Inflammatory Markers and Risk of Developing Type 2 Diabetes in Women
Article Figures & Tables
Figures
- FIG. 1.
A–D: Multivariate OR of type 2 diabetes according to joint classifications of plasma levels of inflammatory and endothelial markers. Adjusted for the same variables as in Table 3.
- FIG. 2.
Multivariate OR of type 2 diabetes according to quintiles of CRP levels stratified by regular aspirin use (≥1/week). P for interaction = 0.0002. Adjusted for the same variables as in Table 3.
Tables
- TABLE 1
Comparison of diabetes risk factors between case and control subjects at baseline*
Case Control P n 737 785 Age (years) 56.3 ± 6.9 56.2 ± 6.9 0.69 BMI (kg/m2) 30.3 ± 5.6 26.2 ± 6.1 <0.001 Physical activity (METs/week)† 12.3 ± 15.2 15.6 ± 27.2 0.004 Alcohol consumption (g/day) 3.7 ± 7.1 6.5 ± 9.0 <0.001 Waist circumference (in) 35.3 ± 4.9 31.3 ± 4.9 <0.001 Diet score‡ 7.8 ± 2.7 8.2 ± 2.7 <0.001 Current smoking (%) 14.1 13.3 0.62 Postmenopausal status (%) 36.0 42.3 0.01 Current postmenopausal hormone use (%) 39.8 36.0 0.35 Family history of diabetes in first-degree relative (%) 46.8 21.0 <0.001 Race (Caucasian) (%) 94.8 94.3 0.68 Aspirin use ≥1/week 25.1 20.9 0.05 Biomarkers (median values) TNF-αR2 (pg/ml) 2,646.5 2,383.8 <0.001 CRP (mg/dl) 0.36 0.16 <0.001 IL-6 (pg/ml) 2.38 1.84 <0.001 E-selectin (pg/ml) 61.25 45.37 <0.001 Fasting insulin (uU/ml)§ 11.96 8.27 <0.001 Data are means ± SE unless otherwise indicated.
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* Case and control subjects were matched on age, fasting status, and race.
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† MET, metabolic equivalent; 1 MET hour is equivalent to energy expended by sting quietly for 1 h.
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‡ Intakes for trans fat, cereal fiber, glycemic load, and P-to-S (polyunsaturated fat-to-saturated fat) ratio were categorized into quintiles and for each participant, the quintile value for each nutrient (a higher quintile score represents a lower risk) was summed and the sum was recategorized into quintiles.
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§ A total of 432 case and 398 control subjects had fasting insulin measurement.
- TABLE 2
Spearman correlation coefficients* between BMI, waist circumference, fasting insulin, and inflammatory markers in control subjects
BMI Waist circumference Fasting insulin CRP IL-6 TNF-αR2 E-selectin BMI 1.0 — — — — — — Waist circumference 0.78 1.0 — — — — — Fasting insulin 0.29 0.27 1.0 — — — — CRP 0.44 0.37 0.26 1.0 — — — IL-6 0.30 0.29 0.18 0.37 1.0 — — TNF-αR2 0.24 0.25 0.15 0.27 0.28 1.0 — E-selectin 0.28 0.27 0.26 0.24 0.25 0.23 1.0 - *
* All correlation coefficients were statistically significant at P < 0.05.
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- TABLE 3
RR (95% CI) of type 2 diabetes according to quintiles of inflammatory markers estimated from conditional logistic regression models
Q1 Q2 Q3 Q4 Q5 P for trend TNFαR2 (pg/ml) Range ≤1,927.7 1,827.8–2,224.4 2,224.5–2,530.0 2,530.1–3,023.5 ≥3,023.6 Median 1,705.6 2,085.5 2,385.9 2,737.5 3,448.4 n 96/167 98/155 124/153 192/155 227/155 Crude RR* 1.00 1.14 (0.79, 1.65) 1.29 (0.90, 1.84) 2.10 (1.49, 2.95) 2.59 (1.84, 3.65) <0.001 BMI-adjusted RR† 1.00 1.00 (0.68, 1.48) 1.11 (0.76, 1.62) 1.56 (1.08, 2.24) 1.67 (1.16, 2.42) <0.001 Multivariate RR‡ 1.00 0.89 (0.58, 1.37) 1.09 (0.73, 1.64) 1.47 (0.99, 2.18) 1.64 (1.10, 2.45) 0.001 IL-6 (pg/ml) Range ≤1.12 1.13–1.62 1.63–2.13 2.15–3.07 ≥3.08 Median 0.88 1.34 1.84 2.55 4.24 n 88/185 110/150 134/150 176/151 229/149 Crude RR 1.00 1.60 (1.11, 2.31) 1.77 (1.24, 2.53) 2.44 (1.71, 3.46) 3.25 (2.30, 4.58) <0.001 BMI-adjusted RR 1.00 1.29 (0.87, 1.90) 1.21 (0.83, 1.78) 1.55 (1.06, 2.26) 1.95 (1.34, 2.84) <0.001 Multivariate RR 1.00 1.24 (0.82, 1.88) 1.23 (0.81, 1.86) 1.43 (0.95, 2.15) 1.91 (1.27, 2.86) 0.001 CRP (mg/dl) Range ≤0.055 0.056–0.118 0.119–0.208 0.209–0.404 ≥0.405 Median 0.03 0.083 0.158 0.291 0.627 n 55/176 58/152 89/153 216/152 319/152 Crude RR 1.00 1.36 (0.87, 2.13) 2.11 (1.38, 3.22) 4.93 (3.33, 7.31) 7.08 (4.84, 10.37) <0.001 BMI-adjusted RR 1.00 1.20 (0.75, 1.91) 1.68 (1.08, 2.62) 3.64 (2.42, 5.49) 4.18 (2.78, 6.29) <0.001 Multivariate RR 1.00 1.30 (0.80, 2.13) 1.62 (1.01, 2.06) 3.61 (2.33, 5.60) 4.36 (2.80, 6.80) <0.001 - *
* Conditioned on matching variables: age, fasting status, and race;
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† BMI as a continuous variable;
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‡ adjusted for time at blood drawn, alcohol consumption (nondrinkers, 0–4.9, 5–10, and >10 g/day), physical activity (quintiles of METs/week), smoking status (never, past, and current smoking of 1–14, 15–24, and ≥25 cigarettes per day), BMI (continuous), family history of diabetes, postmenopausal hormone use and menopausal status (never/unknown user or premenopausal status, past, and current user), and diet score (in quintiles).
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- TABLE 4
Multivariate RR (95% CI) of type 2 diabetes according to quintiles of inflammatory markers stratified by BMI, physical activity, diet score, and family history of diabetes*
Q1 Q2 Q3 Q4 Q5 P for trend P for interaction TNFαR2 BMI <30 kg/m2 1.00 0.95 (0.58–1.57) 1.16 (0.72–1.87) 1.62 (1.02–2.59) 2.25 (1.39–3.62) <0.001 BMI ≥30 kg/m2 1.00 0.67 (0.26–1.68) 1.33 (0.53–3.35) 1.05 (0.45–2.44) 0.93 (0.41–2.09) 0.99 0.01 Physical activity levels Low 1.00 1.02 (0.58–1.77) 1.74 (1.02–2.98) 1.96 (1.18–3.28) 2.14 (1.29–3.54) <0.001 High 1.00 0.75 (0.41–1.38) 0.86 (0.48–1.54) 1.29 (0.74–2.26) 1.30 (0.72–2.34) 0.11 0.72 Diet score Low 1.00 0.74 (0.42–1.29) 1.04 (0.61–1.76) 1.45 (0.89–2.36) 2.05 (1.25–3.36) <0.001 High 1.00 1.06 (0.58–1.94) 1.32 (0.73–2.38) 1.78 (0.98–3.23) 1.18 (0.64–2.18) 0.48 0.21 Family history of diabetes Yes 1.00 0.73 (0.38–1.39) 0.75 (0.38–1.45) 1.15 (0.60–2.19) 1.51 (0.75–3.07) 0.07 No 1.00 0.93 (0.54–1.62) 1.45 (0.87–2.41) 1.82 (1.12–2.96) 1.88 (1.16–3.04) 0.002 0.46 IL-6 BMI <30 kg/m2 1.00 1.20 (0.75–1.92) 1.14 (0.70–1.84) 1.44 (0.90–2.30) 1.84 (1.16–2.94) 0.006 BMI ≥30 kg/m2 1.00 0.90 (0.31–2.62) 1.11 (0.41–3.00) 1.07 (0.41–2.78) 1.46 (0.57–3.76) 0.17 0.29 Physical activity levels Low 1.00 1.31 (0.75–2.29) 1.27 (0.73–2.23) 1.70 (1.00–2.91) 2.47 (1.44–4.24) <0.001 High 1.00 1.38 (0.77–2.45) 1.63 (0.93–2.86) 1.44 (0.81–2.53) 1.77 (1.01–3.08) 0.09 0.73 Diet score Low 1.00 0.96 (0.56–1.65) 1.36 (0.80–2.29) 1.30 (0.78–2.16) 1.86 (1.12–3.09) 0.004 High 1.00 1.74 (0.96–3.15) 1.28 (0.69–2.36) 1.85 (1.01–3.37) 2.16 (1.19–3.92) 0.024 0.38 Family history of diabetes Yes 1.00 1.99 (1.02–3.88) 1.79 (0.90–3.55) 2.19 (1.14–4.20) 1.97 (1.04–3.73) 0.16 No 1.00 0.90 (0.54–1.50) 1.15 (0.70–1.87) 1.29 (0.80–2.10) 1.95 (1.21–3.13) <0.001 0.13 CRP BMI <30 kg/m2 1.00 0.80 (0.46–1.37) 0.98 (0.57–1.69) 2.42 (1.49–3.95) 3.57 (2.13–5.96) <0.001 BMI ≥30 kg/m2 1.00 1.74 (0.48–6.27) 1.42 (0.49–4.18) 2.76 (1.01–7.58) 3.38 (1.31–8.77) 0.004 0.13 Physical activity levels Low 1.00 1.28 (0.69–2.37) 1.51 (0.83–2.74) 3.71 (2.14–6.43) 4.28 (2.47–7.43) <0.001 High 1.00 0.86 (0.42–1.78) 1.34 (0.68–2.62) 2.81 (1.49–5.30) 4.01 (2.09–7.68) <0.001 0.87 Diet score Low 1.00 1.03 (0.55–1.92) 1.28 (0.72–2.27) 2.91 (1.70–5.01) 4.33 (2.50–7.49) <0.001 High 1.00 1.23 (0.61–2.49) 1.69 (0.83–3.46) 3.89 (2.05–7.36) 4.10 (2.13–7.88) <0.001 0.94 Family history of diabetes Yes 1.00 1.49 (0.66–3.36) 1.84 (0.89–3.79) 3.27 (1.61–6.61) 3.73 (1.85–7.56) <0.001 No 1.00 0.94 (0.51–1.72) 1.15 (0.64–2.11) 3.30 (1.97–5.52) 4.66 (2.74–7.89) <0.001 0.15 - *
* Physical activity and diet score were classified into low and high groups according to median values. RRs were adjusted for the same variables as in table 3.
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