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Marjolein Visser, PhD; Lex M. Bouter, PhD; Geraldine M. McQuillan, PhD; Mark H. Wener, MD; Tamara B. Harris, MD, MS

JAMA. 1999;282:2131-2135.

Context  Human adipose tissue expresses and releases the proinflammatory cytokine interleukin 6, potentially inducing low-grade systemic inflammation in persons with excess body fat.

Objective  To test whether overweight and obesity are associated with low-grade systemic inflammation as measured by serum C-reactive protein (CRP) level.

Design and Setting  The Third National Health and Nutrition Examination Survey, representative of the US population from 1988 to 1994.

Participants  A total of 16,616 men and nonpregnant women aged 17 years or older.

Main Outcome Measures  Elevated CRP level of 0.22 mg/dL or more and a more stringent clinically raised CRP level of more than 1.00 mg/dL.

Results  Elevated CRP levels and clinically raised CRP levels were present in 27.6% and 6.7% of the population, respectively. Both overweight (body mass index [BMI], 25-29.9 kg/m²) and obese (BMI, 30 kg/m²) persons were more likely to have elevated CRP levels than their normal-weight counterparts (BMI, <25 kg/m²). After adjustment for potential confounders, including smoking and health status, the odds ratio (OR) for elevated CRP was 2.13 (95% confidence interval [CI], 1.56-2.91) for obese men and 6.21 (95% CI, 4.94-7.81) for obese women. In addition, BMI was associated with clinically raised CRP levels in women, with an OR of 4.76 (95% CI, 3.42-6.61) for obese women. Waist-to-hip ratio was positively associated with both elevated and clinically raised CRP levels, independent of BMI. Restricting the analyses to young adults (aged 17-39 years) and excluding smokers, persons with inflammatory disease, cardiovascular disease, or diabetes mellitus and estrogen users did not change the main findings.

Conclusion  Higher BMI is associated with higher CRP concentrations, even among young adults aged 17 to 39 years. These findings suggest a state of low-grade systemic inflammation in overweight and obese persons.

Author Affiliations: Institute for Research in Extramural Medicine, Faculty of Medicine (Dr Visser and Prof Bouter), Vrije Universiteit, Amsterdam, the Netherlands; Epidemiology, Demography, and Biometry Program, National Institute on Aging, National Institutes of Health, Bethesda, Md (Drs Visser and Harris); National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Md (Dr McQuillan); and the Departments of Laboratory Medicine and Medicine, University of Washington, Seattle (Dr Wener).

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