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Obesity influences relationship between CMV infection, metabolic syndrome in women
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Women with extreme obesity who are seropositive for human cytomegalovirus are less likely to develop metabolic syndrome vs. women of normal weight who have the virus, according to findings from a cross-sectional study published in Obesity.
“The key initiator of [metabolic syndrome] is chronic, low-grade inflammation, rather than obesity per se, which helps to explain why the inflammation and metabolic dysregulation associated with [metabolic syndrome] are absent in roughly a third of those with obesity, yet can still manifest in the normal-weight population,” Shannon Fleck-Derderian, MPH, of the department of pediatrics at University of California, San Francisco, and colleagues wrote. “Consequently, it is worth exploring whether alternative sources of chronic, low-grade inflammation, other than obesity, are contributing to the burden of [metabolic syndrome].”
Fleck-Derderian and colleagues analyzed pooled data, including BMI, metabolic syndrome components and cytomegalovirus (CMV) status, from 2,532 adults aged 20 to 49 years participating the 1999-2004 National Health and Nutrition Examination Survey (48.6% women; 68.2% white; federal poverty level ≥ 85.8%). Researchers used logistic regression analysis to assess the association between CMV and metabolic syndrome, stratified by sex and BMI, categorized as normal weight (BMI, 18.5-24.9 kg/m²), overweight (BMI, 25-29.9 kg/m²), obesity (BMI, 30-39.9 kg/m²) and extreme obesity (BMI ≥ 40 kg/m²).
Within the cohort, 24.9% met criteria for metabolic syndrome, with a higher prevalence in men vs. women (26.9% vs. 22.8%; P = .04); 53.8% were CMV seropositive, with a higher prevalence in women vs. men (61.3% vs. 46.6%; P < .001).
In unadjusted analyses, CMV infection was associated with metabolic syndrome in women (OR = 1.5; 95% CI, 1.05-2.13), but not in men. After adjustment for age, race, poverty level and statin use, researchers found that the odds of developing metabolic syndrome was higher in normal-weight women with CMV (adjusted OR = 65.31; 95% CI, 6.82-625.61) vs. women who were CMV-negative; however, odds for metabolic syndrome were lower in women with extreme obesity who were CMV-positive (adjusted OR = 0.25; 95% CI, 0.1-0.9) vs. normal-weight women who were CMV-negative.
Researchers also observed associations between CMV seropositivity and immunometabolic outcomes. Women of normal weight who were CMV-positive were 1.95 times more likely to have low HDL cholesterol vs. women of normal weight who were CMV-negative (P = .038). However, women with extreme obesity who were CMV-positive had only a 0.13 times increased risk for low HDL cholesterol vs. CMV-negative, normal-weight women (P = .018). Women with extreme obesity who were CMV-positive also had lower odds of developing hypertriglyceridemia (adjusted OR = 0.24; 95% CI, 0.08-0.76) and elevated insulin levels (adjusted OR = 0.01; 95% CI, 0.01-0.23) vs. normal-weight women who were CMV-negative.
“It is clear that metabolic dysregulation and metabolic syndrome are highly associated with obesity; however, the findings of this study add to the increasing notion that other factors, such as chronic viral infection, also play a significant role in influencing the development of metabolic dysregulation in certain adults,” Fleck-Derderian told Endocrine Today. “Clinicians should therefore consider taking into account a patient’s infectious disease history when assessing for metabolic syndrome, particularly in females of normal weight, who generally are not viewed as at risk for metabolic syndrome.”
“While it is intriguing that our findings suggest CMV infection in extremely obese females is associated with a healthier metabolic profile and, most strikingly, a reduced prevalence of metabolic syndrome, it is still important to recognize that the overall prevalence of metabolic syndrome in CMV-positive, extremely obese females still remains higher than that observed in females of normal weight,” Fleck-Derderian said. – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.
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