International Journal of Obesity (2001) 25, Suppl 2, S74±S87 ß 2001 Nature Publishing Group All rights reserved 0307±0565/01 $15.00 www.nature.com/ijo Track 6 Cardiovascular system and obesity P152 P154 Urinary albumin excretion is independently associated with C-reactive Association of early carotid atherosclerosis with hyperinsulinemia and low protein levels in overweight and obese women DHEA(S) in normotensive severe obese women N Pannacciulli1, FP Cantatore2, A Minenna1, M Bellacicco1, R Giorgino1, and S Savastano1, AM Bel®ore2, R Valentino3, M Dorato2, N De Luca4, F Micanti5, G De Pergola1 C Mauriello2, C Falconi2, G Lupoli1, and G Lombardi1 1Department of Emergency and Organ Transplantation - Section of Internal 1Department of Molecular and Clinical Endocrinology and Oncology, University Medicine, Endocrinology and Metabolic Diseases, University of Bari, Bari, Italy; Federico II Medical School Naples, Via S. Pansini n. 5 - 80131 Italy; 2Department of Internal Medicine and Public Health - Section of Rheumatology, 2Department of Neurosciences, Unit of Physiology, University Federico II Medical University of Bari, Bari, Italy School Naples, Via S. Pansini n. 5 - 80131 Italy; 3C.E.O.S., CNR, Department of Cellular and Molecular Biology and Pathology, University Federico II Medical INTRODUCTION: The aim of the present study was to evaluate the possible 4 correlation between urinary albumin excretion (UAE), marker of endothelial School Naples, Via S. Pansini n. 5 - 80131 Italy; Department of Clinical Medicine and Cardiovascular Science, University Federico II Medical School dysfunction, and C-reactive protein (CRP), marker of chronic in¯ammation of 5 the arterial wall, in overweight and obese premenopausal women. Naples, Via S. Pansini n. 5 - 80131 Italy; Unit of Psychotherapy, Department METHODS: CRP levels and UAE rate were measured in 103 overweight (BMI of Psychiatry, University Federico II Medical School Naples, Via S. Pansini n. 25.0 ± 29.9 Kg=m2) and obese (BMI 30.0 Kg=m2) premenopausal women, 5 - 80131 Italy aged 18 ± 45 years. Other measurements included central fat accumulation, as INTRODUCTION: Hypertension, hyperlipemia, smoking, and hyperinsulinae- evaluated by waist circumference, insulin resistance, as calculated by home- mia are well known risk factors in the progression of atherosclerosis. Newer risk ostasis model assessment (HOMAIR), systolic and diastolic blood pressure, and factors, such as hyperandrogenism or DHEAS and DHEA [DHEA(S)] levels have fasting plasma levels of glucose, insulin, and lipids. also been recently suggested, although the direct evidence that hyperinsuli- RESULTS: UAE was positively correlated with BMI (P < 0.01), waist circumfer- naemia or DHEA(S) per se are directly involved has been con¯icting. We ence (P < 0.00l), diastolic blood pressure (P < 0.01), triglyceride (P < 0.01), investigate the cross-sectional association of early carotid atherosclerosis, HOMAIR (P < 0.05), and CRP levels (P < 0.05), and negatively associated with measured as intima-media thickness (IMT), with hyperinsulinaemia, and low HDL-cholesterol (P < 0.001). After multivariate analysis, diastolic blood pres- circulating DHEA(S) levels in 17 normotensive severe obese premenopausal sure, HDL-cholesterol, and CRP levels maintained their signi®cant correlation women and 10 normal-weight age-matched subjects. with UAE (P < 0.05, P < 0.01, and P < 0.01, respectively). Lastly, we observed a METHODS: Oral glucose tolerance test (OGTT), adrenal secretion, carotid gradual increase in CRP plasma levels across the quartiles in which the whole diameter (CD), and left ventricular mass index (LVMi) were determined. population was divided according to UAE levels (F: 5.67, P 0.001 for linear RESULTS: Impaired glucose tolerance was present in 29% of the obese trend). patients. DHEA(S) levels (P < 0.001) were lower and negatively correlated CONCLUSION: Our study shows a strong relationship between UAE rate and with simulated insulin (r70.7; P < 0.01), in spite of normal values of other CRP concentrations, irrespective of age and other anthropometric and meta- androgens and increased plasma cortisol and urinary free cortisol were found bolic variables. On this basis, it can be argued that in¯ammation of the arterial in 53% of the obese patients, with normal dexamethasone suppression test. wall, as indicated by higher CRP plasma levels, and endothelial dysfunction, as No differences were observed in systolic and diastolic blood pressure, heart shown by higher UAE rate, might represent simultaneous phenomena in the rate, fasting triglycerides, or total cholesterol between the groups. CD, IMT, development of atherosclerosis in overweight and obese premenopausal and LVMi were higher in obese women than in controls (P < 0.05); using women. simple regression analysis, we found that CD was also positively correlated with BMI (r 0.5; P < 0.05) and fasting insulin (r 0.6; P < 0.05); a weak positive correlation was present between IMT and LVMi (r 0.6; P < 0.05), while a strong negative correlation was present between IMT and DHEA(S) P153 (r 0.9; P < 0.01). The multiple regression analysis, using insulin, BMI, and DHEA(S) as covariates, showed insulin (P < 0.01) and DHEA(S) (P < 0.001) to C-reactive protein is independently associated with total body fat, central be the most powerful predictors for CD and IMT, respectively. fat, and insulin resistance in adult women CONCLUSION: In normotensive severe obese premenopausal women with- G De Pergola1, N Pannacciulli1, FP Cantatore2, A Minenna1, M Bellacicco1, and out hyperandrogenism, hyperinsulinaemia and low DHEA(S) as early carotid R Giorgino1 atherosclerosis can be detected in absence of other covariated risk factors for 1Department of Emergency and Organ Transplantation - Section of Internal cardiovascular disease, suggesting their independent role in atherosclerosis Medicine, Endocrinology and Metabolic Diseases, University of Bari, Bari, Italy; progression. 2Department of Internal Medicine and Public Health - Section of Rheumatology, University of Bari, Bari, Italy P155 INTRODUCTION: The relationship between C-reactive protein (CRP) and atherotrombosis is well established. Moreover, the prevalence of elevated Left ventricular hypertrophy regression: role of weight loss and insulin CRP levels has been shown to be higher in overweight and obese patients than changes in obese normotensive subjects in normal weight subjects. The aim of our study was to investigate whether 1,2 1 1 1 3 3 CRP concentrations are in¯uenced by body composition, insulin resistance F Vetta , S Ronzoni , MR Lupattelli , V Spallone , MG Bendini ,AMeo, 1 1 1 1 1 2 and body fat distribution in apparently healthy women. P Fabbriconi , B Novi , A Pannone , E Cicconetti , C Ficoneri , F Russo , and 1 METHODS: CRP plasma levels, body composition (fat mass, FM, and fat-free MR Bollea 1 mass, FFM), as measured by bioimpedance analysis, central fat accumulation, Department of Internal Medicine, "Tor Vergata" University, Rome, Italy; 2 as evaluated by waist circumference, and metabolic parameters, including Department of Internal Medicine, "SS. Gonfalone" Hospital, Monterotondo, 3 fasting glucose, insulin levels and insulin resistance, as calculated by home- Italy; Institute of Cardiology U.C.S.C. Rome, Italy ostasis model assessment (HOMAIR) have been determined in 201 apparently Obesity and hypertension are the most important determinants of left healthy normal weight, overweight, and obese women, aged 18 ± 60 years. ventricular hypertrophy (LVH). Our previous reports have suggested the RESULTS: CRP was positively correlated with age (P < 0.001), BMI prime role of hyperinsulinism as determinant of LVH independently of blood (P < 0.0001), waist circumference (P < 0.0001), fasting glucose (P < 0.0001), pressure values in obese subjects. fasting insulin (P < 0.000l), HOMAIR (P < 0.000l), FFM (P < 0.0001), and FM Therefore, on the ground of present knowledge, the aim of this study was (P < 0.0001). After multivariate analyses, age, HOMAIR, waist, and FM main- to evaluate, in obese subjects, the in¯uence of weight loss on left ventricular tained their independent association with CRP (P < 0.005, P < 0.00l, P < 0.05, mass (LVM) in relation with changes in glycaemic and insulinemic metabo- and P < 0.05, respectively). Lastly, we observed a gradual increase in CRP lism, 24 h blood pressure values and centripetal adipose tissue distribution. We plasma levels across the quartiles in which the whole population was divided included in our study 24 obese subjects (BMI 34.3) mean age 38.9 years according to HOMAIR levels (F: 4.83, P 0.003 for linear trend). and 14 lean subjects (BMI 23.8) acted as controls age and sex matched. At CONCLUSION: Our study of apparently healthy adult women has shown a enrollment and after a period of at least 6 months ensuing the weight loss strong relationship of total body fat, central fat accumulation, and insulin (74.8 points of BMI), all subjects underwent a 24 h ABPM (Spacelabs 90202), resistance with CRP plasma levels, irrespective of age and other anthropo- a complete anthropoplicometric and bioimpedance analysis (Dietosystem) metric and biochemical variables. Since CRP has been shown to be one of the and biochemical determinations. most powerful predictors of risk of cardiovascular events, it can be hypothe- Areas under glucose and insulin curves were assessed using Haffner's sized that atherogenic mild, chronic in¯ammation may be a further feature of formula by values obtained with OGTT,