Relationship between inflammatory markers and visceral obesity in obese and overweight Korean adults: An observational study

Abstract

Obesity is now considered a state of chronic low-grade inflammation. We investigated the relationship between several inflammatory markers and body composition for identifying patients with an increased risk of visceral obesity and compared the predictive values of inflammatory indices in visceral obesity.Six hundred individuals who received health checkups for obesity-related risk factors in Severance Hospital between January 2008 and March 2017 were included in our study. Serum inflammatory markers, such as white blood cell (WBC), high-sensitivity C-reactive protein (hsCRP), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) levels were assessed. Intra-abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) areas were measured with computed tomography. We performed analysis of covariance, trend analysis, Steiger's Z tests, and multiple linear regression analysis to investigate associations between abdominal adiposity indices and inflammatory markers.Pearson's correlation analysis revealed a stronger association of VAT with WBC counts (r = 0.157, P < .001) than with levels of NLR (r = 0.108, P = .11; Steiger's Z test, P = .04) and PLR (r = 0.036, P = .39; Steiger's Z test, P = .003). WBC and hsCRP levels linearly increased with VAT area (overall P < .001 and trend P < .001) and VAT/SAT ratio (overall P = .001 and trend P = .002; overall P < .001 and trend P < .001, respectively) but linearly decreased with SAT (overall P = .02 and trend P = .17; overall P = .03 and trend P = .01, respectively). Visceral adipose tissue area was more highly associated with WBC and hsCRP levels than with NLR and PLR. Only VAT area was significantly associated with WBC, hsCRP, and NLR levels after adjusting for confounding variables.We found that VAT, but not SAT area is independently associated with several inflammatory markers. WBC and hsCRP are more strongly correlated with VAT compared with NLR and PLR. Thus, WBC and hsCRP could be useful parameters for identifying individuals at risk for visceral obesity and cardiometabolic diseases.

Figure 1

Patient selection flow chart. hsCRP = high-sensitivity C-reactive protein, WBC = white blood cell.

Figure 2

Inflammatory markers according to abdominal fat composition tertiles after adjusting for age, sex, and BMI. Mean (estimated) and standard error (indicated with error bars). ^∗P < .05 and ^∗∗P < .01 indicate significant differences among tertiles using analysis of covariance. ^†trend P < .05; ^††trend P < .01. T, tertile. A, B, C, D: T1 (24.2–78.4), T2 (79.1–117.2), T3 (117.3–411) cm²; E, F, G, H: T1 (33–196.23), T2 (196.61–287.44), T3 (287.54–1189.11) cm²; I, J, K, L: T1 (0.08–0.3), T2 (0.3–0.48), T3 (0.48–10.82). hsCRP = high-sensitivity C-reactive protein, NLR = neutrophil-lymphocyte ratio, PLR = platelet-lymphocyte ratio, SAT = subcutaneous adipose tissue, VAT = visceral adipose tissue, V/S ratio = VAT/SAT ratio; WBC, white blood cell.