Diet, Exercise, and C-Reactive Protein Levels in People With Abdominal Obesity: The ATTICA Epidemiological Study

We evaluated the association of physical activity and diet with C-reactive protein (CRP) levels among subjects with abdominal obesity. During 2001-2002, we enrolled 625 men (18 to 87 years old) and 712 women (18 to 89 years old) with abdominal obesity (waist-to-hip ratio ≥0.95 in men and ≥0.8 in women) from the Attica area, Greece. The sampling was stratified by the age-gender distribution of the region (census 2001). Among several variables, we also measured plasma high-sensitivity CRP, physical activity status, dietary habits, blood lipids, and blood pressure levels. Adherence to the Mediterranean diet was evaluated through a diet score (0 to 55) that assessed the inherent characteristics of the diet. Compared with those with low CRP levels, subjects with high CRP levels (ie, >3.0 mg/L) were physically inactive (P = .01), were less likely to adopt the Mediterranean diet (P = .008), had higher glucose levels, had a higher prevalence of hypertension, had a lower high-density lipoprotein cholesterol, and had increased smoking habits and higher anthropometric indices (all P < .05). Moreover, adoption of the Mediterranean diet in combination with medium physical activity seems to reduce the likelihood of having high CRP levels by 72% (P = .018), irrespective of smoking and various clinical and biological characteristics. Among subjects with abdominal obesity, low-grade systemic inflammation appears to be associated with the adoption of an unfavorable lifestyle, including physical inactivity and unhealthy dietary habits, as well as increased blood pressure levels and low high-density lipoprotein cholesterol.

[1]  D. Mikhailidis,et al.  The prevalence of the metabolic syndrome in Greece: The MetS‐Greece Multicentre Study , 2005, Diabetes, obesity & metabolism.

[2]  S. Haffner,et al.  The relation of body fat mass and distribution to markers of chronic inflammation , 2001, International Journal of Obesity.

[3]  P. Ridker.  Clinical application of C-reactive protein for cardiovascular disease detection and prevention. , 2003, Circulation.

[4]  Adherence to the Mediterranean diet attenuates inflammation and coagulation process in healthy adults: The ATTICA Study. , 2004, Journal of the American College of Cardiology.

[5]  Nancy R Cook,et al.  C-Reactive Protein, the Metabolic Syndrome, and Risk of Incident Cardiovascular Events: An 8-Year Follow-Up of 14 719 Initially Healthy American Women , 2003, Circulation.

[6]  B. Spiegelman,et al.  Increased adipose tissue expression of tumor necrosis factor-alpha in human obesity and insulin resistance. , 1995, The Journal of clinical investigation.

[7]  W. Dietz,et al.  Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. , 2002, JAMA.

[8]  Boyd Swinburn,et al.  Diet, nutrition and the prevention of chronic diseases. , 2003, World Health Organization technical report series.

[9]  P. Ridker,et al.  C-reactive protein and the risk of developing hypertension. , 2003, JAMA.

[10]  J. Gauldie,et al.  The acute phase response. , 1994, Immunology today.

[11]  E. Rimm,et al.  Relationship between adiponectin and glycemic control, blood lipids, and inflammatory markers in men with type 2 diabetes. , 2004, Diabetes care.

[12]  D. Panagiotakos,et al.  Impact of lifestyle habits on the prevalence of the metabolic syndrome among Greek adults from the ATTICA study. , 2004, American heart journal.

[13]  G. Reaven,et al.  Insulin resistance/compensatory hyperinsulinemia, essential hypertension, and cardiovascular disease. , 2003, The Journal of clinical endocrinology and metabolism.

[14]  The Treatment of Coronary Heart Disease: An Update , 2001, Current medical research and opinion.

[15]  B. Wisse,et al.  The inflammatory syndrome: the role of adipose tissue cytokines in metabolic disorders linked to obesity. , 2004, Journal of the American Society of Nephrology : JASN.

[16]  D. Panagiotakos,et al.  Epidemiology of cardiovascular risk factors in Greece: aims, design and baseline characteristics of the ATTICA study , 2003, BMC public health.

[17]  D. Giugliano,et al.  The metabolic syndrome and inflammation: association or causation? , 2004, Nutrition, metabolism, and cardiovascular diseases : NMCD.

[18]  S. Grundy.  Inflammation, hypertension, and the metabolic syndrome. , 2003, JAMA.

[19]  K. Shirai.  Obesity as the core of the metabolic syndrome and the management of coronary heart disease , 2004, Current medical research and opinion.

[20]  R. Marfella,et al.  Effect of a mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. , 2004, JAMA.

[21]  G. Colditz,et al.  The disease burden associated with overweight and obesity. , 1999, JAMA.

[22]  B. Nicklas,et al.  Behavioural treatments for chronic systemic inflammation: effects of dietary weight loss and exercise training , 2005, Canadian Medical Association Journal.

[23]  Paul M. Ridker,et al.  C-Reactive Protein, the Metabolic Syndrome, and Risk of Incident Cardiovascular Events: An 8-Year Follow-Up of 14 719 Initially Healthy American Women , 2003 .

[24]  J. Schneider,et al.  Low plasma adiponectin levels are associated with increased hepatic lipase activity in vivo. , 2005, Diabetes care.

[25]  A Trichopoulou,et al.  Reproducibility and relative validity of an extensive semi-quantitative food frequency questionnaire using dietary records and biochemical markers among Greek schoolteachers. , 1997, International journal of epidemiology.

[26]  M. Walker,et al.  Aromatase activity and interleukin-6 production by normal and malignant breast tissues. , 1995, The Journal of clinical endocrinology and metabolism.

[27]  M. Joffres,et al.  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 , 2001, International Journal of Obesity.

[28]  Y. Sharabi,et al.  Adiponectin: linking the metabolic syndrome to its cardiovascular consequences , 2005, Expert review of cardiovascular therapy.

[29]  N. Sattar,et al.  Relation of C-reactive protein to body fat distribution and features of the metabolic syndrome in Europeans and South Asians , 2001, International Journal of Obesity.

[30]  Ronald M. Krauss,et al.  American Heart Association Call to Action: Obesity as a Major Risk Factor for Coronary Heart Disease , 1998 .

[31]  Paul M. Ridker,et al.  CDC/AHA Workshop on Markers of Inflammation and Cardiovascular Disease Application to Clinical and Public Health Practice: Report From the Clinical Practice Discussion Group , 2004 .

[32]  J. Seward,et al.  C-reactive protein is related to arterial wave reflection and stiffness in asymptomatic subjects from the community. , 2005, American journal of hypertension.

[33]  M. Raftery,et al.  Oxidation of High Density Lipoproteins , 1998, The Journal of Biological Chemistry.