Role of Procalcitonin As an Inflammatory Marker in a Sample of Egyptian Children with Simple Obesity

Ghada M. El Kassas; Manal A. Shehata; Maged A. El Wakeel; Ahmed F. Amer; Fatma A. Elzaree; Marwa K. Darwish; Marwa F. Amer

doi:10.3889/oamjms.2018.323

Authors

Ghada M. El Kassas Department of Child Health, National Research Centre, Cairo
Manal A. Shehata Department of Child Health, National Research Centre, Cairo
Maged A. El Wakeel Department of Child Health, National Research Centre, Cairo
Ahmed F. Amer Department of Child Health, National Research Centre, Cairo
Fatma A. Elzaree Department of Child Health, National Research Centre, Cairo
Marwa K. Darwish Biochemistry Department, Faculty of Science, Suez University
Marwa F. Amer Department of Medical Biochemistry, Cairo University, Cairo

DOI:

https://doi.org/10.3889/oamjms.2018.323

Keywords:

Procalcitonin, Inflammatory Marker, Egyptian Children, Obesity

Abstract

BACKGROUND: Obesity is a multifactorial disease, associated with metabolic disorders and chronic low-grade inflammation. Procalcitonin (PCT) is well known as a biomarker of infection, and systemic inflammation. Recently, it has potential as a marker for chronic low-grade inflammation.

AIM: This study aims to evaluate the role of serum PCT as an inflammatory biomarker in the diagnosis of obesity-related low-grade inflammation.

METHOD: In this case-control study, 50 obese and 35 normal weight children and adolescents aged 5â€“15 years were enrolled. Anthropometric parameters were measured in all subjects. Blood samples were collected for measurement of lipid profile, blood glucose, insulin, high sensitivity-CRP (Hs-CRP) and serum procalcitonin. Serum (PCT) levels were assessed using enzyme-linked immunosorbent assay.

RESULTS: Obese participants had higher concentrations of serum PCT, total cholesterol, triglycerides, LDL-c, glucose and Hs-CRP than control group. On correlation analysis, procalcitonin had significant positive correlation with (BMI) z-score (P = 0.02), insulin (P = 0.00), insulin resistance (HOMA-IR) (P = 0.006), Hs-CRP (P = 0.02), total cholesterol (P = 0.04) and triglycerides (P = 0.00) in obese group.

CONCLUSION: The increased serum procalcitonin concentrations were closely related to measures of adiposity, Hs-CRP and insulin resistance, suggesting that PCT may be an excellent biomarker for obesity-related chronic low-grade inflammation in children and adolescents.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

World Health Organization (WHO). Childhood overweight and obesity. Global Strategy on Diet, Physical Activity and Health, 2018. Available at http://www.who.int/dietphysicalactivity/childhood/en/ Last accessed 11/6/ 2018.

Castro AM, Macedo-de la Concha LE, Pantoja-MelÃ©ndez CA. Low-grade inflammation and its relation to obesity and chronic degenerative diseases. Rev Med Hosp Gen MÃ©x. 2017; 80(2):101-105. https://doi.org/10.1016/j.hgmx.2016.06.011

Castro AM, Toledo Rojas A, Macedo de la Concha LE, et al. Laobesidad infantil, un problema de salud multisistÃ©mico. Rev Med Hosp Gen Mex. 2001; 75:37-40.

Becker KL, Snider R, Nylen ES. Procalcitonin in sepsis and systemic inflammation: a harmful biomarker and a therapeutic target. British journal of pharmacology. 2010; 159(2):253-64. https://doi.org/10.1111/j.1476-5381.2009.00433.x PMid:20002097 PMCid:PMC2825349

El Wakeel MA, Nassar MS, El Batal WH, Amer AF, Darwish MK, Aziz AA. Evaluation of procalcitonin as a biomarker for bacterial and nonbacterial community-acquired pneumonia in children. J Arab Soc Med Res. 2017; 12:68-72. https://doi.org/10.4103/jasmr.jasmr_19_17

Maruna P, Nedelnikova K, Gurlich R. Physiology and genetics of procalcitonin. Physiological Research. 2000; 49:S57-62. PMid:10984072

Briel M, Schuetz P, Mueller B, Young J, Schild U, Nusbaumer C, PÃ©riat P, Bucher HC, Christ-Crain M. Procalcitonin-guided antibiotic use vs a standard approach for acute respiratory tract infections in primary care. Archives of internal medicine. 2008; 168(18):2000-7. https://doi.org/10.1001/archinte.168.18.2000 PMid:18852401

Linscheid P, Seboek D, Zulewski H, Keller U, Muller B. Autocrine/paracrine role of inflammation-mediated calcitonin gene-related peptide and adrenomedullin expression in human adipose tissue. Endocrinology. 2005; 146(6):2699-708. https://doi.org/10.1210/en.2004-1424 PMid:15761041

Abbasi A, Corpeleijn E, Postmus D, Gansevoort RT, De Jong PE, Gans RO, Struck J, Hillege HL, Stolk RP, Navis G, Bakker SJ. Plasma procalcitonin is associated with obesity, insulin resistance, and the metabolic syndrome. The Journal of Clinical Endocrinology & Metabolism. 2010; 95(9):E26-31. https://doi.org/10.1210/jc.2010-0305 PMid:20534760

Lohman TG, Roche AF. Anthropometric standardization reference manual. Martorell R, editor. Champaign: Human kinetics books, 1988. PMCid:PMC279682

Tanner JM. Growth and physique studies. Human biology: a guide to field methods. 1969.

World Health Organization. WHO AnthroPlus for personal computers Manual: Software for assessing growth of the world's children and adolescents. Geneva: WHO, 2009.

Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clinical chemistry. 1972; 18(6):499-502. PMid:4337382

World Health Organization. WHO child growth standards: length/height for age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age, methods and development. World Health Organization, 2006.

Wadsworth C, Wadsworth E. Efficacy of latex agglutination and quantification methods for determination of C-reactive protein (CRP) in pediatric sera. Clin Chim Acta. 1984; 138(3):309-18. https://doi.org/10.1016/0009-8981(84)90138-4

Arkader R, Troster EJ, Lopes MR, JÃºnior RR, Carcillo JA, Leone C, Okay TS. Procalcitonin does discriminate between sepsis and systemic inflammatory response syndrome. Archives of disease in childhood. 2006; 91(2):117-20. https://doi.org/10.1136/adc.2005.077446 PMid:16326799 PMCid:PMC2082702

Lumeng CN, Saltiel AR. Inflammatory links between obesity and metabolic disease. J Clin Invest. 2011; 121(6):2111â€“2117. https://doi.org/10.1172/JCI57132 PMid:21633179 PMCid:PMC3104776

Lackey DE, Olefsky JM. Regulation of metabolism by the innate immune system. Nat Rev Endocrinol. 2016; 12(1):15â€“28. https://doi.org/10.1038/nrendo.2015.189 PMid:26553134

Ghanem AI, Khalid M. Association of Serum Procalcitonin (PCT) and High-Sensitivity C-Reactive Protein (hs-CRP) Levels with Insulin Resistance and Obesity in Type 2 Egyptian Diabetic Patients. Acta Medica Mediterranea. 2012; 28(2):95.

Hatzistilianou M, Hitoglou S, Gougoustamou D, Rekliti A, Tzouvelekis G, Nanas C, Catriu D, Kotsis A. Serum procalcitonin, adenosine deaminase and its isoenzymes in the aetiological diagnosis of pneumonia in children. International journal of immunopathology and pharmacology. 2002; 15(2):119-27. https://doi.org/10.1177/039463200201500207 PMid:12590874

Puder JJ, Varga S, Kraenzlin M, De Geyter C, Keller U, MuÌˆller B. Central fat excess in polycystic ovary syndrome: relation to low-grade inflammation and insulin resistance. The Journal of Clinical Endocrinology & Metabolism. 2005; 90(11):6014-21. https://doi.org/10.1210/jc.2005-1002 PMid:16105965

van Ree RM, de Vries AP, Oterdoom LH, Seelen MA, Gansevoort RT, Schouten JP, Struck J, Navis G, Gans RO, van der Heide JJ, van Son WJ, Bakker SJ. Plasma procalcitonin is an independent predictor of graft failure late after renal transplantation. Transplantation. 2009; 88:279-287. https://doi.org/10.1097/TP.0b013e3181ac9ea0 PMid:19623026

Linscheid P, Seboek D, Nylen ES, Langer I, Schlatter M, Becker KL, Keller U, MuÌˆller B. In vitro and in vivo calcitonin I gene expression in parenchymal cells: a novel product of human adipose tissue. Endocrinology. 2003; 144(12):5578-84. https://doi.org/10.1210/en.2003-0854 PMid:12960010

Linscheid P, Seboek D, Schaer DJ, Zulewski H, Keller U, MÃ¼ller B. Expression and secretion of procalcitonin and calcitonin gene-related peptide by adherent monocytes and by macrophage-activated adipocytes. Critical care medicine. 2004; 32(8):1715-21. https://doi.org/10.1097/01.CCM.0000134404.63292.71 PMid:15286549

BlÃ¼her M. Adipose tissue dysfunction contributes to obesity related metabolic diseases. Best Prac Res Clin Endocrinol Metab. 2013; 27:163-177. https://doi.org/10.1016/j.beem.2013.02.005 PMid:23731879

Van Gaal LF, Mertens IL, Christophe E. Mechanisms linking obesity with cardiovascular disease. Nature. 2006; 444(7121):875. https://doi.org/10.1038/nature05487 PMid:17167476

Ghanem AI, Khalid M. Association of Serum Procalcitonin (PCT) and High-Sensitivity C-Reactive Protein (hs-CRP) Levels with Insulin Resistance and Obesity in Type 2 Egyptian Diabetic Patients. Med J Cairo Univ. 2016; 84(1):1165-1171.

Boursier G, Avignon A, Kuster N, Boegner C, Leprieur E, Picandet M, Bargnoux AS, Badiou S, Dupuy AM, Cristol JP, Sultan A. Procalcitonin, an Independent Marker of Abdominal Fat Accumulation in Obese Patients. Clinical laboratory. 2016; 62(3):435-41. https://doi.org/10.7754/Clin.Lab.2015.150736

Wilding JPH. Obesity and nutritional factors in the pathogenesis of type 2 diabetes mellitus. In: Text book of Diabetes, 3rd ed. Pickup JC, Ed. Oxford, U.K., Black-well Science Ltd., 2003:21-21.

Saltiel AR, Olefsky JM. Inflammatory mechanisms linking obesity and metabolic disease. The Journal of clinical investigation. 2017; 127(1):1-4. https://doi.org/10.1172/JCI92035 PMid:28045402 PMCid:PMC5199709

Chen J, Wildman RP, Hamm LL, Muntner P, Reynolds K, Whelton PK, He J. Association between inflammation and insulin resistance in US nondiabetic adults: results from the Third National Health and Nutrition Examination Survey. Diabetes care. 2004; 27(12):2960-5. https://doi.org/10.2337/diacare.27.12.2960 PMid:15562214

Indulekha K, Suren-Dar J, Moha V. High Sensitivity C-Reactive Protein, Tumor Necrosis Factor-a, Interleukin-6, and Vascular Cell Adhesion Molecule-1 Levels in Asian Indians with Metabolic Syndrome and Insulin Resistance (CURES-105). Journal of Diabetes Science and Technology. 2011; 5(4):982-988. https://doi.org/10.1177/193229681100500421 PMid:21880241 PMCid:PMC3192605

Calabro P, Golia E, Maddaloni V, Malvezzi M, Casillo B, Marotta C, Calabro R, Golino P. Adipose tissue-mediated inflammation: the missing link between obesity and cardiovascular disease?. Internal and emergency medicine. 2009; 4(1):25-34. https://doi.org/10.1007/s11739-008-0207-2 PMid:19052701

Mathieu P, Poirier P, Pibarot P, Lemieux I, DesprÃ©s JP. Visceral obesity: the link among inflammation, hypertension, and cardiovascular disease. Hypertension. 2009; 53(4):577-84. https://doi.org/10.1161/HYPERTENSIONAHA.108.110320 PMid:19237685

Yu YH, Ginsberg HN. Adipocyte signaling and lipid homeostasis: sequelae of insulin-resistant adipose tissue. Circulation research. 2005; 96(10):1042-52. https://doi.org/10.1161/01.RES.0000165803.47776.38 PMid:15920027

RodrÃguez-HernÃ¡ndez H, Simental-MendÃa LE, RodrÃguez-RamÃrez G, Reyes-Romero MA. Obesity and inflammation: epidemiology, risk factors, and markers of inflammation. International journal of endocrinology. 2013; 2013.

Ford ES. The metabolic syndrome and C-reactive protein, fibrinogen, and leukocyte count: findings from the Third National Health and Nutrition Examination Survey. Atherosclerosis. 2003; 168(2):351-8. https://doi.org/10.1016/S0021-9150(03)00134-5

Park HS, Park JY, Yu R. Relationship of obesity and visceral adiposity with serum concentrations of CRP, TNF-Î± and IL-6. Diabetes research and clinical practice. 2005; 69(1):29-35. https://doi.org/10.1016/j.diabres.2004.11.007 PMid:15955385

Ahmed HH, Abdel Hameed ER, Shehata MA, El Wakeel MA, Elsawy DH, Elshafie AI. Relation between afamin level and some inflammatory markers in obese children. Medical Research Journal. 2015; 14(1):1-6. https://doi.org/10.1097/01.MJX.0000464329.16129.c0