovascular disease were randomly selected to participate into

Distribution of central fat and obesity

Mean waist circumference was 98 ± 13 cm in men and 84 ± 22 cm in women (p < 0.001), while mean hip was 106 ± 28 cm in men and 103 ± 13 cm in women (p < 0.001). Central fat (as assessed by the waist-to-hip ratio) prevailed in 36% of men and 43% of women (p < 0.001). Additionally, mean BMI in men was 27.4 ± 3.8 kg/m² and in women 25.3 ± 4.9 kg/m². The prevalence of overweight and obesity was 53 and 20%, in men, and 31 and 15% in women, respectively. BMI, waist circumference and waist-to-hip ratio were correlated with

Discussion

We evaluated the association between inflammation process and obesity status in a population-based sample of 3042 cardiovascular disease free adults. We observed a consistent relationship between all obesity indices and inflammatory markers studied, even after adjusting for age and various other potential confounders, namely smoking, physical activity, dietary habits, blood pressure and lipid levels. Moreover, we revealed that the relationship between inflammatory markers and obesity was more

Acknowledgements

The ATTICA study is supported by research grants from the Hellenic Society of Cardiology (grant—1, HCS2002).

The authors would like to thank the field investigators of “ATTICA” study: Dr. Yannis Skoumas (head, field examination), Dr. Natassa Katinioti (physical examination), Dr. Akis Zeimbekis (physical examination), Dr. Spiros Vellas (physical examination), Dr. Efi Tsetsekou (physical/psychological evaluation), Dr. Dina Massoura (physical examination), Dr. Lambros Papadimitriou (physical

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The implication of obesity and central fat on markers of chronic inflammation: The ATTICA study

Abstract

Objective

Methods

Results

Conclusion

Introduction

Section snippets

Population of the study

Distribution of central fat and obesity

Discussion

Acknowledgements

Am J Clin Nutr

Med Clin North Am

Med Clin North Am

Immunol Today

Obesity as the core of the metabolic syndrome and the management of coronary heart disease

Curr Med Res Opin

The disease burden associated with overweight and obesity

JAMA

American Heart Association call to action: obesity as a major risk factor for coronary heart disease

Circulation

The treatment of coronary heart disease: an update. Part 1: an overview of the risk factors for cardiovascular disease

Curr Med Res Opin

A comparative evaluation of waist circumference, waist-to-hip ratio and body mass index as indicators of cardiovascular risk factors. The Canadian Heart Health Surveys

Int J Obes Relat Metab Disord

Reproducibility and relative validity of an extensive semi-quantitative food frequency questionnaire using dietary records and biochemical markers among Greek schoolteachers

Int J Epidemiol

Epidemiology of cardiovascular risk factors in Greece; aims, design and baseline characteristics of the ATTICA study

BMC Public Health

Status and management of hypertension, in Greece; the role of the adoption of Mediterranean diet: the ATTICA study

J Hypertens

The impact of lifestyle habits on the prevalence of the metabolic syndrome among Greek adults from the ATTICA study

Am Heart J

Inflammatory status as a main determinant of outcome in patients with unstable angina, independent of coagulation activation and endothelial cell function

Eur Heart J

Inflammation and thrombosis: the clot thickens

Circulation