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Mean Platelet Volume (MPV) as an inflammatory marker in type 2 diabetes mellitus and obesity

Authors:
Gulali Aktas at Karamanoglu Mehmetbey Üniversitesi
Gulali Aktas
Mehmet Zahid Kocak
Mehmet Zahid Kocak
Mehmet Zahid Kocak
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Tuba Taslamacıoğlu Duman
Tuba Taslamacıoğlu Duman
Tuba Taslamacıoğlu Duman
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Edip Erkus at Konya Training and Research Hospital
Edip Erkus
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Abstract and Figures

Background: Type 2 diabetes mellitus and obesity are two important disorders which are associated with the enormous amount of morbidity and mortality. Inflammation plays a crucial role in development and complications of these diseases. Aim: We aimed to compare mean platelet volume (MPV) as an inflammatory marker in well and poorly controlled type 2 diabetic subjects and to observe its association with obesity indices, body mass index (BMI) and waist circumference. Method: Data of type 2 diabetic patients obtained from institutional database retrospectively analyzed. Patients were divided into two groups according to the HbA1c level as follows: HbA1c lower than 7% were classified as well-controlled, and HbA1c equal to or greater than 7% were classified as poorly controlled diabetics. Result: Both MPV, body mass index (BMI) and waist circumference were significantly higher in poorly controlled diabetics compared to patients with well-controlled type 2 DM. Conclusion: MPV could be considered as a marker of inflammatory burden in type 2 DM and obesity. Due to its cost-effective and easy to assess nature, MPV may be screened periodically in these patients, along with HbA1c and other measures to keep both physicians and patients aware of the inflammatory load of these diseases. Keywords: Type 2 diabetes mellitus, body mass index, obesity, mean platelet volume, inflammation
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ORIGINAL ARTICLE
Bali Medical Journal (Bali Med J) 2018, Volume 7, Number 3: 650-653
P-ISSN.2089-1180, E-ISSN.2302-2914
650 Open access: www.balimedicaljournal.org and ojs.unud.ac.id/index.php/bmj
CrossMark
Published by DiscoverSys
1Abant Izzet Baysal University
Hospital, Department of Internal
Medicine, Bolu, Turkey
2Abant Izzet Baysal University
Hospital, Department of General
Surgery, Bolu, Turkey
*authors were at the equal
contribution in generating the
study and this article.
ABSTRACT
Background: Type 2 diabetes mellitus and obesity are two important
disorders which are associated with the enormous amount of morbidity
and mortality. Inflammation plays a crucial role in development and
complications of these diseases.
Aim: We aimed to compare mean platelet volume (MPV) as an
inflammatory marker in well and poorly controlled type 2 diabetic
subjects and to observe its association with obesity indices, body mass
index (BMI) and waist circumference.
Method: Data of type 2 diabetic patients obtained from
institutional database retrospectively analyzed. Patients were
divided into two groups according to the HbA1c level as follows:
HbA1c lower than 7% were classified as well-controlled, and
HbA1c equal to or greater than 7% were classified as poorly
controlled diabetics.
Result: Both MPV, body mass index (BMI) and waist circumference
were significantly higher in poorly controlled diabetics compared to
patients with well-controlled type 2 DM.
Conclusion: MPV could be considered as a marker of inflammatory
burden in type 2 DM and obesity. Due to its cost-effective and easy
to assess nature, MPV may be screened periodically in these patients,
along with HbA1c and other measures to keep both physicians and
patients aware of the inflammatory load of these diseases.
Keywords: Type 2 diabetes mellitus, body mass index, obesity, mean platelet volume, inflammation
Cite This Article: Aktas, G., Kocak, M.Z., Duman, T.T., Erkus, E. Atak, B.M., Sit, M., Savli, H. 2018. Mean Platelet Volume (MPV) as an inflammatory
marker in type 2 diabetes mellitus and obesity. Bali Medical Journal 7(3): 650-653. DOI:10.15562/bmj.v7i3.806
Mean Platelet Volume (MPV) as an inflammatory
marker in type 2 diabetes mellitus and obesity
Gulali Aktas,1* Mehmet Z. Kocak,1 Tuba T. Duman,1 Edip Erkus,1
Burcin M. Atak,1 Mustafa Sit,2 Haluk Savli1
INTRODUCTION
Type 2 diabetes mellitus (DM) is one of the most
important cause of morbidity and mortality around
the world. e uncontrolled disease is associated
with increased morbidity and mortality. Obesity
is another serious condition which has a close
relation to mortal and debilitating diseases, such
as, cardiovascular diseases, type 2 DM, cerebro-
vascular diseases and hypertension. Both type 2
diabetes mellitus and obesity increase the inam-
matory burden and cause a continuous low-grade
inammation. Authors suggest that inammatory
microenvironment in obese and diabetic patients is
responsible for many of the complications of these
disorders.1
While inammation plays a crucial role in the
development of many diseases and their complica-
tions, hemogram parameters, such as mean platelet
volume (MPV) is considered as a novel inam-
matory marker. Mean platelet volume has been
reported to be associated with mortality in critical
care.2 Beside overt inammation, such as inam-
matory bowel disease,3 and rheumatoid arthritis,4 it
has also been found to be associated with low-grade
inammatory conditions.5 Previously, we showed
the association between MPV and type 2 DM.6
In present retrospective study, we aimed to
compare MPV values of the well and poorly
controlled type 2 diabetic subjects and to observe
its association with obesity indices, body mass
index (BMI) and waist circumference.
RESEARCH DESIGN AND METHODS
We retrospectively screened the computerized data-
base and patient les of our institution and collected
the data from subjects with type 2 diabetes mellitus.
Patients with infection or any other inammatory
diseases were excluded. We also did not include
pregnant subjects in the study. General character-
istics, such as age, gender, antidiabetic medications
used, and ndings in physical examination, such as
height, weight, waist circumference, blood pressure
(systolic and diastolic) and heart rate were recorded.
We calculated body mass index by the division of
weight by the square of height.
We obtained and recorded the laboratory
parameters from database and patient les. ose
include glycated hemoglobin (HbA1c), fasting
plasma glucose (FPG), blood urea, creatinine,
aspartate aminotransferase (AST), alanine amino-
transferase (ALT), white blood cell count (WBC),
hemoglobin (Hb), hematocrit (Htc), platelet count
(PLT) and MPV. Patients were divided into two
groups according to the HbA1c level. Subjects
*Correspondence to:
Gulali Aktas, Abant Izzet Baysal
University Hospital, Department
of Internal Medicine, Bolu, Turkey
authors were at the equal contri-
bution in generating the study and
this article
draliaktas@yahoo.com
Received: 2017-08-10
Accepted: 2018-6-28
Published: 2018-9-1
Volume No.: 7
Issue: 3
First page No.: 650
P-ISSN.2089-1180
E-ISSN.2302-2914
Doi: http://dx.doi.org/10.15562/bmj.v7i3.806
ORIGINAL ARTICLE
651
Published by DiscoverSys | Bali Med J 2018; 7(3): 650-653 | doi: 10.15562/bmj.v7i3.806
ORIGINAL ARTICLE
with an HbA1c lower than 7% were classied as
well-controlled, and equal to or greater than 7%
were classied as poorly controlled diabetics.
Statistical analyses were conducted by SPSS
software (SPSS 15.0; SPSS Inc., IBM, Chicago,
IL, USA). Homogenous variables were compared
between groups by t-test and expressed as
mean ± SD. Nonhomogenous variables were
compared between groups by Mann-Whitney
U test and expressed as median (min.-max.).
Nonparametric variables were analyzed by
chi-square test. Statistically, significance was
set on the level of a p-value lower than 0.05. We
conducted correlation analyses using Pearson’s
correlation. The significance of correlation was
set on a p-value lower than 0.01. The study was
approved by the institutional directorate.
RESULTS
A total of 115 subjects enrolled in the study, 54 in
well-controlled and 61 in poorly controlled type 2
diabetes mellitus group. Age of the well-controlled
diabetics (64 [35-77] years) was signicantly
advanced than that of the poorly controlled subjects
(58 [25-81] years) (p = 0.02).
While 24 of 54 subjects in well-controlled diabe-
tes group were men and 30 were women, 26 were
men, and 35 were women in poorly controlled
diabetes group. Gender was not statistically dier-
ent between study groups (p=0.84). Systolic and
diastolic blood pressures, heart rate, blood Hb,
Htc, WBC, PLT, urea, creatinine, AST and ALT
levels were not statistically dierent between
well-controlled and poorly controlled subjects
Table 1 General characteristics of the study groups
Characteristics
Well-controlled Poorly controlled
pMedian (Min-Max)
Age (years) 64 (35-77) 58 (25-81) 0.02
Waist circumference (cm) 88 (74-121) 96 (79-110) 0.001
Systolic BP (mmHg) 122 (110-142) 128 (110-141) 0.19
Diastolic BP (mmHg) 80 (68-90) 80 (68-89) 0.96
Mean ± SD
Heart rate (beat per minute) 79 ± 4 78 ± 5 0.45
BMI (kg/m2) 27.3 ± 4.7 29.1 ± 4.3 0.03
Chi-Square test
Gender Men (n) 24 26 0.84
Women (n) 30 35
Metformin usage Ye s 33 25 0.03
No 21 36
Table 2 Laboratory parameters of the study groups
Laboratory parameters
Well-controlled Poorly controlled
pMean ± SD
WBC (u/mm3) 7.3 ± 1.6 7.8 ± 1.7 0.13
Hb (g/dl) 14 ± 1.3 14 ± 1.5 0.92
Htc (%) 42 ± 3.5 42 ± 4 0.98
PLT (u/mm3) 252 ± 77 273 ± 74 0.13
MPV (fL) 7.9 ± 1.3 9.6 ± 1.1 < 0.001
Median (Min-Max)
HbA1c (%) 6.5 (5.5-6.9) 9.3 (7.1-12.5) < 0.001
Urea (mg/dl) 33 (17-51) 28 (15-68) 0.24
Creatinine (mg/dl) 0.81 (0.6-1.5) 0.80 (0.50-1.81) 0.97
AST (IU/L) 19 (10-91) 18 (10-71) 0.55
ALT (IU/L) 20 (8-28) 24 (9-66) 0.21
FPG (mg/dl) 124 (92-134) 190 (104-315) < 0.001
652 Published by DiscoverSys | Bali Med J 2018; 7(3): 650-653 | doi: 10.15562/bmj.v7i3.806
ORIGINAL ARTICLE
(p > 0.05 for all). Waist circumference and BMI
were signicantly higher in poorly controlled
subjects compared to well-controlled diabetics
(p = 0.001 for waist circumference and p = 0.03 for
BMI). Table 1 shows the general characteristics of
the study groups, and table 2 shows the summary
of laboratory data.
Pearson correlation analysis revealed that MPV
was positively and strongly correlated with both
HbA1c (p < 0.001, r = 0.55), fasting plasma glucose
(p < 0.001, r=0.39), waist circumference (p < 0.001,
r = 0.53), and BMI (p < 0.001, r = 0.42). On the
other hand, neither HbA1c (p = 0.13, r = 0.14) nor
fasting plasma glucose (p = 0.49, r = 0.06) were
correlated with BMI.
DISCUSSION
e main nding of the present retrospective anal-
ysis is that MPV could be considered as a marker of
the inammatory burden of glycemic control and
obesity in patients with type 2 diabetes mellitus.
Association between obesity and inammation
is well established. Authors found that adipos-
ity caused elevated C-reactive protein levels in
bloodstream.7 Obesity-related chronic low-grade
inammation is now considered as both an under-
lying trigger of the metabolic syndrome and its
complications.8 Reduction in the serum levels of
inammatory indices and improvement in insu-
lin sensitivity could be achieved by weight loss of
the obese subjects.9-11 Inammation is a response
of the body to the noxious stimulants, however, if
the immune cells fail to remove the harmful stim-
uli chronic inammation persists. Recent stud-
ies suggested that perpetual activation of innate
immune cells were responsible for chronic inam-
mation in extremely obese subjects.12 Because
inammation in obesity is unsurpassed and activa-
tion range of the immune cells are not widespread
as seen in infection or autoimmunity, the chronic
inammation in obesity and metabolic syndrome
is called a low-grade inammatory condition,13 or
as meta-inammation,14 or para-inammation.15
Many studies in literature pointed out an associa-
tion between obesity and inammatory indices.16,17
Similar to the literature data, a positive correlation
was demonstrated between MPV and BMI in the
present study.
Association between type 2 DM and activation
of the inammatory system is also well established
since the beginning of the 2000s.18,19 Moreover,
serum c-reactive protein of pregnant women in
the rst trimester who develop gestational DM
subsequently was signicantly increased compared
to pregnant women that remain normoglycemic
during pregnancy.20 Beside the role of inamma-
tion in the pathogenesis and development of the
disease, inammatory markers may also reect the
control level of type 2 DM. A study showed that
aspirin treatment resulted in a reduction in fasting
plasma glucose, and in c-reactive protein levels in
subjects with DM.21 Consistently with the litera-
ture, MPV elevation, as an inammatory marker,
was associated with worse control of the type 2 DM
in the present study.
In literature, the correlation between diabetic
control level and MPV is controversial. Researchers
studied MPV in 265 type 2 diabetic subjects and
compared to those in 151 nondiabetic controls,
and found a signicantly higher MPV in diabetic
subjects than controls. However, they could not
show a correlation between MPV and HbA1c
level.22 On the other hand, in another study in liter-
ature, authors found a strong correlation between
MPV and HbA1c level.23 Similarly, we also found
the correlation between MPV and HbA1c in our
report.
Although MPV tends to increase with age,
well-controlled diabetics with lower MPV were
signicantly older than poorly controlled diabet-
ics. is nding suggests MPV’s strength to state
inammation in type 2 diabetes mellitus.
Lack of correlation between HbA1c and BMI
may be explained by small study population of
the present report and a higher percentage of
metformin use in well-controlled diabetic subjects.
ere are two main limitations of this study.
First, relatively small cohort and second, retro-
spective design. However, a strong correlation
between MPV and diabetic regulation and obesity
indices that reported in our study adequately
make our results to be interpreted with the clinical
practice.
CONCLUSION
In conclusion, MPV could be considered as a
marker of inammatory burden in type 2 DM and
obesity. Due to its cost-eective and easy to assess
nature, MPV may be screened periodically in these
patients, along with HbA1c and other measures,
to keep both physicians and patients aware of the
inammatory load of these diseases.
CONFLICT OF INTEREST
e authors declare that they have no conicts of
interest with the contents of this article. is study
has not been funded by any organizations.
653
Published by DiscoverSys | Bali Med J 2018; 7(3): 650-653 | doi: 10.15562/bmj.v7i3.806
ORIGINAL ARTICLE
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This work is licensed under a Creative Commons Attribution
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Purpose Elevated serum gamma-glutamyltranspeptidase (GGT) is an independent marker of the activation of systemic inflammation, while conditions associated with elevated triglyceride (TG) levels, such as type 2 diabetes, non-alcoholic fatty liver disease, obesity, and metabolic syndrome, are associated with an increased inflammatory burden. Moreover, serum liver enzymes (GGT, alanine aminotransferase [ALT], aspartate aminotransferase [AST], and alkaline phosphatase [ALP]) are associated with metabolic syndrome and its components, including hypertriglyceridemia. However, the relationship between liver enzymes and postprandial hypertriglyceridemia (PHTG) remains unclear. Therefore, in this study we conducted oral fat tolerance tests (OFTTs) to understand the differences in serum liver enzyme levels among individuals with different lipid tolerance levels and their correlation with PHTG. Patients and Methods For the OFTT, we enrolled 202 non-diabetic volunteers whose fasting triglyceride (TG) levels were less than 1.7 mmol/L in this case-control study. The participants were categorized into two groups according to the TG levels at the 0- and 4-h OFTT: a postprandial normal TG (PNTG) group and a PHTG group. Routine fasting serum biochemical indices, liver enzyme (GGT, ALT, AST, and ALP) levels, and 0- and 4-h OFTT lipid levels were assessed. Results The PHTG group had significantly higher serum GGT and ALT levels and a lower AST/ALT ratio than those in the PNTG group. However, no significant difference was observed in AST and ALP levels compared with the PNTG group. After adjusting for major confounders, logistic regression analysis indicated a significant correlation between serum GGT and PHTG (odds ratio = 1.168, P < 0.001), but not with ALT level, AST level, AST/ALT ratio, and ALP level. The receiver operating characteristic curve analysis demonstrated that the serum GGT level was an effective predictor of PHTG. Conclusion Serum GGT levels are significantly associated with PHTG risk and serve as an effective biomarker for early identification.
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Full-text available
  • Jan 2024
Obesity increases the risk of various diseases. Black rice, renowned for its high anthocyanin content, is considered a potential functional food for preventing metabolic disorders. The current study investigated the effects of black rice crunch (BRC) on body weight and haematological profiles in obese rats. Rats were fed with high-fat diet to induce obesity and supplemented with different concentrations of BRC for 4 and 8 weeks. The results showed that high-fat diet effectively induced obesity, as evidenced by significant increase in body weight. Importantly, 75% BRC supplementation resulted in significant weight reduction in obese rats. Further analysis revealed an increase in erythrocyte numbers in obese groups supplemented with 75% BRC, but no significant changes in haemoglobin concentration or haematocrit percentage. Further investigation showed that 75% BRC led to a decrease in mean corpuscular hae-moglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), and mean corpuscular volume (MCV), potentially affecting the size and concentration of haemoglobin within erythrocytes. The total leucocytes count increased with the high-fat diet, while BRC supplementation alone did not have significant impact. Lymphocyte percentage remained stable across the groups, indicating minimal influence of the dietary interventions. Neutrophil percentage varied initially but was not specific to BRC or the high-fat diet. Platelet count and distribution width were not significantly influenced, but mean platelet volume (MPV) increased after 8 weeks of BRC treatment, suggesting larger platelet sizes associated with obesity. Overall, the study provides important insights into the effects of BRC supplementation on body weight and haemato-logical parameters related to obesity.
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... Inflammation has also been identified as one of the key risk factors contributing to the development of T2D [2,10,11]. The chronic inflammatory microenvironment established by obesity and T2D in people with these conditions results in various metabolic disorders associated with weight gain [12][13][14][15], including diabetic dyslipidemia, characterized by high low-density lipoprotein (LDL) cholesterol and triglycerides, and low high-density lipoprotein (HDL) cholesterol, comprising a major cardiovascular risk factor [16]; and elevated plasma levels of liver enzymes, such as aspartate aminotransferase (AST) and alanine transaminase (ALT) [17]. Furthermore, weight loss in people with obesity was shown to reduce serum levels of inflammatory markers, subsequently improving insulin sensitivity [18][19][20]. ...
Impact of Weight Change on Glycemic Control and Metabolic Parameters in T2D: A Retrospective US Study Based on Real-World Data
Article
Full-text available
  • Dec 2023
Weight loss has been identified as a key strategy for improving glycemic and metabolic outcomes in people with type 2 diabetes (T2D). However, the long-term, real-world impact of weight loss on these outcomes remains unclear. This study aimed to investigate (1) the association between weight loss and glycemic control, (2) association between weight loss and metabolic parameters, and (3) predictors of weight loss and how weight change trajectory varies based on index body mass index (BMI). A retrospective, longitudinal cohort study using the linked IQVIA Ambulatory electronic medical records and PharMetrics® Plus databases was performed from January 1, 2010 through December 31, 2019 in adults with T2D. Participants were categorized into 1-year and 5-year follow-up cohorts based on their observed weight change over time. Longitudinal values for vital signs and laboratory parameters, including BMI, weight, glycated hemoglobin (HbA1c), and metabolic parameters (liver enzymes and cholesterol), were reported at index date and every 6 months post index date. Multivariable logistic regression analysis was used to evaluate the factors associated with weight loss. Of 1,493,964 people evaluated, 1,061,354 (71%) and 308,320 (20.6%) were classified into the 1-year and 5-year follow-up cohorts. Average HbA1c reductions of 1.2% and 0.5% were observed among people who lost ≥ 15% of index weight in the 1-year and 5-year follow-up cohorts, respectively. Higher weight loss percentages were associated with numerically greater improvements in metabolic parameters. The presence of bariatric surgery and higher index BMIs were identified as the strongest predictors of ≥ 15% and ≥ 10% weight loss in both follow-up cohorts. Results from this study suggest that modest and sustained weight loss can lead to clinically meaningful improvements in glycemic and metabolic parameters among people with T2D. These findings highlight the importance of weight management in managing T2D and preventing its associated complications.
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Evaluation of the Effectiveness of In-Hospital Exercise Rehabilitation in Middle-Aged and Elderly Patients with Type 2 Diabetes Mellitus Combined with Sarcopenia Effect of Lifestyle Management on Disease Status in Patients with Type 2 Diabetes Mellitus
Article
  • May 2024
  • ENDOCR RES
Objective: The aim of this study was to explore the effects of in-hospital exercise rehabilitation on glucose and lipid metabolism and healthy physical fitness in middle-aged and elderly patients with type 2 diabetes mellitus (T2DM) combined with sarcopenia, and to provide a reference for the effective implementation of exercise rehabilitation for middle-aged and elderly patients with T2DM combined with sarcopenia in healthcare institutions. Methods: This study retrospectively included 122 patients with T2DM combined with sarcopenia treated at the General Hospital of Ningxia Medical University from August 2017 to August 2020 and randomly divided into a control group and an experimental group. The control group was given conventional treatment and the experimental group was given exercise rehabilitation in the hospital for 12 weeks to compare the indexes related to glucose and lipid metabolism and healthy fitness in the two groups. Results: After the intervention, the experimental group showed significant decreases in fasting blood glucose (FBG), glycated hemoglobin (HbA1c), insulin resistance index (HOMA-IR), triglycerides (TG), total cholesterol (TC), low-density cholesterol (LDL-C) and body fat percentage (p < 0.05), while high-density cholesterol (HDL-C), grip strength, lower limb extension, lower limb flexion, peak oxygen uptake were significantly higher (p < 0.05) and were more significant at 12 weeks compared to the 6-week intervention (p < 0.05). However, there were no significant changes in any of the glucose metabolism indicators in the control group before and after the intervention. A two-way repeated measures ANOVA showed that at control baseline levels, HbA1c decreased significantly in the experimental group after both 6 and 12 weeks of intervention compared to the control group (p < 0.05). After 6 weeks of intervention, the experimental group showed a significant decrease in body fat percentage and a significant increase in grip strength. After 12 weeks of intervention, the experimental group showed an increase in glycemic control from 33.3% to 73.3%, a significant decrease in body fat percentage and a significant increase in grip strength, lower limb extension and lower limb flexion strength and peak oxygen uptake. Conclusion: In-hospital exercise rehabilitation can effectively improve the glycemic and lipid profiles of patients with T2DM combined with sarcopenia and enhance their health fitness, with good clinical rehabilitation effects.
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Correlation of presence and severity of glucose derangements with severity of Liver Cirrhosis: a hospital-based cross sectional observational study from New Delhi
Article
  • Nov 2023
Association between liver cirrhosis (LC) and glucose intolerance has been known since long. Many studies in the past have attempted to explore the correlation of glucose metabolism disorders (GMD) with the severity of LC with mixed results (some favouring i.e. higher prevalence of GMD in more severe LC; others negating). This study was conducted to shed further light on the significance of this association. This study has been carried out with the aim of studying the correlation between GMD and the severity of LC, as determined by the Child-Turcotte-Pughe (CTP) score. 100 patients with LC admitted in medical wards were studied and tested with fasting plasma glucose (FPG), 2 h post-75 g oral glucose load plasma glucose (PPG), glycosylated haemoglobin (HbA1c) and fasting plasma insulin. They were categorized based on the severity of LC into CTP A, B or C class and then patients belonging to different classes were compared for the presence of GMD and insulin resistance (IR). Out of 100 patients, 6, 21 and 73 were respectively found as falling under CTP class A, B and C of LC. The frequency of diabetes mellitus (DM) was found to progressively increase with worsening grade of cirrhosis (17%-A, 24%-B and 27%-C), however this was not significant (p value 0.82). The p values for IR, GMD (pre-diabetes or DM), pre-diabetes (pre-DM) were 0.629, 0.382 and 0.189 respectively. To conclude, development of GMD and IR may be independent of the severity of LC. However more studies may be required to further study this association.
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The roles of type 2 diabetes and obesity in disease activity and progression of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis
Article
Objective: We examined the roles of type 2 diabetes (T2D) and obesity in disease activity and fibrosis progression/regression in patients with non-alcoholic fatty liver disease/non-alcoholic steatohepatitis (NAFLD/NASH). Methods: This multi-center, retrospective study included patients with suspected or histologically proven NAFLD/NASH from the NASH Clinical Research Network. Outcomes included disease activity and rate of fibrosis, assessed using liver-biopsy driven measures (NAFLD activity score [NAS] and fibrosis score [FS]). Logistic regression and doubly robu estimation of causal effects tested relationships among T2D, obesity, and NAFLD/NASH. Results: The analytical sample included 870 adult patients with baseline biopsy data and 157 patients with multiple biopsy data. Patients with NAFLD/NASH and T2D had significantly higher baseline average NAS (4.52 vs. 4.13; p = 0.009) and FS (2.17 vs. 1.56; p < 0.0001); those with T2D had a significantly greater reduction in average NAS over time (-0.77/year vs. -0.17/year; p = 0.0008). Change in FS over time did not differ significantly by T2D status (-0.23/year vs. -0.04/year; p = 0.34). Baseline NAS, baseline FS, and change in average NAS over time did not differ significantly by obesity status (4.17 vs. 4.47; p = 0.16; 1.73 vs.1.92; p = 0.31; -0.40/year vs. -0.59/year; p = 0.62, respectively). Patients with obesity had a slight increase in FS but those without obesity had a reduction in average FS over time (0.07/year vs. -0.27/year; p = 0.008). Conclusions: Patients with NAFLD/NASH and T2D had greater baseline disease activity versus those without T2D, but there was greater regression of disease activity over time among those with T2D. Patients with NAFLD/NASH and obesity had worsening of fibrosis versus those without obesity. NCT00063622.
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Mean platelet volume increases in type 2 diabetes mellitus independent of HbA1c level
Article
Full-text available
  • Jan 2014
  • ACTA MEDICA MEDITERR
Aims: Diabetes mellitus is an important health problem worldwide and associated with subclinical inflammation. Several inflammatory markers have been studied in these conditions. Mean platelet volume and red cell distribution width are hemogram parameters that are suggested to be related with inflammation. We aimed to study hemogram parameters of type 2 diabetic patients, and compare to healthy subjects, retrospectively. Methods: We included patients with type 2 diabetes mellitus in this retrospective study. Healthy subjects admitted to our institution for a routine check-up were included as control group. Laboratory data such as, white blood cell count (WBC), hemoglobin (Hb), red cell distribution width (RDW), platelet count (PLT) and mean platelet volume (MPV) and concomitant HbA1c values of the participants recorded. Results: We could not found a significant difference in RDW levels between groups. On the other hand, MPV was significantly elevated in study group compared to control subjects. Conclusion: We suggest that MPV is associated with type 2 diabetes mellitus. Prospective studies with a larger cohort are necessity to define the relationship of MPV and the level of metabolic control.
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Red cell distribution width and mean platelet volume in patients with irritable bowel syndrome
Article
Full-text available
  • Jun 2014
  • PRZ GASTROENTEROL
Introduction: Possible pathophysiological mechanisms of irritable bowel syndrome (IBS) are interactions between microbial flora of the gut and the mucosal/systemic immune system, post-infectious status and inflammation. Mean platelet volume (MPV) and red cell distribution width (RDW) have been reported as inflammatory markers in patients with inflammatory bowel disease, but they have not been studied in functional gastrointestinal disorders. Aim: To investigate whether there was an association between haemogram parameters (RDW and MPV) and IBS. Material and methods: Forty patients with IBS and 44 healthy controls were included to this retrospective study. Patients diagnosed with IBS according to Rome III criteria were included as the IBS group. They were all screened for psychiatric or organic bowel diseases for the sake of precise diagnosis. Results: Both RDW (p < 0.001) and MPV (p = 0.046) were increased in patients with IBS compared to controls. This increase in RDW and MPV was independent of the type of IBS. Conclusions: The RDW and MPV should be laboratory indicators of IBS. More prospective studies with larger cohorts are needed to confirm our results.
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Chronic Inflammation in Obesity and the Metabolic Syndrome
Article
Full-text available
The increasing incidence of obesity and the metabolic syndrome is disturbing. The activation of inflammatory pathways, used normally as host defence, reminds the seriousness of this condition. There is probably more than one cause for activation of inflammation. Apparently, metabolic overload evokes stress reactions, such as oxidative, inflammatory, organelle and cell hypertrophy, generating vicious cycles. Adipocyte hypertrophy, through physical reasons, facilitates cell rupture, what will evoke an inflammatory reaction. Inability of adipose tissue development to engulf incoming fat leads to deposition in other organs, mainly in the liver, with consequences on insulin resistance. The oxidative stress which accompanies feeding, particularly when there is excessive ingestion of fat and/or other macronutrients without concomitant ingestion of antioxidant-rich foods/beverages, may contribute to inflammation attributed to obesity. Moreover, data on the interaction of microbiota with food and obesity brought new hypothesis for the obesity/fat diet relationship with inflammation. Beyond these, other phenomena, for instance psychological and/or circadian rhythm disturbances, may likewise contribute to oxidative/inflammatory status. The difficulty in the management of obesity/metabolic syndrome is linked to their multifactorial nature where environmental, genetic and psychosocial factors interact through complex networks.
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Mean platelet volume in patients with rheumatoid arthritis: The effect of anti-TNF-alpha therapy
Article
Full-text available
  • Jun 2010
  • RHEUMATOL INT
A number of mediators are involved in the inflammatory processes that affect joints and vascular wall of patients with rheumatoid arthritis (RA). Tumour necrosis factor alpha (TNFa) is one such mediator, and it is widely regarded as an important target for anti-rheumatic treatment. Most recent studies show that anti-TNFa medication suppresses inflammation and reduces overall activity of RA. The aim of the current study was to investigate changes of mean platelet volume (MPV) in response to the 3-month anti-TNFa therapy in RA. Twenty-one RA patients without established cardiovascular disease were recruited for anti-TNFa therapy and underwent thorough clinical and laboratory evaluation at baseline, 2 weeks, and 12 weeks. Anti-TNFa therapy resulted in a significant (p = 0.01) increase in MPV over the duration of the study (7.7 +/- 0.9, 7.8 +/- 1.1, and 8.4 +/- 1.1 fL at baseline, 2 weeks, and 12 weeks, respectively). The results of the study expand perspectives of the use of MPV in conditions associated with high-grade inflammation, particularly RA, for monitoring anti-inflammatory treatment. More prospective studies with large numbers of patients are warranted to ascertain associations of high and low values of MPV with diverse markers of inflammation and vascular pathology.
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Calprotectin — A Novel Marker of Obesity
Article
Full-text available
The two inflammatory molecules, S100A8 and S100A9, form a heterodimer, calprotectin. Plasma calprotectin levels are elevated in various inflammatory disorders. We hypothesized that plasma calprotectin levels would be increased in subjects with low-grade systemic inflammation i.e. either obese subjects or subjects with type 2 diabetes. Plasma calprotectin and skeletal muscle S100A8 mRNA levels were measured in a cohort consisting of 199 subjects divided into four groups depending on presence or absence of type 2 diabetes (T2D), and presence or absence of obesity. There was a significant interaction between obesity and T2D (p = 0.012). Plasma calprotectin was increased in obese relative to non-obese controls (p<0.0001), whereas it did not differ between obese and non-obese patients with T2D (p = 0.62). S100A8 mRNA levels in skeletal muscle were not influenced by obesity or T2D. Multivariate regression analysis (adjusting for age, sex, smoking and HOMA2-IR) showed plasma calprotectin to be strongly associated with BMI, even when further adjusted for fitness, CRP, TNF-alpha or neutrophil number. Plasma calprotectin is a marker of obesity in individuals without type 2 diabetes.
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Association Between Hemogram Parameters and Survival of Critically Ill Patients
Article
  • Jun 2019
  • J Intensive Care Med
Aim: Recently, hemogram parameters, such as mean platelet volume (MPV), had been proposed as novel inflammatory and prognostic factors. In present retrospective analysis, we aimed to determine and compare MPV of survived and dead patients whom admitted to intensive care unit (ICU) of our institution. Methods: We recorded hemogram parameters and other laboratory data and demographic characteristics of patients treated in ICU. Patients are divided into 2 groups-dead patients and survived patients. Laboratory data of survived patients compared to those of dead patients. Results: Age, gender, and other laboratory variables were not significantly different between dead and survived patients. On the other hand, MPV of survived patients was significantly higher than that of the dead patients ( P = .001). Conclusion: We think that elevated MPV levels in an ICU patient should alert clinicians for worse outcome. Physicians should be more careful in the management of these patients.
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Serum C-Reactive Protein and White Blood Cell Count in Morbidly Obese Surgical Patients
Article
  • Apr 2009
Obesity has been widely recognized as a chronic inflammatory condition and associated with elevated inflammatory indicators including C-reactive protein (CRP) and white blood cell count (WBC). Recent studies have shown elevated CRP or WBC is a significant risk factor for cardiac events and stroke but the clinical significance of CRP and WBC has not been clearly studied in morbidly obese patients. This study is aimed at the clinical significance of WBC and CRP in morbidly obese patients and the change after bariatric surgery. The study was a prospectively controlled clinical study. From December 1, 2001 to January 31, 2006, of 640 (442 females and 198 males) consecutive morbid obese patients enrolled in a surgically supervised weight loss program with at least 1 year's follow-up were examined. Of the patients, 476 (74.4%) had elevated CRP and 100 (15.6%) had elevated WBC at preoperative study. CRP and WBC were significantly related and both increased with increasing body mass index (BMI). CRP is also increased with increasing waist, glucose level, hemoglobin, albumin, Ca, insulin, C-peptide, and metabolic syndrome while WBC is increased with metabolic syndrome but decreased with increasing age. Multivariate analysis confirmed fasting glucose level and hemoglobin are independent predictors of the elevation of CRP while age is the only independent predictor for elevated WBC. Both WBC and CRP levels decreased rapidly after obesity surgery. These improvements resulted in a 69.8% reduction of CRP and 26.4% reduction of WBC 1 year after surgery. Although individuals who underwent laparoscopic gastric bypass lost significantly more weight (36.8 +/- 11.7 kg vs. 17.3 +/- 10.8 kg; p = 0.000) and achieved a lower BMI (27.8 +/- 4.6 vs. 35.0 +/- 5.5; p = 0.000) than individuals who underwent laparoscopic gastric banding, there was no difference in the resolution of elevated CRP 1 year after surgery (95.9% vs. 84.5%; p = 0.169) and WBC (99.4% vs. 98.3%; p = 0.323). Both baseline WBC and CRP are elevated in morbid obese patients but CRP has a better clinical significance. Significant weight reduction 1 year after surgery markedly reduced CRP and WBC with a resolution rate of 93.9% and 98.2% separately. Obesity surgery performed by laparoscopic surgery is recommended for obese patients with elevated CRP or WBC.
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Medzhitov, R. Origin and physiological roles of inflammation. Nature 454, 428-435
Article
  • Jul 2008
  • NATURE
Inflammation underlies a wide variety of physiological and pathological processes. Although the pathological aspects of many types of inflammation are well appreciated, their physiological functions are mostly unknown. The classic instigators of inflammation - infection and tissue injury - are at one end of a large range of adverse conditions that induce inflammation, and they trigger the recruitment of leukocytes and plasma proteins to the affected tissue site. Tissue stress or malfunction similarly induces an adaptive response, which is referred to here as para-inflammation. This response relies mainly on tissue-resident macrophages and is intermediate between the basal homeostatic state and a classic inflammatory response. Para-inflammation is probably responsible for the chronic inflammatory conditions that are associated with modern human diseases.
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[Soluble intercellular adhesion molecule-1 and C reactive protein after bariatric surgery].
Article
  • Mar 2010
Obesity is associated with a state of chronic low-grade inflammation. A causal association between inflammatory processes and atherogenesis has been proposed. The aim of this study was to evaluate changes in the proinflammatory profile of morbidly obese patients who underwent bariatric surgery. Serum C-reactive protein (CRP) and soluble intercellular adhesion molecule-1 (sICAM-1) concentrations were measured before and after massive weight loss due to gastric bypass. In this prospective study we measured CRP and sICAM-1 concentrations in 50 morbidly obese patients (19 men and 31 women) at baseline and 3, 6 and 12 months after gastric bypass. Body mass index (BMI), CRP, and sICAM-1 decreased significantly. BMI correlated with CRP but not with sICAM-1. The improvement in vascular risk profile after weight loss in morbidly obese patients could be partially explained by changes in inflammatory status.
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