title: Variations in levels of IL-6 and TNF-α in type 2 diabetes mellitus between rural and urban Ashanti Region of Ghana.
abstract: BACKGROUND
  A surge in pro-inflammatory markers, Il-6 and TNF-α, has been associated with type 2 diabetes mellitus (T2DM). However, there is no data on the dynamics of these markers in T2DM Ghanaian populations. The aim of this study was to determine variations in the levels of IL-6 and TNF-α in T2DM patients. This study also examined the associations of IL-6 and TNF-α with anthropometric measurement and the effect of co-morbidity with hypertension using rural and urban dwellers in the Ashanti region, Ghana.
  
  
  METHODS
  A nested case-control design using participants aged 25-70 years consisting of 77 T2DM ± hypertension patients and 112 controls were selected from a larger study on Research on Obesity and Diabetes among African Migrants (RODAM). Anthropometric measurements, blood pressure and body fat percentage were measured. Fasting blood samples were analyzed for glucose, IL-6 and TNF-α levels.
  
  
  RESULTS
  The median level of IL-6 was significantly higher (p < 0.0001) among rural dwellers compared to urban dwellers. Inversely, urban dwellers had significantly higher (p = 0.0424) median level of TNF-α compared to rural cases. No significant differences were observed in IL-6 (p = 0.3571) and TNF-α (p = 0.2581) among T2DM patients compared with T2DM ± hypertension patients. A weak negative correlation was found between IL-6 and BMI in urban T2DM.
  
  
  CONCLUSIONS
  The average level of IL-6 was higher in rural T2DM participants compared with those in urban setting. However, higher levels of TNF-α was observed among the study participants with T2DM in urban settings compared to those of rural.﻿ In this study, we observed that co-morbidity of hypertension had no significant effect on the levels of IL-6 and TNF-α. We are of the opinion that higher physical activity levels among rural particpants and high obesity levels in urabn participants explain the observation but needs more numbers to validate.
  
  
  CONCLUSIONS
  This study revealed that IL-6 levels were higher among rural dwellers than urban while TNF-α levels were higher in urban dwellers than rural in patients with T2DM. There was no association of body fat percentage and body mass index with IL-6 and TNF-α levels. Co-morbidity of hypertension with T2DM had no effect on IL-6 and TNF-α levels.
authors.affiliation: Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana. s.darko28@gmail.com.
authors.forename: Samuel N
authors.initials: SN
authors.lastname: Darko
authors.affiliation: Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana. yar@kccr.de.
authors.forename: Denis D
authors.initials: DD
authors.lastname: Yar
authors.affiliation: Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana. owusudabo@kccr.de.|School of Public Health, KNUST, Kumasi, Ghana. owusudabo@kccr.de.
authors.forename: Ellis
authors.initials: E
authors.lastname: Owusu-Dabo
authors.affiliation: Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana. kwameafumadjei@yahoo.com.
authors.forename: Anthony Afum-Adjei
authors.initials: AA
authors.lastname: Awuah
authors.affiliation: Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana. onedaps@gmail.com.
authors.forename: Williams
authors.initials: W
authors.lastname: Dapaah
authors.affiliation: Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana. addofoh@kccr.de.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Addofoh
authors.affiliation: Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana. pandam@kccr.de.|Department of Biochemistry and Biotechnology, KNUST, Kumasi, Ghana. pandam@kccr.de.
authors.forename: Samson P
authors.initials: SP
authors.lastname: Salifu
authors.affiliation: Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana. awua.boateng@kccr.de.
authors.forename: Nana Y
authors.initials: NY
authors.lastname: Awua-Boateng
authors.affiliation: Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana. fred.adomakoboateng@gmail.com.|Ghana Health Service, Kumasi, Ashanti Region, Ghana. fred.adomakoboateng@gmail.com.
authors.forename: Fred
authors.initials: F
authors.lastname: Adomako-Boateng
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015992:Body Mass Index; D016022:Case-Control Studies; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000453:epidemiology; D004734:Energy Metabolism; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000097:blood; D015850:Interleukin-6 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009790:Occupations / Q000706:statistics & numerical data*; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*; D014505:Urban Population / Q000706:statistics & numerical data*
chemical_list: D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha