تاثیر 12 هفته تمرین مقاومتی بر سطوح سرمی کوپپتین، hs-CRP و مقاومت به انسولین در زنان سالمند

نوع مقاله : مقاله پژوهشی

نویسندگان

1 دانشجوی کارشناس ارشد فیزیولوژی ورزشی، گروه علوم ورزشی،دانشکده ادبیات و علوم انسانی، دانشگاه شهرکرد، شهرکرد، ایران

2 دانشیار فیزیولوژی ورزشی، گروه علوم ورزشی، دانشکده ادبیات و علوم انسانی، دانشگاه شهرکرد، شهرکرد، ایران .

10.22080/jaep.2023.25799.2150

چکیده

اهداف: افزایش سطح کوپپتین با افزایش التهاب و مقاومت به انسولین همراه است و غلظت آن در افراد سالمند به طور قابل توجهی بالاتر از جوانان است. بنابراین، مطالعه حاضر با هدف بررسی تأثیر 12 هفته تمرین مقاومتی با باند الاستیک (EBRT) بر سطوح سرمی کوپپتین، hs-CRP و مقاومت به انسولین انجام شد.
روش مطالعه: بیست و هشت زن سالمند (سن 69/4±04/74 سال و شاخص توده بدنی 35/3±21/28 کیلوگرم بر متر مربع) بر اساس معیارهای ورود به مطالعه انتخاب  شدند و به طور تصادفی در گروه تمرین (14 نفر) و کنترل (14 نفر) تقسیم شدند تا در پروتکل 12 هفته­ای EBRT شرکت کنند (3 روز در هفته). شدت تمرینات بر اساس مقیاس بورگ در نقطه 12 تا 14 کنترل می­­شد. اندازه­گیری­­های پیش آزمون قبل از شروع پروتکل تمرین و اندازه­گیری­های پس آزمون 48 ساعت بعد از آخرین جلسه تمرین انجام شد. داده­ها با استفاده از آزمون ANOVA دو طرفه با اندازه­گیری­های مکرر تحلیل شد.
یافته­ها: پس از ۱۲ هفته EBRT، تفاوت معناداری در شاخص‌های پیکرسنجی غیر از درصد چربی بدن مشاهده نشد. کاهش بیشتر و معنادار درصد چربی بدن در گروه تمرین مشاهده شد (۰۲۳/0p=). سطوح سرمی گلوکز تغییر معناداری نداشت اما سطوح سرمی انسولین (035/0p=) و مقاومت به انسولین (045/0p=) به طور معناداری کاهش یافت. تغییر معناداری در سطوح سرمی کوپپتین بر اثر 12 هفته تمرین مشاهده نشد، اما کاهش سطوح سرمی hs-CRP معنادار بود (037/0p=).
نتیجه گیری: اگرچه سطوح سرمی کوپپتین پس از 12 هفته EBRT تغییر معنی داری نداشت، به نظر می­رسد کاهش مقاومت به انسولین و hs-CRP می­تواند ناشی از بهبود ترکیب بدنی بوده و نشان دهنده کاهش التهاب و بهبود سلامت در زنان سالمند باشد.

کلیدواژه‌ها


عنوان مقاله [English]

The effect of 12 weeks of resistance training on serum copeptin levels, hs-CRP, and insulin resistance in elderly women

نویسندگان [English]

  • Esmaeil Moradi Sarteshnizi 1
  • Akbar Azamian Jazi 2
1 Department of Sport Sciences, Faculty of Letters and Humanities, Shahrekord University, Shahrekord, Iran.
2 Department of Sport Sciences, Faculty of Letters and Humanities, Shahrekord University, Shahrekord, Iran.
چکیده [English]

Objectives: Increased copeptin level is associated with increased inflammation and insulin resistance, and its concentration is significantly higher in the elderly than in the young. Therefore, the present study aimed to investigate the effect of 12 weeks of elastic band resistance training (EBRT) on the serum levels of copeptin, hs-CRP, and insulin resistance.
Methods: Twenty-eight elderly women (age 74.04±4.69 years and body mass index 28.21±3.35 kg/m2) were selected based on the inclusion criteria and randomly assigned into one of two groups, exercise (n = 14) or control (n = 14) to participate in a 12-week (3d/wk) supervised EBRT. The exercise intensity was checked using the Borg scale at points 12 to 14. Pre-test measurements were taken before starting the training protocol, and post-test measurements were performed 48 hours after the last training session. Data were analyzed using two-way repeated-measures ANOVA.
Results: After 12 weeks of EBRT, no significant difference was observed in the anthropometric indices other than body fat percentage. A greater and significant decrease in body fat percentage was observed in the training group (p=0.023). Serum glucose levels did not change significantly, but serum insulin levels (p=0.035) and insulin resistance (p=0.045) decreased significantly. No significant change in serum levels of copeptin was observed after 12 weeks of training, but the reduction of hs-CRP serum levels was significant (p=0.037).
Conclusion: Although the serum levels of copeptin did not change significantly after 12 weeks of EBRT, it seems that the reduction of insulin resistance and hs-CRP could be due to body composition improvement and indicate reduced inflammation and improved health in elderly women.

کلیدواژه‌ها [English]

  • Elderly
  • Resistance training
  • Copeptin
  • hs-CRP
  • Insulin resistance
## Lang, T., Streeper, T., Cawthon, P., Baldwin, K., Taaffe, D. R., & Harris, T. B. (2010). Sarcopenia: etiology, clinical consequences, intervention, and assessment. Osteoporos Int, 21(4), 543-559.  https://doi.org/10.1007/s00198-009-1059-y ##Diminich, E. D., Clouston, S., Scott, S. B., Palekar, N., santiago, E. D., Bromet, E., & Luft, B. (2019). biological markers of aging: chronic stress and cognitive impairment in responders from the world trade center. Innov Aging, 3(Suppl 1), S93-94.##Remigante, A., Spinelli, S., Basile, N., Caruso, D., Falliti, G., Dossena, S., Marino, A., & Morabito, R. (2022). Oxidation Stress as a Mechanism of Aging in Human Erythrocytes: Protective Effect of Quercetin. Int J Mol Sci, 23(14). https://doi.org/10.3390/ijms23147781 ##Yang, H., Fang, B., Wang, Z., Chen, Y., & Dong, Y. (2023). The Timing Sequence and Mechanism of Aging in Endocrine Organs. Cells, 12(7). https://doi.org/10.3390/cells12070982## van den Beld, A. W., Kaufman, J. M., Zillikens, M. C., Lamberts, S. W. J., Egan, J. M., & van der Lely, A. J. (2018). The physiology of endocrine systems with ageing. Lancet Diabetes Endocrinol, 6(8), 647-658. https://doi.org/10.1016/s2213-8587(18)30026-3##Koseoglu, M., Ozben, S., Gozubatik-Celik, G., Tutuncu, M., Kucuksayan, E., Hanikoğlu, A., Atakli, D., & Ozben, T. (2020). Plasma copeptin levels in patients with multiple sclerosis. Journal of Clinical Neuroscience, 78, 143-146. https://doi.org/https://doi.org/10.1016/j.jocn.2020.04.095##Aydin, S., Kuloglu, T., & Aydin, S. (2013). Copeptin, adropin and irisin concentrations in breast milk and plasma of healthy women and those with gestational diabetes mellitus. Peptides, 47, 66-70. https://doi.org/10.1016/j.peptides.2013.07.001 ##Kmiec, Z. (2010). Central control of food intake in aging. Interdiscip Top Gerontol, 37, 37-50. https://doi.org/10.1159/000319993 ##Kmiec, Z. (2011). Aging and peptide control of food intake. Curr Protein Pept Sci, 12(4), 271-279. ## Redman, L. M., & Ravussin, E. (2009). Endocrine alterations in response to calorie restriction in humans. Mol Cell Endocrinol, 299(1), 129-136. https://doi.org/10.1016/j.mce.2008.10.014## Shanik, M. H., Xu, Y., Škrha, J., Dankner, R., Zick, Y., & Roth, J. (2008). Insulin resistance and hyperinsulinemia. Diabetes care, 31(Supplement 2), S262-S268. ##Stallone, F., Twerenbold, R., Wildi, K., Reichlin, T., Rubini Gimenez, M., Haaf, P., Fuechslin, N., Hillinger, P., Jaeger, C., Kreutzinger, P., Puelacher, C., Radosavac, M., Moreno Weidmann, Z., Moehring, B., Honegger, U., Schumacher, C., Denhaerynck, K., Arnold, C., Bingisser, R., . . . Mueller, C. (2014). Prevalence, characteristics and outcome of non-cardiac chest pain and elevated copeptin levels. Heart, 100(21), 1708-1714. https://doi.org/10.1136/heartjnl-2014-305583 ##Christ-Crain, M. (2019). Vasopressin and Copeptin in health and disease. Rev Endocr Metab Disord, 20(3), 283-294. https://doi.org/10.1007/s11154-019-09509-9 ##Lattuca, B., Sy, V., Nguyen, L. S., Bernard, M., Zeitouni, M., Overtchouk, P., Yan, Y., Hammoudi, N., Ceccaldi, A., Collet, J. P., Kerneis, M., Diallo, A., Montalescot, G., & Silvain, J. (2019). Copeptin as a prognostic biomarker in acute myocardial infarction. Int J Cardiol, 274, 337-341. https://doi.org/10.1016/j.ijcard.2018.09.022##Parizadeh, S. M., Ghandehari, M., Parizadeh, M. R., Ferns, G. A., Ghayour-Mobarhan, M., Avan, A., & Hassanian, S. M. (2018). The diagnostic and prognostic value of copeptin in cardiovascular disease, current status, and prospective. J Cell Biochem, 119(10), 7913-7923. https://doi.org/10.1002/jcb.27093##Rizzuto, D., Melis, R. J. F., Angleman, S., Qiu, C., & Marengoni, A. (2017). Effect of Chronic Diseases and Multimorbidity on Survival and Functioning in Elderly Adults. J Am Geriatr Soc, 65(5), 1056-1060. https://doi.org/10.1111/jgs.14868##Sahin, I., Gungor, B., Ozkaynak, B., Uzun, F., Kucuk, S. H., Avci, II, Ozal, E., Ayca, B., Cetin, S., Okuyan, E., & Dinckal, M. H. (2017). Higher copeptin levels are associated with worse outcome in patients with hypertrophic cardiomyopathy. Clin Cardiol, 40(1), 32-37. https://doi.org/10.1002/clc.22602 ##Tasevska, I., Enhorning, S., Persson, M., Nilsson, P. M., & Melander, O. (2016). Copeptin predicts coronary artery disease cardiovascular and total mortality. Heart, 102(2), 127-132. https://doi.org/10.1136/heartjnl-2015-308183 ##Thomsen, C. F., Dreier, R., Goharian, T. S., Goetze, J. P., Andersen, L. B., Faber, J., Ried-Larsen, M., Grontved, A., & Jeppesen, J. L. (2019). Association of copeptin, a surrogate marker for arginine vasopressin secretion, with insulin resistance: Influence of adolescence and psychological stress. Peptides, 115, 8-14. https://doi.org/10.1016/j.peptides.2019.02.005 ##Velho, G., Ragot, S., El Boustany, R., Saulnier, P.-J., Fraty, M., Mohammedi, K., Fumeron, F., Potier, L., Marre, M., Hadjadj, S., & Roussel, R. (2018). Plasma copeptin, kidney disease, and risk for cardiovascular morbidity and mortality in two cohorts of type 2 diabetes. Cardiovascular diabetology, 17(1), 110-110. https://doi.org/10.1186/s12933-018-0753-5 ##Widecka, J., Ozegowska, K., Banaszewska, B., Kazienko, A., Safranow, K., Branecka-Wozniak, D., Pawelczyk, L., & Kurzawa, R. (2019). Is copeptin a new potential biomarker of insulin resistance in polycystic ovary syndrome? Ginekol Pol, 90(3), 115-121. https://doi.org/10.5603/gp.2019.0021##Ebert, T., Platz, M., Kralisch, S., Lossner, U., Jessnitzer, B., Richter, J., Bluher, M., Stumvoll, M., & Fasshauer, M. (2016). Serum Levels of Copeptin are Decreased in Gestational Diabetes Mellitus. Exp Clin Endocrinol Diabetes, 124(4), 257-260. https://doi.org/10.1055/s-0035-1565172 ##Katan, M., & Christ-Crain, M. (2010). The stress hormone copeptin: a new prognostic biomarker in acute illness. Swiss Med Wkly, 140, w13101. https://doi.org/10.4414/smw.2010.13101##Wojsyk-Banaszak, I., Sobkowiak, P., Jonczyk-Potoczna, K., Narozna, B., Langwinski, W., Szczepanik, M., Kycler, Z., Breborowicz, A., & Szczepankiewicz, A. (2019). Evaluation of Copeptin during Pulmonary Exacerbation in Cystic Fibrosis. Mediators Inflamm, 2019, 1939740. https://doi.org/10.1155/2019/1939740 ##Wannamethee, S. G., Welsh, P., Papacosta, O., Lennon, L., Whincup, P. H., & Sattar, N. (2015). Copeptin, Insulin Resistance, and Risk of Incident Diabetes in Older Men. J Clin Endocrinol Metab, 100(9), 3332-3339. https://doi.org/10.1210/JC.2015-2362 ##Stacey, M. J., Delves, S. K., Britland, S. E., Allsopp, A. J., Brett, S. J., Fallowfield, J. L., & Woods, D. R. (2018). Copeptin reflects physiological strain during thermal stress. Eur J Appl Physiol, 118(1), 75-84. https://doi.org/10.1007/s00421-017-3740-8##Mellor, A. J., Boos, C. J., Ball, S., Burnett, A., Pattman, S., Redpath, M., & Woods, D. R. (2015). Copeptin and arginine vasopressin at high altitude: relationship to plasma osmolality and perceived exertion. Eur J Appl Physiol, 115(1), 91-98. https://doi.org/10.1007/s00421-014-2994-7 ##Popovic, M., Timper, K., Seelig, E., Nordmann, T., Erlanger, T. E., Donath, M. Y., & Christ-Crain, M. (2019). Exercise upregulates copeptin levels which is not regulated by interleukin-1. PLoS One, 14(5), e0217800. https://doi.org/10.1371/journal.pone.0217800 ##Abbasian, S., Ravasi, A. A., Soori, R., Aydin, S., Choobineh, S., & Aydin, S. (2022). High-intensity interval training ameliorates endothelial dysfunction through adropin, nitric oxide, MR-proADM, and copeptin changes in overweight subjects. Hormones (Athens), 21(4), 707-717. https://doi.org/10.1007/s42000-022-00402-w##Trippel, T. D., Holzendorf, V., Halle, M., Gelbrich, G., Nolte, K., Duvinage, A., Schwarz, S., Rutscher, T., Wiora, J., Wachter, R., Herrmann-Lingen, C., Duengen, H. D., Hasenfuß, G., Pieske, B., & Edelmann, F. (2017). Ghrelin and hormonal markers under exercise training in patients with heart failure with preserved ejection fraction: results from the Ex-DHF pilot study. ESC Heart Fail, 4(1), 56-65. https://doi.org/10.1002/ehf2.12109 ##Mayer, C. U., Treff, G., Fenske, W. K., Blouin, K., Steinacker, J. M., & Allolio, B. (2015). High incidence of hyponatremia in rowers during a four-week training camp. Am J Med, 128(10), 1144-1151. https://doi.org/10.1016/j.amjmed.2015.04.014 ##Krogh, J., Gotze, J. P., Jorgensen, M. B., Kristensen, L. O., Kistorp, C., & Nordentoft, M. (2013). Copeptin during rest and exercise in major depression. J Affect Disord, 151(1), 284-290. https://doi.org/10.1016/j.jad.2013.06.007 ##DuttaRoy, S., Nilsson, J., Hammarsten, O., Cider, Å., Bäck, M., Karlsson, T., Wennerblom, B., & Borjesson, M. (2015). High frequency home-based exercise decreases levels of vascular endothelial growth factor in patients with stable angina pectoris. Eur J Prev Cardiol, 22(5), 575-581. https://doi.org/10.1177/2047487314529349  ##Monteiro-Junior, R. S., de Tarso Maciel-Pinheiro, P., da Matta Mello Portugal, E., da Silva Figueiredo, L. F., Terra, R., Carneiro, L. S. F., Rodrigues, V. D., Nascimento, O. J. M., Deslandes, A. C., & Laks, J. (2018). Effect of Exercise on Inflammatory Profile of Older Persons: Systematic Review and Meta-Analyses. J Phys Act Health, 15(1), 64-71. https://doi.org/10.1123/jpah.2016-0735 ##Plaisance, E. P., & Grandjean, P. W. (2006). Physical activity and high-sensitivity C-reactive protein. Sports Med, 36(5), 443-458. https://doi.org/10.2165/00007256-200636050-00006 ##Hammar, M., & Ostgren, C. J. (2013). Healthy aging and age-adjusted nutrition and physical fitness. Best Pract Res Clin Obstet Gynaecol, 27(5), 741-752. https://doi.org/10.1016/j.bpobgyn.2013.01.004 ##Martins, W. R., Safons, M. P., Bottaro, M., Blasczyk, J. C., Diniz, L. R., Carlos Fonseca, R. M., Bonini-Rocha, A. C., & de Oliveira, R. J. (2015). Effects of short term elastic resistance training on muscle mass and strength in untrained older adults: a randomized clinical trial. BMC GERIATRICS, 15. ##Nelson, M. E., Rejeski, W. J., Blair, S. N., Duncan, P. W., Judge, J. O., King, A. C., Macera, C. A., & Castaneda-Sceppa, C. (2007). Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Circulation, 116(9), 1094. ##Colado, J. C., García-Massó, X., Pellicer, M., Alakhdar, Y., Benavent, J., & Cabeza-Ruiz, R. (2010). A comparison of elastic tubing and isotonic resistance exercises. International journal of sports medicine, 31(11), 810-817. ##Huang, S. W., Ku, J. W., Lin, L. F., Liao, C. D., Chou, L. C., & Liou, T. H. (2017). Body composition influenced by progressive elastic band resistance exercise of sarcopenic obesity elderly women: a pilot randomized controlled trial. Eur J Phys Rehabil Med, 53(4), 556-563. https://doi.org/10.23736/S1973-9087.17.04443-4 ##Verrill, D., Shoup, E., McElveen, G., Witt, K., & Bergey, D. (1992). Resistive exercise training in cardiac patients. Sports Medicine, 13(3), 171-193. ##Hedayati, M., Saghebjoo, M., & Ghanbari-Niaki, A. (2012). Effects of circuit resistance training intensity on the plasma ghrelin to obestatin ratios in healthy young women. International journal of endocrinology and metabolism, 10(2), 475.##Hawley, J. A. (2004). Exercise as a therapeutic intervention for the prevention and treatment of insulin resistance. Diabetes/metabolism research and reviews, 20(5), 383-393.##Bastard, J.-P., Maachi, M., Lagathu, C., Kim, M. J., Caron, M., Vidal, H., Capeau, J., & Feve, B. (2006). Recent advances in the relationship between obesity, inflammation, and insulin resistance. European cytokine network, 17(1), 4-12. ##Matthews, D. R., Hosker, J. P., Rudenski, A. S., Naylor, B. A., Treacher, D. F., & Turner, R. C. (1985). Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia, 28(7), 412-419.##Riebe, D., Ehrman, J. K., Liguori, G., & Magal, M. (2017). ACSM's Guidelines for Exercise Testing and Prescription. Wolters Kluwer. https://books.google.com/books?id=m_L-jwEACAAJ ##Maeder, M. T., Staub, D., Brutsche, M. H., Arenja, N., Socrates, T., Reiter, M., Meissner, J., Morgenthaler, N. G., Bergmann, A., Struck, J., & Mueller, C. (2010). Copeptin response to clinical maximal exercise tests. Clin Chem, 56(4), 674-676. https://doi.org/10.1373/clinchem.2009.136309 ##Roussel, R., El Boustany, R., Bouby, N., Potier, L., Fumeron, F., Mohammedi, K., Balkau, B., Tichet, J., Bankir, L., Marre, M., & Velho, G. (2016). Plasma Copeptin, AVP Gene Variants, and Incidence of Type 2 Diabetes in a Cohort From the Community. J Clin Endocrinol Metab, 101(6), 2432-2439. https://doi.org/10.1210/jc.2016-1113 ##Asad, M. R., Farbod Mohana, F., & Barzegari, A. (2020). The effect of four training method on the copeptin and mid-regional pro-adrenomedullin in the left ventricle of male wistar rats [Research]. Studies in Medical Sciences, 31(3), 219-229. [In Persion]. ##Asferg, C. L., Andersen, U. B., Linneberg, A., Goetze, J. P., & Jeppesen, J. L. (2014). Copeptin, a surrogate marker for arginine vasopressin secretion, is associated with higher glucose and insulin concentrations but not higher blood pressure in obese men. Diabet Med, 31(6), 728-732. https://doi.org/10.1111/dme.12411 ##Barb, D., Neuwirth, A., Mantzoros, C. S., & Balk, S. P. (2007). Adiponectin signals in prostate cancer cells through Akt to activate the mammalian target of rapamycin pathway. Endocr Relat Cancer, 14(4), 995-1005. https://doi.org/10.1677/ERC-06-0091 ##Mir E, Attarzadeh Hosseini SR, Hejazi K, & Mir Sayeedi M. (2016). Effect of eight weeks of endurance and resistance training on serum adiponectin and Insulin resistance index of inactive elderly men [Original Articles]. Journal of Gorgan University of Medical Sciences, 18(1), 69-77. [In Persion].##Sproston, N. R., & Ashworth, J. J. (2018). Role of C-Reactive Protein at Sites of Inflammation and Infection. Front Immunol, 9, 754. https://doi.org/10.3389/fimmu.2018.00754 ##Verma, S., Bhatta, M., Davies, M., Deanfield, J. E., Garvey, W. T., Jensen, C., Kandler, K., Kushner, R. F., Rubino, D. M., & Kosiborod, M. N. (2023). Effects of once-weekly semaglutide 2.4 mg on C-reactive protein in adults with overweight or obesity (STEP 1, 2, and 3): Exploratory analyses of three randomised, double-blind, placebo-controlled, phase 3 trials. EClinicalMedicine, 55, 101737. https://doi.org/10.1016/j.eclinm.2022.101737 ##Azamian Jazi, A., Sarteshnizi, E. M., & Fathi, M. (2021). Effect of selected elastic band resistance training on serum levels of fibroblast growth factor 23, TNF-α and hsCRP in overweight elderly women. The Iranian Journal of Obstetrics, Gynecology and Infertility, 24(1), 26-35. [In Persion]. https://doi.org/10.22038/ijogi.2021.17990##Ihalainen, J. K., Schumann, M., Eklund, D., Hamalainen, M., Moilanen, E., Paulsen, G., Hakkinen, K., & Mero, A. A. (2018). Combined aerobic and resistance training decreases inflammation markers in healthy men. Scand J Med Sci Sports, 28(1), 40-47. https://doi.org/10.1111/sms.12906 ##Kargarfard, M., Nobari, H., Kamyar, K., Zadeh, A. K., & Oliveira, R. (2022). Effects of 12-week moderate aerobic exercise on ROCK2 activity, hs-CRP and glycemic index in obese patients with impaired glucose tolerance. Physiol Behav, 257, 113976. https://doi.org/10.1016/j.physbeh.2022.113976 ##Zheng, G., Qiu, P., Xia, R., Lin, H., Ye, B., Tao, J., & Chen, L. (2019). Effect of Aerobic Exercise on Inflammatory Markers in Healthy Middle-Aged and Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Aging Neurosci, 11, 98. https://doi.org/10.3389/fnagi.2019.00098 ##Jensen, C. S., Bahl, J. M., Ostergaard, L. B., Hogh, P., Wermuth, L., Heslegrave, A., Zetterberg, H., Heegaard, N. H. H., Hasselbalch, S. G., & Simonsen, A. H. (2019). Exercise as a potential modulator of inflammation in patients with Alzheimer's disease measured in cerebrospinal fluid and plasma. Exp Gerontol, 121, 91-98. https://doi.org/10.1016/j.exger.2019.04.003 ##Kabir, B., Taghian, F., & Ghatreh Samani, K. (2018). Dose 12 week resistance training Influence IL-18 and CRP levels in elderly men? [Research]. Razi Journal of Medical Sciences, 24(165), 77-84. [Persian]. ##Anty, R., Bekri, S., Luciani, N., Saint-Paul, M. C., Dahman, M., Iannelli, A., Amor, I. B., Staccini-Myx, A., Huet, P. M., Gugenheim, J., Sadoul, J. L., Le Marchand-Brustel, Y., Tran, A., & Gual, P. (2006). The inflammatory C-reactive protein is increased in both liver and adipose tissue in severely obese patients independently from metabolic syndrome, Type 2 diabetes, and NASH. Am J Gastroenterol, 101(8), 1824-1833. https://doi.org/10.1111/j.1572-0241.2006.00724.x##Calabro, P., Chang, D. W., Willerson, J. T., & Yeh, E. T. (2005). Release of C-reactive protein in response to inflammatory cytokines by human adipocytes: linking obesity to vascular inflammation. J Am Coll Cardiol, 46(6), 1112-1113.https://doi.org/10.1016/j.jacc.2005.06.017##de Mattos, A. M., Ovidio, P. P., Jordão, A. A., da Costa, J. A., & Chiarello, P. G. (2013). Association of body fat with inflammation in peritoneal dialysis. Inflammation, 36(3), 689-695. https://doi.org/10.1007/s10753-013-9593-3 ## Fedewa, M. V., Hathaway, E. D., & Ward-Ritacco, C. L. (2017). Effect of exercise training on C reactive protein: a systematic review and meta-analysis of randomised and non-randomised controlled trials. Br J Sports Med, 51(8), 670-676. https://doi.org/10.1136/bjsports-2016-095999##