Association of GFR, Fiber-Rich Regimen and Metabolic Syndrome With Elevated C-Reactive Protein Levels: Results of a Multicenter National Survey

  • Zahra Hosseini Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
  • Saeed Ghodsi Mail Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
  • Seyed-Ali Sadre-Bafghi Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
  • Mehrnaz Mohebi Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
  • Alipasha Meisamie Department of Preventive Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
  • Saeed Tofighi Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
  • Hamidreza Soleimani Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
Cardiovascular disease, C-reactive protein, Metabolic syndrome, Inflammation, Glomerular filtration rate (GFR), Fiber intake, Risk factors, Third national survey of non-communicable diseases (SuRFNCD-2007)


The present study investigates the association of cardiovascular risk factors such as metabolic syndrome (MetS), fiber-rich regimen, and Glomerular Filtration Rate (GFR) with elevated high-sensitivity C-reactive protein (hsCRP) levels. We designed a cross-sectional study based on data of the third National Survey of non-communicable diseases (SuRFNCD-2007); among 2125, Iranian adults (1168 women) aged 25-64 years. Demographic and anthropometric characteristics were collected. Biochemical assessments, were determined on venous blood samples. Quantitative highly sensitive CRP was measured via enzyme-linked immunoassay. Elevated CRP was defined as values above 3 mg/l. Metabolic syndrome was defined according to the ATP III (Adult Treatment Panel III report, 2005). GFR was calculated with the MDRD formula. Multivariable logistic regression accompanied by complex sample survey analysis, including stratified weighting, were recruited. The fiber-rich regimen was determined by the daily consumption of more than five units of vegetables or fruits. Mean age of the population was 39.4±4.5 years. Adjusted odds ratios for prediction of high CRP pertaining to High LDL, Low Physical activity, BUN, MetS ATP III, Declined GFR (per 30 units reduction), optimal Fiber intake, and Current Smoking were calculated. Corresponding values with 95 % CI were 1.36 (1.04-1.85), 1.31(1.11-4.20), 1.04(1.04-1.12), 1.47 (1.04-2.09), 1.22 (1.11-3.36), 0.84 (0.87-1.48), 1.74 (0.39-1.38), respectively. We figured out that MetS, declined GFR in early stages of CKD, and low physical activity were related to high inflammatory state, while fiber-rich regimen decreased the likelihood of high CRP in smokers.


1. Libby P, Ridker PM: Inflammation and atherothrombosis from population biology and bench research to clinical practice.
J Am Coll Cardiol 2006; 48:A33–A46.
2. Paffen E, DeMaat MP. C-reactive protein in atherosclerosis: a causal factor? Cardiovasc Res 2006; 71:30–9.

3. Ridker PM, Wilson PW, Grundy SM: Should C-reactive protein be added to metabolic syndrome and to assessment of global cardiovascular risk? Circulation 2004; 109:2818–2825.

4. Koenig W, Lowel H, Baumert J, Meisinger C: C-reactive protein modulates risk prediction based on the Framingham Score:
Implications for future risk assessment: Results from a large cohort study in southern Germany. Circulation 2004; 109:1349–

5. Ridker PM, Rifai N, Rose L, Buring JE, Cook NR. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med 2002; 347:1557–65.

6. Sattar N, McConnachie A, Shaper AG, et al: Can metabolic syndrome usefully predict cardiovascular disease and diabetes? Outcome data from two prospective studies. Lancet 2008, 371:1927-1935.

7. Festa A, D’Agostino R Jr, Howard G, et al. Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS).Circulation 2000;102 (1):42–7.

8. Van Guilder GP, Hoetzer GL, Greiner JJ, Stauffer BL, Desouza CA. Influence of metabolic syndrome on biomarkers of oxidative stress and inflammation in obese adults. Obesity (Silver Spring) 2006; 14 (12):2127–31.
9. Pischon T, Hu FB, Rexrode, et al. Inflammation, the metabolic syndrome, and risk of coronary heart disease in women and men. Atherosclerosis 2008; 197 (1):392–9.
10.Langenberg C, Bergstrom J, Scheidt-Nave C, et al. Cardiovascular death and the metabolic syndrome: role of adiposity-signaling hormones and inflammatory markers. Diabetes Care 2006; 29:1363.
11. Wong ND, Pio JR, Franklin SS, et al: Preventing coronary events by optimal control of blood pressure and lipids in patients with the metabolic syndrome. Am J Cardiol 2003, 91:1421-1426.
12. Esteghamati A, Meysamie A, Khalilzadeh O, et al. Third National Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD-2007) in Iran: methods and results on prevalence of diabetes, hypertension, obesity, central obesity, and dyslipidemia. BMC Public Health 2009; 9:167.

13.Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005; 112:2735.

14.Wilson PW, D’Agostino RB, Levy D, et al. Prediction of coronary heart disease using risk factor categories. Circulation 1998; 97:1837– 47.
15. Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Int Med. 1999 Mar 16;130(6):461-70. PubMed ID: 10075613
16. Blaha MJ, Rivera JJ, Budoff MJ, et al. Association between obesity, high-sensitivity C-reactive protein ≥2 mg/L, and subclinical atherosclerosis: implications of JUPITER from the Multi-Ethnic Study of Atherosclerosis. Arterioscler Thromb Vasc Biol. 2011 Jun; 31(6):1430-8. Doi: 10.1161/ATVBAHA.111.223768.
17. Meysamie A, Ghodsi S, Ghalehtaki R et al . Distributions of High-Sensitivity C - reactive protein, Total Cholesterol-HDL Ratio and 10-Year Cardiovascular Risk: National Population-Based Study. Acta Med Iran. 2017 Apr;55(4):218-227.

18. Kuo-Liong Chien, Hsiu-Ching Hsu, Ming-Fong Chen and Yuan-Teh Lee. Association of C - reactive protein, Smoking and Metabolic Syndrome among the Health Check-up Population. Acta Cardiol Sin 2005; 21:98-104

19. Earl S. Ford. The metabolic syndrome and C-reactive protein, fibrinogen, and leukocyte count: findings from the Third National Health and Nutrition Examination Survey. Atherosclerosis 168 (2003) 351-358.

20. Bhavita Patel , Dilip Taviad , Brahmareddy Malapati , Ruchi Gokani ,Nadeem Shaikh , Rita Shah. Association of hs-CRP levels with Obesity & Metabolic syndrome in patients with Type-2 Diabetes Mellitus: a link between inflammation, adiposity & insulin resistance. Int J Biol Med Res.2015; 6(3):5104-5108.

21. Florez H, Castillo-Florez S, Mendez A, et al.C-reactive protein is elevated in obese patients with the metabolic syndrome. Diabetes Res Clin Pract. 2006 Jan; 71(1):92-100. Epub 2005 Jul 5

22.Voils SA, Cooper-DeHoff RM. Association between high sensitivity C-reactive protein and metabolic syndrome in subjects completing the National Health and Nutrition Examination Survey (NHANES) 2009-10. Diabetes Metab Syndr. 2014 Apr-Jun; 8(2):88-90. doi: 10.1016/j.dsx.2014.04.021.

23. Tomoyuki Kawada, Toshiaki Otsuka, Masao Katsumata, Hiroko Suzuki. Association between Components of the Metabolic Syndrome and Serum Levels of C - reactive protein in Japanese Workingmen. Journal of the Cardio Metabolic Syndrome 06/2006; 1(3):168-72. DOI: 10.1111/j.1559-4564.2006.05706.x

24. Maria A. Martínez, Juan G. Puig, Marta Mora, et al. Metabolic syndrome: prevalence, associated factors, and C-reactive protein;The MADRIC (MADrid RIesgo Cardiovascular) Study. Metabolism Clinical and Experimental 57 (2008) 1232–1240.

25. K Tamakoshi, H Yatsuya, T Kondo, et al. The metabolic syndrome is associated with elevated circulating C-reactive protein in healthy reference range, a systemic low-grade inflammatory state. International Journal of Obesity (2003) 27, 443–449.
26. Mussarat Riaz, Asher Fawwad, M. Zafar Iqbal Hydrie, Abdul Basit, and A. Samad Shera. Is There Any Association of Serum High-Sensitivity C-Reactive Protein with Various Risk Factors for Metabolic Syndrome in a Healthy Adult Population of Karachi, Pakistan? .Metabolic Syndrome and Related Disorders. June 2011, 9(3): 177-182.

27. Esmaillzadeh A, Kimiagar M, Mehrabi Y, Azadbakht L, Hu FB, Willett WC . Dietary patterns and markers of systemic inflammation among Iranian women. J Nutr 2007 Apr; 137(4): 992-8.

28. Dana E. King, Brent M. Egan, Robert F. Woolson, et al. Effect of a High-Fiber Diet vs a Fiber Supplemented Diet on C-Reactive Protein Level. Arch Intern Med. 2007; 167:502-50

29. Fisk PS, Middaugh AL, Rhee YS, Brunt AR. Few favorable associations between fruit and vegetable intake and biomarkers for chronic disease risk in American adults.Source: Nutrition Research (New York, N.Y.) [Nutr Res] 2011 Aug; Vol. 31 (8), pp. 616-24.Date of Electronic Publication: 2011 Aug 16.
How to Cite
Hosseini Z, Ghodsi S, Sadre-Bafghi S-A, Mohebi M, Meisamie A, Tofighi S, Soleimani H. Association of GFR, Fiber-Rich Regimen and Metabolic Syndrome With Elevated C-Reactive Protein Levels: Results of a Multicenter National Survey. Acta Med Iran. 58(5):207-213.