title: Low-grade systemic inflammation and the development of type 2 diabetes: the atherosclerosis risk in communities study.
abstract: To examine the association of low-grade systemic inflammation with diabetes, as well as its heterogeneity across subgroups, we designed a case-cohort study representing the approximately 9-year experience of 10,275 Atherosclerosis Risk in Communities Study participants. Analytes were measured on stored plasma of 581 incident cases of diabetes and 572 noncases. Statistically significant hazard ratios of developing diabetes for those in the fourth (versus first) quartile of inflammation markers, adjusted for age, sex, ethnicity, study center, parental history of diabetes, and hypertension, ranged from 1.9 to 2.8 for sialic acid, orosomucoid, interleukin-6, and C-reactive protein. After additional adjustment for BMI, waist-to-hip ratio, and fasting glucose and insulin, only the interleukin-6 association remained statistically significant (HR = 1.6, 1.01-2.7). Exclusion of GAD antibody-positive individuals changed associations minimally. An overall inflammation score based on these four markers plus white cell count and fibrinogen predicted diabetes in whites but not African Americans (interaction P = 0.005) and in nonsmokers but not smokers (interaction P = 0.13). The fully adjusted hazard ratio comparing white nonsmokers with score extremes was 3.7 (P for linear trend = 0.008). In conclusion, a low-grade inflammation predicts incident type 2 diabetes. The association is absent in smokers and African-Americans.
authors.affiliation: Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil. bbduncan@orion.ufrgs.br
authors.forename: Bruce B
authors.initials: BB
authors.lastname: Duncan
authors.forename: Maria Inês
authors.initials: MI
authors.lastname: Schmidt
authors.forename: James S
authors.initials: JS
authors.lastname: Pankow
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
authors.forename: David
authors.initials: D
authors.lastname: Couper
authors.forename: Alvaro
authors.initials: A
authors.lastname: Vigo
authors.forename: Ron
authors.initials: R
authors.lastname: Hoogeveen
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Folsom
authors.forename: Gerardo
authors.initials: G
authors.lastname: Heiss
mesh_terms: D044383:Black People; D001786:Blood Glucose / Q000378:metabolism; D016022:Case-Control Studies; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007249:Inflammation / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D012307:Risk Factors; D012907:Smoking; D014481:United States / Q000453:epidemiology; D044465:White People; D001741:Black or African American
chemical_list: D001786:Blood Glucose