The metabolic syndrome and C-reactive protein, fibrinogen, and leukocyte count: findings from the Third National Health and Nutrition Examination Survey

  • Earl S. Ford
    Tel.: +1-770-488-6015; fax: +1-770-488-8150
    Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop K66, Atlanta, GA 30341, USA
    Search for articles by this author


      To examine the association between the metabolic syndrome and C-reactive protein, fibrinogen, and leukocyte count, the author did a cross-sectional analysis of data from 8570 participants aged ≥20 years from the Third National Health and Nutrition Examination Survey (1988–1994). The metabolic syndrome was defined using criteria established by the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. The age-adjusted prevalence of having an elevated C-reactive protein concentration was 29.0% (S.E.: 1.6%) for participants with the metabolic syndrome and 12.1% (S.E.: 0.6%) for participants without the metabolic syndrome (adjusted odds ratio (OR), 2.80; 95% confidence interval (CI): 2.36, 3.33). Compared with participants who had no abnormalities, the corresponding adjusted ORs were 1.91 (95% CI: 1.27, 2.87), 3.00 (95% CI: 1.96, 4.60), 5.01 (95% CI: 3.39, 7.41), 5.97 (95% CI: 3.83, 9.31), and 6.79 (95% CI: 3.55, 12.99) for participants with 1, 2, 3, 4, and 5 metabolic abnormalities, respectively. Participants with the metabolic syndrome had higher fibrinogen concentrations and white blood cell counts than those without this syndrome. Many people with the metabolic syndrome have a low-grade inflammation, which may increase their risk for future adverse events. A better understanding of the potential consequences of the high prevalence of low-grade inflammation among people with the metabolic syndrome is needed.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. National Institutes of Health. Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Executive Summary. NIH Publication No. 01-3670, 2001.

        • Alberti K.G.
        • Zimmet P.Z.
        Definition, diagnosis and classification of diabetes mellitus and its complications. 1. Diagnosis and classification of diabetes mellitus provisional report of a WHO consultation.
        Diabet. Med. 1998; 15: 539-553
        • Ford E.S.
        • Giles W.H.
        • Dietz W.H.
        Prevalence of the metabolic syndrome among US adults: findings from the Third National Health and Nutrition Examination Survey.
        J. Am. Med. Assoc. 2002; 287: 356-359
        • Danesh J.
        • Whincup P.
        • Walker M.
        • Lennon L.
        • Thomson A.
        • Appleby P.
        • Gallimore J.R.
        • Pepys M.B.
        Low grade inflammation and coronary heart disease: prospective study and updated meta-analyses.
        Br. Med. J. 2000; 321: 199-204
        • Isomaa B.
        • Almgren P.
        • Tuomi T.
        • Forsen B.
        • Lahti K.
        • Nissen M.
        • Taskinen M.R.
        • Groop L.
        Cardiovascular morbidity and mortality associated with the metabolic syndrome.
        Diabetes Care. 2001; 24: 683-689
        • Trevisan M.
        • Liu J.
        • Bahsas F.B.
        • Menotti A.
        • Risk Factor and Life Expectancy Research Group
        Syndrome X and mortality: a population-based study.
        Am. J. Epidemiol. 1998; 148: 958-966
        • Haffner S.M.
        • Valdez R.A.
        • Hazuda H.P.
        • Mitchell B.D.
        • Morales P.A.
        • Stern M.P.
        Prospective analysis of the insulin-resistance syndrome (syndrome X).
        Diabetes. 1992; 41: 715-722
        • Wilson P.W.
        • Kannel W.B.
        • Silbershatz H.
        • D'Agostino R.B.
        Clustering of metabolic factors and coronary heart disease.
        Arch. Intern. Med. 1999; 159: 1104-1109
        • Schmidt M.I.
        • Duncan B.B.
        • Sharrett A.R.
        • Lindberg G.
        • Savage P.J.
        • Offenbacher S.
        • Azambuja M.I.
        • Tracy R.P.
        • Heiss G.
        Markers of inflammation and prediction of diabetes mellitus in adults (Atherosclerosis Risk in Communities Study): a cohort study.
        Lancet. 1999; 353: 1649-1652
        • Barzilay J.I.
        • Abraham L.
        • Heckbert S.R.
        • Cushman M.
        • Kuller L.H.
        • Resnick H.E.
        • Tracy R.P.
        The relation of markers of inflammation to the development of glucose disorders in the elderly: the Cardiovascular Health Study.
        Diabetes. 2001; 50: 2384-2389
        • Pradhan A.D.
        • Manson J.E.
        • Rifai N.
        • Buring J.E.
        • Ridker P.M.
        C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus.
        J. Am. Med. Assoc. 2001; 286: 327-334
        • Ford E.S.
        Leukocyte count, erythrocyte sedimentation rate, and diabetes incidence in a national sample of US adults.
        Am. J. Epidemiol. 2002; 155: 57-64
        • Vozarova B.
        • Weyer C.
        • Lindsay R.S.
        • Pratley R.E.
        • Bogardus C.
        • Tataranni P.A.
        High white blood cell count is associated with a worsening of insulin sensitivity and predicts the development of type 2 diabetes.
        Diabetes. 2002; 51: 455-461
        • Festa A.
        • D'Agostino Jr., R.
        • Tracy R.P.
        • Haffner S.M.
        Elevated levels of acute-phase proteins and plasminogen activator inhibitor-1 predict the development of type 2 diabetes: the insulin resistance atherosclerosis study.
        Diabetes. 2002; 51: 1131-1137
        • Pickup J.C.
        • Mattock M.B.
        • Chusney G.D.
        • Burt D.
        NIDDM as a disease of the innate immune system: association of acute-phase reactants and interleukin-6 with metabolic syndrome X.
        Diabetologia. 1997; 40: 1286-1292
        • Festa A.
        • D'Agostino Jr., R.
        • Howard G.
        • Mykkanen L.
        • Tracy R.P.
        • Haffner S.M.
        Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS).
        Circulation. 2000; 102: 42-47
        • Frohlich M.
        • Imhof A.
        • Berg G.
        • Hutchinson W.L.
        • Pepys M.B.
        • Boeing H.
        • Muche R.
        • Brenner H.
        • Koenig W.
        Association between C-reactive protein and features of the metabolic syndrome: a population-based study.
        Diabetes Care. 2000; 23: 1835-1839
        • Kelly C.C.
        • Lyall H.
        • Petrie J.R.
        • Gould G.W.
        • Connell J.M.
        • Sattar N.
        Low grade chronic inflammation in women with polycystic ovarian syndrome.
        J. Clin. Endocrinol. Metab. 2001; 86: 2453-2455
      2. Centers for Disease Control and Prevention. Plan and operation of the third National Health and Nutrition Examination Survey, 1988–94. National Center for Health Statistics, Bethesda, MD, Vital Health Stat. 1994;1(32).

      3. Centers for Disease Control and Prevention. The Third National Health and Nutrition Examination Survey (NHANES III 1988–94) reference manuals and reports. National Center for Health Statistics, Bethesda, MD, 1996 (CD-ROM).

        • Ford E.S.
        Body mass index, diabetes, and C-reactive protein among U.S. adults.
        Diabetes Care. 1999; 22: 1971-1977
        • Facchini F.
        • Hollenbeck C.B.
        • Chen Y.N.
        • Chen Y.D.
        • Reaven G.M.
        Demonstration of a relationship between white blood cell count, insulin resistance, and several risk factors for coronary heart disease in women.
        J. Intern. Med. 1992; 232: 267-272
        • Targher G.
        • Seidell J.C.
        • Tonoli M.
        • Muggeo M.
        • De Sandre G.
        • Cigolini M.
        The white blood cell count: its relationship to plasma insulin and other cardiovascular risk factors in healthy male individuals.
        J. Intern. Med. 1996; 239: 435-441
        • Mennen L.I.
        • Balkau B.
        • Charles M.A.
        • D'Hour A.
        • le Mauff J.M.
        Gender differences in the relation between fibrinogen, tissue-type plasminogen activator antigen and markers of insulin resistance: effects of smoking. D.E.S.I.R. Study Group. Data from an Epidemiological Study on Insulin Resistance Syndrome.
        Thromb. Haemost. 1999; 82: 1106-1111
        • Raynaud E.
        • Perez-Martin A.
        • Brun J.
        • Aissa-Benhaddad A.
        • Fedou C.
        • Mercier J.
        Relationships between fibrinogen and insulin resistance.
        Atherosclerosis. 2000; 150: 365-370
        • Temelkova-Kurktschiev T.
        • Siegert G.
        • Bergmann S.
        • Henkel E.
        • Koehler C.
        • Jaross W.
        • Hanefeld M.
        Subclinical inflammation is strongly related to insulin resistance but not to impaired insulin secretion in a high risk population for diabetes.
        Metabolism. 2002; 51: 743-749
        • Landin K.
        • Tengborn L.
        • Smith U.
        Elevated fibrinogen and plasminogen activator inhibitor (PAI-1) in hypertension are related to metabolic risk factors for cardiovascular disease.
        J. Intern. Med. 1990; 227: 273-278
        • Valek J.
        • Valkova L.
        • Vlasakova Z.
        • Topinka V.
        Increased fibrinogen levels in the offspring of hypertensive men. Relation with hyperinsulinemia and the metabolic syndrome.
        Arterioscler. Thromb. Vasc. Biol. 1995; 15: 2229-2233
        • Sakkinen P.A.
        • Wahl P.
        • Cushman M.
        • Lewis M.R.
        • Tracy R.P.
        Clustering of procoagulation, inflammation, and fibrinolysis variables with metabolic factors in insulin resistance syndrome.
        Am. J. Epidemiol. 2000; 152: 897-907
        • Ble A.
        • Palmieri E.
        • Volpato S.
        • Costantini F.
        • Fellin R.
        • Zuliani G.
        White blood cell count is associated with some features of metabolic syndrome in a very old population.
        Nutr. Metab. Cardiovasc. Dis. 2001; 11: 221-226