The Correlation between Apolipoprotein B Levels and

Inflammatory Markers in Obese Individuals

Dian Anindita Lubis

, Dharma Lindarto

Department of Internal Medicine, Faculty of Medicine, Universitas Sumatera Utara,

H. Adam Malik Hospital, Jalan Bunga Lau No 17, Medan 20136, Indonesia

Keywords: Apolipoprotein B, obesity, cardiovascular disease, atherosclerosis.

Abstract: Apolipoprotein B (ApoB) levels reflect the total number of potentially atherogenic particles that can

predict cardiovascular risk. The purpose of this study was to assess if the ApoB in obese subjects is

associated with inflammatory markers. This cross-sectional study was conducted in 80 obese patients at

Haji Adam Malik Hospital, Medan, Indonesia. Of the 80 patients studied, the average age was 38.95 +

8.13 years old. There was a strong positive correlation between ApoB and triglycerides (r=0.44,

P<0.001), low-density lipoprotein cholesterol (r=0.74, P<0.001), and HOMA-IR (r=0.31, P=0.005).

However, no strong correlation with the inflammatory markers were seen; adiponectin (r=-0.23,

P=0.41) and Chemerin (r=0.021, P=0.851). In obesity, ApoB is significantly associated with lipid and

insulin resistance, as a risk factor for cardiovascular disease.

1 INTRODUCTION

Obesity, characterized by the excess amount of

abnormal fat, may interfere in an optimal state of

health. It may increase the mortality risk through

chronic diseases, such as cardiovascular disease,

type 2 diabetes, and cancer (Tobias and Hu, 2018).

The increment of cardiovascular disease risk is due

to inflammation, hyperlipidemia, high blood

glucose, elevated insulin levels and high blood

pressure (Adams et al., 2006; Klop et al., 2013).

In obese individuals, the risk for atherosclerotic

disease is still high even after adjustment for

established risk factors. It is thought that there are

abnormalities in lipoprotein metabolism that do not

cause hyperlipidemia and yet accelerate

atherosclerosis (Egusa et al., 1985). Low-density

lipoprotein (LDL) are atherogenic; however, when

triglyceride concentration is high, LDL values are

often not available. Therefore, other markers of

lipoprotein-related to cardiovascular disease are

needed. The measurement of lipoprotein particle

such as apolipoprotein B (ApoB) may enhance the

prediction of the risk of cardiovascular disease

(Holme et al., 2007; Khadem-Ansari et al., 2009).

As part of metabolic syndrome, chronic

inflammation has also been associated with obesity.

Larger adipocytes in abdominal obesity alter the

ability to suppress lipolysis. Fat tissue releases

adipocytokines that may cause insulin resistance and

increased risk of cardiovascular disease. There are

two types of adipocytokines; classical

adipocytokines (adiponectin, resistin, and leptin) and

new adipocytokines (chemerin, omentin, and

omentin) (Ellulu et al., 2015; Gateva et al., 2018).

Several studies have examined the association

between plasma lipid and inflammatory markers.

However, the evaluation of ApoB is rarely included.

Therefore, we aim to examine the association

between ApoB and inflammatory markers such as

adiponectin and chemerin in obesity.

2 MATERIALS AND METHODS

This cross-sectional study was conducted in Haji

Adam Malik Hospital, Medan, Indonesia. Obese

nurses (BMI > 25 kg/m2) aged 30-55 were recruited.

Eighty subjects agreed to participate. Informed

consent was obtained from each subject, following

ethical approval from the Health Research Ethical

Committee of Universitas Sumatera Utara,

Indonesia. Subjects with a secondary illness such as

acute inflammation, anemia, menopause, diabetes,

cardiovascular disease, chronic kidney disease, liver

Lubis, D. and Lindarto, D.

The Correlation between Apolipoprotein B Levels and Inﬂammatory Markers in Obese Individuals.

DOI: 10.5220/0009858900640067

In Proceedings of the 2nd International Conference on Tropical Medicine and Infectious Disease (ICTROMI 2019), pages 64-67

ISBN: 978-989-758-469-5

dysfunction and subjects with secondary obesity

such as pregnancy, smoking cessation, patients

treated with corticosteroid, estrogen, beta-adrenergic

receptor agonists, nitrates, or other vasodilator

agents were excluded.

Blood samples were collected from the subjects

in the morning after 10-12 hours of fasting

combined with ethylenediaminetetraacetate (EDTA)

containing heparin, and then centrifuged.

2.1 Biochemical Analysis

Serum HDL cholesterol (HDL-C) and triglycerides

(TG) were analyzed by the enzymatic colorimetric

method, while Apo-B levels were assessed by the

immunoassay method with Hitachi Modular

analyzer using the Roche Diagnostic kit. Insulin

levels were determined by the chemiluminescence

immunoassay method using the DPC Immulite-I

analyzer (Diagnostic Products Corp, Los Angeles,

CA, USA) kit.

HOMA-IR formula (Matthews et al., 1985) was

used to determine the index of insulin resistance

using the following formula:

HOMA-IR = [(fasting glucose serum (mmol / l)

x fasting insulin (μU / ml) / 22,5]

2.2 Statistical Analysis

Data are presented as mean + standard deviation.

All data were summarized as descriptive statistics.

To determine whether a variable was normally

distributed, we used the Shapiro-Wilk test. The

parametric analysis was performed on variables with

normal distribution, whereas the nonparametric test

was performed on variables with the abnormal

distribution. Furthermore, the Pearson and Spearman

test were used to evaluate the correlation between

variables according to the variable distribution. A

value of P < 0.05 was accepted as an indication of

statistical significance. SPSS for Windows 22.0 was

used for the statistical analysis.

3 RESULTS

This analysis included 80 obese individuals with no

previous history of cardiovascular disease. The mean

age was 38.95 + 8.13 years. The risk factors for

cardiovascular disease and inflammatory markers

(adiponectin and chemerin) measured in this study

are presented in Table 1.

Pearson correlation of Apo-B with all

traditional risk factors is presented in Table 2. In

general, apoB correlated positively with LDL-C,

TG, HOMA-IR and negatively with HDL-C. Apo-B

also has a strong correlation with HOMA-IR.

However, there is no correlation between Apo-B and

inflammatory markers.

Table 1: Baseline Characteristic of Obese Individuals.

Parameters Total (mean±SD); n=80

Age (years) 38.95 + 8.13

Body weight (Kg) 75.35 ±13.49

WC (cm) 91.95 ± 9.59

LDL-C (mg/dL) 138.12 ± 32,40

HDL-C (mg/dL) 53.72 ± 16.73

TG (mg/dL) 131.30 ± 75.92

Adiponectin 4.42 ± 2.40

Chemerin (ng/mL) 408.64 + 118.41

ApoB (g/L) 98..43 ± 20.27

HOMA-IR 2.36 ± 3.02

Abbreviations: WC, waist circumference; HOMA-IR: homeostasis model assessment of insulin

resistance; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein

cholesterol; TG, triglycerides; ApoB: apolipoprotein B.

The Correlation between Apolipoprotein B Levels and Inﬂammatory Markers in Obese Individuals

Table 2: Association between ApoB, Traditional Risk Factors of Cardiovascular Disease and Inflammatory Markers in

Obese Individuals.

Abbreviations: BMI, body mass index; WC, waist circumference; HOMA-IR: homeostasis model

assessment of insulin resistance; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density

lipoprotein cholesterol; TG, triglycerides; ApoB: apolipoprotein B.

*P<0.05, ** P <0.01

4 DISCUSSION

This study demonstrated that in obese individuals,

plasma ApoB is positively correlated with several

traditional risk factors for cardiovascular disease and

type 2 diabetes (insulin resistance, LDL-C, and TG).

ApoB is a better atherogenic parameter

compared to the traditional lipid parameters (LDL-C

and TG) because ApoB levels indicate the number

of atherogenic lipoprotein particles, such as LDL,

VLDL, and intermediate-density lipoprotein. One

cross-sectional study examined the correlation of

ApoB and the risk of coronary heart disease

(n=13,523), ApoB was found to be independently

related to the risk of CHD using Framingham risk

score (FRS) (Ryoo et al., 2011). Moreover, the

elevation of ApoB levels is also found in

normolipidemic patients with the early coronary

arterial disease even when the total and LDL-C

levels are normal (Dati and Tate, 2001).

Insulin resistance, measured with the

homeostasis index (HOMA-IR), is correlated with

ApoB as shown in this study supports the

association of insulin resistance with lipoprotein

transport. The results of the present study are in

agreement with the previous study on 476 subjects

demonstrating that ApoB was correlated with insulin

resistance (HOMA-IR) (Wang et al., 2017)

Earlier studies have shown that the

increment of plasma ApoB was associated with

inflammatory markers (hsTNF-α, IL-6, hsCRP, and

orosomucoid) (Faraj et al., 2006). Lipoprotein

thought to have triggered inflammation in humans.

However, contradicting to our findings, we did not

find the correlation between ApoB and

inflammatory markers (adiponectin and chemerin).

Schlitt et al. also found that there is no correlation

between ApoB and C-Reactive Protein (Schlitt et al.,

2005).

Our study has some limitations. Since this study

used a cross-sectional method, we could not reflect

causality. This study also did not exclude patients

who used lipid-lowering medication that could affect

the results.

5 CONCLUSION

The association between ApoB and increased

cardiovascular disease risks were related to lipid,

and insulin resistance. Thus, further prospective

studies should be used to investigate the causality

between ApoB and inflammatory markers.

REFERENCES

Adams KF, Schatzkin A, Harris TB, Kipnis V, Wouw T,

Ballard-Barbash R, et al. 2006. Overweight, obesity,

and mortality in a large prospective cohort of persons

50-71 years old. N Engl J Med, 355, pp. 763-78.

Dati F, Tate J. 2001. Reference materials for the

standardization of the Apolipoproteins A-I and B, and

lipoprotein(a). The Journal of the International

Federation of Clinical Chemistry and Laboratory

Medicine, 13, pp. 073-9.

Egusa G, Beltz WF, Grundy SM, Howard BV. 1985.

Influence of obesity on the metabolism of

apolipoprotein B in humans. J Clin Invest, 76, pp. 596-

603.

Parameter r P

Age (year) 0.209 0.063

Body weight (Kg) 0.90 0.420

WC (cm) 0.173 0.124

LDL-C (mg/dl) 0.74 0.000**

HDL-C (mg/dl) -0.33 0.001**

TG (mg/dl) 0.44 0.000**

HOMA-IR 0.31 0.005**

Adiponectin -0.23 0.410

Chemerin (ng/dl) 0.021 0.851

ICTROMI 2019 - The 2nd International Conference on Tropical Medicine and Infectious Disease

Ellulu MS, Patimah I, Khaza’ai H, Rahmat A, Abed Y.

2015. Obesity and inflammation: the linking

mechanism and the complications. Arch Med Sci, 13,

pp. 851-63.

Faraj M, Messier L, Bastard JP, Tardif A, Godbout A,

Prud’homme D, et al. 2006. Apolipoprotein B: a

predictor of inflammatory status in postmenopausal

overweight and obese women. Diabetologia, 49, pp

1637-46.

Gateva A, Assyov Y, Tsakova A, Kamenov Z. 2018.

Classical (adiponectin, leptin, resistin) and new

(chemerin, vaspin, omentin) adipocytokines in patients

with prediabetes. Horm Mol Biol Clin Investig, pp. 1-

Holme I, Hostmark AT, Anderssen SA. 2007. ApoB but

not LDL-cholesterol is reduced by exercise training in

overweight healthy men.results from the 1-year

randomized Oslo diet and exercise study. J Intern

Med, 262, pp. 235-43.

Khadem-Ansari MH, Rasmi Y, Rahimi-Pour A,

Jafarzadeh M. 2009. The association between serum

apolipoprotein A-I and apolipoprotein B and the

severity of angiographical coronary artery disease.

Singapore Med J, 50(6), pp. 610-3.

Klop B, Elte JW, Cabezas MC. 2013. Dyslipidemia in

obesity: Mechanisms and potential targets. Nutrients,

5, pp. 1218-40.

Matthews DR, Hosker JP, Rudenski AS, Naylor BA,

Treacher DF, et al. 1985. Homeostasis model

assessment: insulin resistance and β-cell function from

fasting plasma glucose and insulin concentrations in

man. Diabetologia, 28, pp. 412–9.

Ryoo JH, Ha EH, Kim SG, Ryu S, Lee DW. 2011.

Apolipoprotein B is highly associated with the risk of

coronary heart disease as estimated by the

Framingham risk score in healthy Korean men. J

Korean Med Sci, 26, pp. 631-6.

Schlitt A, Blankenberg S, Bickel C, et al. 2005. Prognostic

value of lipoproteins and their relation to

inflammatory markers among patients with coronary

artery disease. Int J Cardiol, 102, pp. 477-85.

Tobias DK, Hu FB. 2018. The association between BMI

and mortality: implications for obesity prevention.

Lancet Diabetes Endocrinol, 6, pp. 916-7.

Wang W, Blackett P, Khan S, Lee E. 2017.

Apolipoprotein A-I, B, and C-III and obesity in young

adult Cherokee. Journal of Lipids, 2017, pp. 1-7.



The Correlation between Apolipoprotein B Levels and Inﬂammatory Markers in Obese Individuals