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Serum C3 is a stronger inflammatory marker of insulin resistance than C-reactive protein, leukocyte count and erythrocyte sedimentation rate. A comparison study in an elderly population

Antonio Muscari, MD, Serafina Antonelli, MD^*, Giampaolo Bianchi, MD, Giulia Cavrini, PhD, Susanna Dapporto, MD, Amedeo Ligabue, MD^*, Cosimo Ludovico, MD, Donatella Magalotti, MD, Guido Poggiopollini, MD, Marco Zoli, MD on behalf of the Pianoro Study Group

Internal Medicine, Cardioangiology, Hepatology, University of Bologna,
*Laboratory of the Azienda USL Bologna, and
Statistical Sciences, University of Bologna, Bologna, Italy

amuscari{at}med.unibo.it

ABSTRACT

Objective.: This study was performed to ascertain the relative relevance of some inflammatory markers in insulin resistance.

Research Design and Methods.: Four inflammatory markers (leukocyte count, erythrocyte sedimentation rate (ESR), high sensitivity C-reactive protein (CRP) and C3 complement) were assessed as possible determinants of the HOMA (homeostasis model assessment) index, together with the 5 elements of the metabolic syndrome (NCEP-ATPIII definition), total cholesterol, physical activity and 4 indicators of adiposity (body mass index, waist circumference, %body fat and hepatic steatosis) in an unselected population of 990 subjects aged 65-91 years (the Pianoro Study).

Results.: In univariable analysis C3, CRP and leukocyte count, but not ESR, were significantly correlated with HOMA index. In multivariable analysis C3 remained associated with insulin resistance with the highest partial-R² value (0.049), independently of all other covariates. The other most significant (P<0.0001) determinants of HOMA index were total cholesterol (inverse association, partial-R²=0.026), waist circumference (partial-R²=0.023), triglycerides (partial-R²=0.022) and hepatic steatosis (partial-R²=0.021) (R²=0.450 for the whole model).

The adjusted relative risks of having the metabolic syndrome for the subjects with inflammatory markers in the high tertile, with respect to those with lower values, were (prevalence ratio, 95 % CI): 1.77, 1.41-2.22 for C3; 1.38, 1.12-1.70 for leukocyte count; 1.17, 0.94-1.46 for CRP; and 1.13, 0.91-1.40 for ESR.

Conclusions.: Of the 4 inflammatory markers simultaneously assessed in our elderly population, only C3 was strongly associated with insulin resistance, independently of the components of the metabolic syndrome and the main indices of abdominal and general obesity.

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