High sensitivity C-reactive protein and red blood cell distribution width in apparently healthy subjects with different body mass index Ei-Ei-Phyo-Myint1,

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High sensitivity C-reactive protein and red blood cell distribution width in apparently healthy subjects with different body mass index Ei-Ei-Phyo-Myint1, Ohnmar-Myint-Thein1, Zaw-Lin-Thein1, Ohnmar1 1Department of Physiology, University of Medicine 1, Yangon, Myanmar

Introduction Apparently healthy individuals with chronic subclinical inflammation have an increased risk of future cardiovascular events.1,2 High sensitivity C-reactive protein (hs-CRP), a chronic inflammatory marker, helps in quantification of low grade inflammation in healthy individuals.3 Red blood cell distribution width (RDW) is an indicator of anisocytosis, and it is included in routine complete blood count. Recently, RDW is increasingly recognized as an inflammatory marker in different clinical settings.4 The present study aimed to find out the relationship between serum hs-CRP and RDW in apparently healthy subjects with different BMIs.

Materials and Methods Subjects: Apparently healthy subjects aged between 20 and 60 years (n = 128), both male and female subjects - with fasting blood sugar less than 100 mg/dL - SBP < 140 mmHg and DBP < 90 mmHg - without no hematological disorders Lean subjects (BMI: 18.5-24.99 kg/m2) (n = 47) Overweight subjects (BMI: 25-29.99 kg/m2) (n = 42) Obese subjects (BMI: 30-34.99 kg/m2) (n = 39) Serum hs-CRP level: Enzyme-linked immunosorbent assay RDW: Automated haematology analyzer (Sysmex KX-21, Japan)

Results Figure 1. Comparison of serum high sensitivity C-reactive protein level among three different BMI groups of the apparently healthy subjects Figure 2. Comparison of red blood cell distribution width among three different BMI groups of the apparently healthy subjects

Results (Cont.) A B C D Figure 3. Correlation between serum high sensitivity C-reactive protein level and red blood cell distribution width in the apparently healthy subjects (A), in the lean subjects (B), in the overweight subjects (C) and in the obese subjects (D)

Discussion Increasing BMI was related with increased serum hs-CRP level which is a typical marker of chronic inflammation and serum hs-CRP level was significantly higher in obese subjects than the lean and overweight subjects. However, there was no significant difference in RDW among different BMI groups in the present study. It was found that there was no relationship between serum hs-CRP level and RDW in those with different BMIs. Evidence suggests that metabolic syndrome rather than obesity itself can be a powerful cause of RDW variation.5 In the present study, the overweight and obese subjects did not have any features of metabolic syndrome apart from central obesity but had RDW values within normal range.

Conclusion Therefore, it can be concluded that serum hs-CRP is a key inflammatory marker for subclinical inflammatory state like apparently healthy obese subjects RDW could not be considered as a potential inflammatory marker in the apparently healthy subjects with no overt pathological and hematological abnormalities.

References Ridker, P.M., Cushman, M., Stampfer, M.J., Tracy, R.P. and Hennekens, C.H. (1997) Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. New England Journal of Medicine: 336(14); p.973-979. Ridker, P.M., Buring, J.E., Shih, J., Matias, M. and Hennekens, C.H. (1998) Prospective study of C-reactive protein and the risk of future cardiovascular events among apparently healthy women. Circulation: 98(9); p.731-733. Roberts, W.L. (2004) CDC/AHA workshop on markers of inflammation and cardiovascular disease: Application to clinical and public health practice: laboratory tests available to assess inflammation--performance and standardization: a background paper. Circulation: 110(25); p.572-576. Perlstein, T.S., Weuve, J., Pfeffer, M.A. and Beckman, J.A. (2009) Red blood cell distribution width and mortality risk in a community-based prospective cohort. Archives of Internal Medicine: 169(6); p.588-594. Fujita, B., Strodthoff, D., Fritzenwanger, M., Pfeil, A., Ferrari, M., Goebel, B., Figulla, H.R., Geredes, N. and Jung, C. (2013) Altered red blood cell distribution width in overweight adolescents and its association with markers of inflammation. Pediatric Obesity: 8(5); p.385-391.