title: Increased visceral adipose tissue mass is associated with increased C-reactive protein in patients with manifest vascular diseases.
abstract: BACKGROUND
  Obesity is related to the development of vascular diseases and metabolic complications. Low grade inflammation is a key feature of central obesity, characterized by elevated plasma levels of C-reactive protein (CRP). We hypothesize that visceral adipose tissue contributes to systemic concentrations of CRP.
  
  
  METHODS
  In 2410 patients (1729 men and 681 women) with vascular diseases, subcutaneous and visceral fat masses were analyzed with ultrasonography. Metabolic parameters and CRP were measured in a fasting state. The association between fat measurements and plasma CRP was quantified using linear regression analysis. CRP levels were logarithmically transformed. Adjustments were made for age, smoking, type 2 diabetes mellitus, insulin resistance (HOMA-IR) and medication use.
  
  
  RESULTS
  Visceral fat was categorized into quartiles (Q) ranging from 3.2 to 7.8 cm in Q1 (reference) to 11.0-19.8 cm in Q4 in men and 2.7-6.0 cm in Q1 (reference) to 9.0-17.4 cm in Q4 in women. beta-coefficients gradually increased across the quartiles from 0.07 (0.01-0.13) in Q2 to 0.25 (0.19-0.31) in Q4 in men and 0.17 (0.07-0.26) in Q2 to 0.42 (0.32-0.52) in Q4 in women, indicating 0.25 and 0.42 mg/l higher logarithmically transformed (log)CRP levels in Q4 compared to Q1 in respectively men and women. Per standard deviation increase of visceral fat, logCRP levels increased with 0.10 mg/l (0.07-0.12) in men and with 0.11 (0.15-0.19) in women. Likewise, in separate analyses waist circumference and body mass index showed a positive, but weaker association with logCRP levels across quartiles (in men: beta 0.21 (0.15-0.27) in Q4 for waist circumference and beta 0.23 (0.17-0.30) in Q4 for body mass index; in women: beta 0.32 (0.22-0.42) in Q4 for waist circumference and beta 0.32 (0.22-0.42) in Q4 for body mass index). In men subcutaneous fat was not associated with logCRP (beta-coefficients relative to Q1: -0.01 (-0.07 to -0.05), -0.01 (-0.07 to -0.05) and 0.05 (-0.01 to -0.11) in Q2 to Q4 respectively).
  
  
  CONCLUSIONS
  In conclusion, visceral fat thickness is the strongest contributor to the systemic CRP concentrations in patients with vascular diseases.
authors.affiliation: Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Daniël R
authors.initials: DR
authors.lastname: Faber
authors.forename: Yolanda
authors.initials: Y
authors.lastname: van der Graaf
authors.forename: Jan
authors.initials: J
authors.lastname: Westerink
authors.forename: Frank L J
authors.initials: FL
authors.lastname: Visseren
mesh_terms: D050154:Adiposity; D000368:Aged; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000276:immunology; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis*; D003430:Cross-Sectional Studies; D005215:Fasting / Q000097:blood; D005260:Female; D006801:Humans; D007249:Inflammation / Q000000981:diagnostic imaging / Q000209:etiology* / Q000276:immunology; D018836:Inflammation Mediators / Q000097:blood*; D007333:Insulin Resistance; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009765:Obesity / Q000150:complications* / Q000000981:diagnostic imaging / Q000276:immunology; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D050507:Subcutaneous Fat, Abdominal / Q000000981:diagnostic imaging; D014463:Ultrasonography; D015854:Up-Regulation; D055105:Waist Circumference
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators; D002097:C-Reactive Protein