The Role of Adipose Tissue in Elevate ESR Level in Obese Persons

Obesity

Obesity is a serious health problem worldwide, which characterized by elevated inflammatory markers. It has been on the rise through the last decade due to changes in eating habits and a reduction in physical activity [1]. Obesity is a consequence of numerous risk factors, included increased energy consumption, not sleeping enough, Endocrine disruptors, smoking, some medications, obesity genes and reduced physical exercise [2].

Erythrocyte sedimentation rate (ESR)

Is the rate of fall down red blood cells, when anticoagulant whole blood passes through narrow vertical tube. ESR rate measure by millimeters of RBCs per hours.ESR is non-specific, but sensitive inflammatory marker. The level of ESR depend on the formation of rouleaux, the formation of rouleaux depend on the balance between zeta potential and pro inflammatory factors. Pro inflammatory factors also called acute phase reactant, acute phase reactant increase during inflammation process [3]. Acute phase reactants included ferritin, CRP, haptoglobin. Increases of acute phase reactants lead to elevated ESR. There are another pathological conditions included anemia, macrocytosis, Obesity, Pregnancy, Hypercholesterolemia. On the other hand level of ESR decrease in Polycythemia, microcytosis, Sicklecells, spherocytosis, hypogammaglobulinemia, hypofibrinogenemia, High WBC count, hyperviscosity. There are physiological condition lead to increase ESR level as sex and age. Raised ESR is a significant diagnostic criterion for polymyalgia rheumatic and temporal arteritis. ESR may be helpful in detecting occult disease. The most common causes of an elevated ESR in acuteinfection, inflammation, malignancy, systemic lupus erythematous and renal disease. Also, ESR can be differentiating between Iron deficiency anemia and anemia of chronic disease [4].

Interaction between obesity and ESR

Obesity is characterized with increase concentrations of circulating inflammatory cytokines. The chief source of proinflammatory cytokines in obesity is the adipose tissue; they are predominantly produced by macrophages. Adipose tissue is a vital source of cytokines and contributes to the inflammatory process [5]. During inflammation process adipose tissue, and macrophage secrete various cytokines, and interleukins such as TNF alpha, IL6, IL8 which are responsible for estimate the liver to produce fibrinogen, CRP, haptoglobin. Increase inflammation responsible for increase production of fibrinogen which in turn increases ESR level as in Figure 1 [6].

Figure 1: Interaction between obesity and ESR.

In our review obesity was associated with inflammatory markers such as ESR, and fibrinogen levels. Secretion of cytokines in obese people responsible for increase rate of inflammation, hence elevate ESR level.

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