Increased visceral adipose tissue mass is associated with increased C-reactive protein in patients with manifest vascular diseases

Atherosclerosis. 2010 Sep;212(1):274-80. doi: 10.1016/j.atherosclerosis.2010.04.029. Epub 2010 May 21.


Background: Obesity is related to the development of vascular diseases and metabolic complications. Low grade inflammation is a key feature of central obesity, characterized by elevated plasma levels of C-reactive protein (CRP). We hypothesize that visceral adipose tissue contributes to systemic concentrations of CRP.

Methods: In 2410 patients (1729 men and 681 women) with vascular diseases, subcutaneous and visceral fat masses were analyzed with ultrasonography. Metabolic parameters and CRP were measured in a fasting state. The association between fat measurements and plasma CRP was quantified using linear regression analysis. CRP levels were logarithmically transformed. Adjustments were made for age, smoking, type 2 diabetes mellitus, insulin resistance (HOMA-IR) and medication use.

Results: Visceral fat was categorized into quartiles (Q) ranging from 3.2 to 7.8 cm in Q1 (reference) to 11.0-19.8 cm in Q4 in men and 2.7-6.0 cm in Q1 (reference) to 9.0-17.4 cm in Q4 in women. beta-coefficients gradually increased across the quartiles from 0.07 (0.01-0.13) in Q2 to 0.25 (0.19-0.31) in Q4 in men and 0.17 (0.07-0.26) in Q2 to 0.42 (0.32-0.52) in Q4 in women, indicating 0.25 and 0.42 mg/l higher logarithmically transformed (log)CRP levels in Q4 compared to Q1 in respectively men and women. Per standard deviation increase of visceral fat, logCRP levels increased with 0.10 mg/l (0.07-0.12) in men and with 0.11 (0.15-0.19) in women. Likewise, in separate analyses waist circumference and body mass index showed a positive, but weaker association with logCRP levels across quartiles (in men: beta 0.21 (0.15-0.27) in Q4 for waist circumference and beta 0.23 (0.17-0.30) in Q4 for body mass index; in women: beta 0.32 (0.22-0.42) in Q4 for waist circumference and beta 0.32 (0.22-0.42) in Q4 for body mass index). In men subcutaneous fat was not associated with logCRP (beta-coefficients relative to Q1: -0.01 (-0.07 to -0.05), -0.01 (-0.07 to -0.05) and 0.05 (-0.01 to -0.11) in Q2 to Q4 respectively).

Conclusions: In conclusion, visceral fat thickness is the strongest contributor to the systemic CRP concentrations in patients with vascular diseases.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adiposity*
  • Aged
  • Atherosclerosis / diagnostic imaging
  • Atherosclerosis / etiology*
  • Atherosclerosis / immunology
  • Biomarkers / blood
  • Body Mass Index
  • C-Reactive Protein / analysis*
  • Cross-Sectional Studies
  • Fasting / blood
  • Female
  • Humans
  • Inflammation / diagnostic imaging
  • Inflammation / etiology*
  • Inflammation / immunology
  • Inflammation Mediators / blood*
  • Insulin Resistance
  • Intra-Abdominal Fat / diagnostic imaging*
  • Linear Models
  • Male
  • Middle Aged
  • Netherlands
  • Obesity / complications*
  • Obesity / diagnostic imaging
  • Obesity / immunology
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Subcutaneous Fat, Abdominal / diagnostic imaging
  • Ultrasonography
  • Up-Regulation
  • Waist Circumference


  • Biomarkers
  • Inflammation Mediators
  • C-Reactive Protein