SYSTEMIC INFLAMMATION IN COMORBID METABOLIC SYNDROME AND VITILIGO: A REGRESSION ANALYSIS OF RISK FACTORS!
DOI:
https://doi.org/10.22159/ajpcr.2024v17i7.51092Keywords:
Metabolic syndrome, Vitiligo, Vitiligo area severity index, Logistic regressionAbstract
Objective: Systemic inflammatory markers are often raised in comorbid metabolic syndrome (MetS) and vitiligo. Why some patients with vitiligo develop MetS while others do not remain to be elucidated. This study aimed to identify independent risk factors for MetS development in vitiligo patients.
Methods: In this prospective study, disease characteristics (disease duration, severity, and subtype) and high-sensitivity C-reactive protein (hs-CRP) were compared between vitiligo patients (n=100) with and without MetS. Multivariate logistic regression of potential risk factors for MetS was done after adjusting for potential confounders (such as waist circumference, basal metabolic rate, serum lipids, blood pressure, and fasting blood sugar). The performance of these parameters (hs-CRP, age, disease duration, and severity) in predicting MetS development was ascertained by the area under the receiver operating characteristic curve (ROC).
Results: Vitiligo patients with MetS had a significantly longer (p<0.001) disease duration as compared to those without MetS (56±16 versus 14±12 months). On regression analysis, inflammatory markers (hs-CRP) had significantly higher odds (odds ratio [OR]=5.1) as compared to demographic factors such as gender (OR=3.1) and disease factors such as disease duration (OR=2.4) and disease severity (OR=1.8) of developing MetS. On ROC curve analysis, the performance of these parameters for MetS was hs-CRP>Vitiligo Area Scoring Index score>disease duration >increasing age (Area under the curve=0.952, 0.905, 0.851, and 0.697, respectively). The cutoff value of hs-CRP was 6.42 ug/mL.
Conclusion: Elevated hs-CRP has the highest predictive value for MetS development in vitiligo. Systemic inflammation may be the driving force for MetS development.
Downloads
References
Luo L, Zhu J, Guo Y, Li C. Mitophagy and immune infiltration in vitiligo: Evidence from bioinformatics analysis. Front Immunol. 2023;14:1164124. doi: 10.3389/fimmu.2023.1164124, PMID 37287971
Yu X, Cui Y, Zhu X, Xu H, Li L, Gao G. MicroRNAs: Emerging players in the pathogenesis of vitiligo. Front Cell Dev Biol. 2022;10:964982. doi: 10.3389/fcell.2022.964982, PMID 36187493
Xuan Y, Yang Y, Xiang L, Zhang C. The role of oxidative stress in the pathogenesis of vitiligo: A culprit for melanocyte death. Oxid Med Cell Longev. 2022;2022:8498472. doi: 10.1155/2022/8498472, PMID 35103096
Sun C, Ren Y, Zhang W. Association between skin disease and anxiety: A logistic analysis and prediction. Ann Transl Med. 2023;11(2):115. doi: 10.21037/atm-22-6511, PMID 36819527
Chen Y, Griffiths CE, Bulfone-Paus S. Exploring mast Ccell-CD8 T cell interactions in inflammatory skin diseases. Int J Mol Sci. 2023;24(2):1564. doi: 10.3390/ijms24021564, PMID 36675078
Bovolini A, Garcia J, Andrade MA, Duarte JA. Metabolic syndrome pathophysiology and predisposing factors. Int J Sports Med. 2021;42(3):199-214. doi: 10.1055/a-1263-0898, PMID 33075830
Karagün E, Baysak S. Levels of TNF-α, IL-6, IL-17, IL-37 cytokines in patients with active vitiligo. Aging Male. 2020;23(5):1487-92. doi: 10.1080/13685538.2020.1806814, PMID 33191834
Zou P, Xiao Y, Deng Q, Shi Y, You R, Pi Z, et al. Occludin promotes adhesion of CD8+ T cells and melanocytes in vitiligo via the HIF-1α signaling pathway. Oxid Med Cell Longev. 2022;2022:6732972. doi: 10.1155/2022/6732972, PMID 35222802
den Engelsen C, Koekkoek PS, Gorter KJ, van den Donk M, Salomé PL, Rutten GE. High-sensitivity C-reactive protein to detect metabolic syndrome in a centrally obese population: A cross-sectional analysis. Cardiovasc Diabetol. 2012;11:25. doi: 10.1186/1475-2840-11-25, PMID 22417460
Karadag AS, Tutal E, Ertugrul DT. Insulin resistance is increased in patients with vitiligo. Acta Derm Venereol. 2011;91(5):541-4. doi: 10.2340/00015555-1141, PMID 21597678
Chang HC, Lin MH, Huang YC, Hou TY. The association between vitiligo and diabetes mellitus: A systematic review and meta-analysis. J Am Acad Dermatol. 2019;81(6):1442-5. doi: 10.1016/j. jaad.2019.06.022, PMID 31228523
Sharma YK, Bansal P, Menon S, Prakash N. Metabolic syndrome in vitiligo patients among a semi-urban Maharashtrian population: A case control study. Diabetes Metab Syndr. 2017;11 Suppl 1:S77-80. doi: 10.1016/j.dsx.2016.12.009, PMID 28017282
Sallam M, Gaballah MA, State AF, Al-Harrass M. Metabolic syndrome in Egyptian patients with vitiligo. J Egypt Womens Dermatol Soc. 2017;14(2):100-5. doi: 10.1097/01.EWX.0000513078.01555.d6
Namazi N, Amani M, Haghighatkhah HR, Noori E, Abdollahimajd F. Increased risk of subclinical atherosclerosis and metabolic syndrome in patients with vitiligo: A real association or a coincidence? Dermatol Ther. 2021;34(2):e14803. doi: 10.1111/dth.14803, PMID 33496053
Lakhani DR, Prakash DC, Tiwari DS, Purohit DS, Paliwal DV, Mathur DK, et al. Scoring system in dermatology: A review. IOSR. 2016;15(7):89-99. doi: 10.9790/0853-150798999
Grundy SM, Brewer HB Jr., Cleeman JI, Smith SC Jr., Lenfant C, American Heart Association, et al. Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/ American Heart Association conference on scientific issues related
to definition. Circulation. 2004;109(3):433-8. doi: 10.1161/01. CIR.0000111245.75752.C6, PMID 14744958
Alberti KG, Zimmet P, Shaw J. Metabolic syndrome--a new world-wide definition. A consensus statement from the International Diabetes Federation. Diabet Med. 2006;23(5):469-80. doi: 10.1111/j.1464- 5491.2006.01858.x, PMID 16681555
Kozan O, Oguz A, Erol C, Senocak M, Ongen Z, Abacı A, et al. Results of METSAR. National Congress of Cardiology. Antalya.: Metabolic Syndrome Research Group. Antalya: XX. National Congress of Cardiology; 2004. Available from: https://www.metsend.org/pdf/ metsar-metsend.pdfmetabolik
Aguilar M, Bhuket T, Torres S, Liu B, Wong RJ. Prevalence of the metabolic syndrome in the United States, 2003-2012. JAMA. 2015;313(19):1973-4. doi: 10.1001/jama.2015.4260, PMID 25988468
Li FE, Zhang FL, Zhang P, Liu D, Liu HY, Guo ZN, et al. Sex-based differences in and risk factors for metabolic syndrome in adults aged 40 years and above in Northeast China: Results from the cross-sectional China national stroke screening survey. BMJ Open. 2021;11(3):e038671. doi: 10.1136/bmjopen-2020-038671, PMID 33762227
Wu M, Wang L, Wu H, Yang M, He Z, Chen Y, et al. Leptin deficiency in CD8+ T cells ameliorates non-segmental vitiligo by reducing interferon-γ and Granzyme B. Front Immunol. 2023;14:1158883. doi: 10.3389/fimmu.2023.1158883, PMID 37207234
Ye Z, Chen J, Du P, Ni Q, Li B, Zhang Z, et al. Metabolomics signature and potential application of serum polyunsaturated fatty acids metabolism in patients with vitiligo. Front Immunol. 2022;13:839167. doi: 10.3389/fimmu.2022.839167, PMID 35222431
Taneja K, Taneja J, Kaur C, Patel S, Haldar D. Lipid Risk factors in vitiligo: Homocysteine the connecting link? Clin Lab. 2020;66(10). doi: 10.7754/Clin.Lab.2020.200120, PMID 33073941
Mustafa AI, Hamed AM, Kadah AS, Fawzy EM, El Shimi OS. A notorious trio! Inflammation, metabolic syndrome and vitiligo. Indian Dermatol Online J. 2023;14(4):493-9. doi: 10.4103/idoj.idoj_674_22, PMID 37521222
Ataş H, Gönül M. Increased risk of metabolic syndrome in patients with vitiligo. Balkan Med J. 2017;34(3):219-25. doi: 10.4274/ balkanmedj.2016.1005, PMID 28443562
Ibrahim S, El-Tahlawi S, Mogawer RM, El Ansary M, Esmat S, El- Hawary M. Different vitiligo characteristics as predictors of increased risk of metabolic syndrome and insulin resistance: A case-control study. J Cosmet Dermatol. 2022;21(12):7170-7. doi: 10.1111/jocd.15446, PMID 36208004
Tanacan E, Atakan N. Higher incidence of metabolic syndrome components in vitiligo patients: A prospective cross-sectional study. An Bras Dermatol. 2020;95(2):165-72. doi: 10.1016/j.abd.2019.07.006, PMID 32113676
Published
How to Cite
Issue
Section
Copyright (c) 2024 Dr Pavan Kumar Singh, Dr Kanishk Kaushik, Prof Rahul Bhargava
This work is licensed under a Creative Commons Attribution 4.0 International License.
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.
