Abstract
Inflammatory biomarkers provide a minimally invasive means for early detection and specific treatment of metabolic syndrome and related disorders. The objective of this work was to search for inflammatory biomarkers of cardiometabolic risk in obese type 2 diabetics. The study was performed on 165 persons attending the medical outpatient clinic of Ismailia General Hospital. Their mean age was (50.69 ± 10.15) years. They were divided into three groups. The control group was composed of 55 non-obese, non-diabetic healthy volunteers, 32 males and 23 females. Two study groups were included in this study: group 2 was composed of 55 obese, non-diabetic subjects, 25 males and 30 females matched for age and gender. All patients including the control were subjected to clinical history taking, a clinical examination for the measurement of body mass index (BMI). Investigations were carried out for fasting blood glucose, fasting serum insulin, insulin resistance (IR), the lipid profile, lipoprotein band lipoprotein phospholipase A2, and non-high-density lipoprotein cholesterol (non-HDL-C). Urea, albumin and creatinine analysis and liver function tests were performed, and a complete blood count (CBC) was taken. Hemoglobin A1C (HbA1C), serum high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were tested. There were statistically significant differences among the studied groups in terms of total cholesterol, non-HDL-C, high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), lipoprotein-associated phospholipase A2 and apolipoprotein B. The inflammatory biomarkers hs-CRP, IL-6 and TNF-α were significantly statistically increased in the study groups by (1.62 ± 0.99, 2.32 ± 1.11), (1.73 ± 1.14, 2.53 ± 1.34), and (1.87 ± 1.09, 2.17 ± 0.89) respectively, where p < 0.01. Significant positive correlation was found between Homeostatic Model Assessment (HOMA)-IR, hs-CRP and IL-6. There was a significant positive correlation between non-HDL and hs-CRP, IL-6 and TNF-α and triglycerides and hs-CRP. In conclusion, in this study, CRP, IL-6, and TNF-α were significantly elevated in obese Egyptian type 2 diabetics and were positively correlated with insulin resistance, non-HDL and triglycerides. These inflammatory biomarkers could help in the premature identification of obese type 2 diabetic patients at high cardiometabolic risk. Additionally, these biomarkers are critical for providing prognostics and the validity of future potential anti-inflammatory therapeutic modalities.
Highlights
The World Health Organization (WHO) current estimates of obesity as a global health crisis are that 500 million adults are obese, and 1.5 billion adults are overweight, the majority of which in developing countries [1]
In this study, CRP, IL-6, and tumor necrosis factor-α (TNF-α) were significantly elevated in obese Egyptian type 2 diabetics and were positively correlated with insulin resistance, non-HDL and triglycerides
This study showed no significant difference in white blood cells (WBCs), red blood cells (RBCs), platelet count, or Hb among the studied groups, just as no significant difference was found between diabetics and non-diabetics in
Summary
The World Health Organization (WHO) current estimates of obesity as a global health crisis are that 500 million adults are obese, and 1.5 billion adults are overweight, the majority of which in developing countries [1]. Dysfunctional visceral white adipose tissue due to adipocyte hypertrophy and hyperplasia with faulty remodeling induced by mild hypoxia, increased free fatty acids and metabolic endotoxins leads to increased infiltration by active M1-type tissue macrophages [9] These M1 macrophages secrete local and systemic proinflammatory cytokines such as interleukin-1B (IL-1B), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) [10]. Ebron et al [13] reported that a high body mass index (BMI) is associated with increased atherogenic dyslipidemia and insulin resistance in metabolic syndrome; both are linked to low-grade inflammation. These associations are evident by the positive association between BMI, proinflammatory C-reactive protein and IL-6 [13]. Additional stratification of hs-CRP into low (3 mg/L) groups for those with DM has shown incremental predictive values for future CVD events [18]
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