Low-grade inflammation

Increases in plasma S-AA levels have previously been reported in patients with coronary disease (57). S-AA and plasma intracellular adhesion molecule-1 were elevated in patients with CAD and hyperhomocysteinemia, but only S-AA decreased after vitamin supplementation (35). Homocysteine activates nuclear factor- in endothelial cells, possibly via oxidative stress (58), and increases monocyte chemoattractant protein-1 expression in vascular smooth muscle cells (59). Additionally, it stimulates interleukin-8 expression in human endothelial cultures (60). These inflammatory factors are known to participate in the development of atherosclerosis. Taken together, these reports suggest an association of elevated tHcy and low-grade inflammation in CAD. 

The metabolic syndrome , characterised by abdominal obesity, insulin resistance, dislip-idaemia, low-grade inflammation, hypertension and cardiovascular disease, is a common and serious medical problem throughout the developed world that merits particular attention. Obesity is a growing problem in children. 

Devaux B, Scholz D, Hirche A, Klovekorn WP, Schaper J. Upregulation of cell adhesion molecules and the presence of low grade inflammation in human chronic heart failure. Eur Heart J 1997 18 470-479. 

Dialysis patients with ESRD tend to have a poor appetite. Protein metabolism is also altered in the setting of chronic acidosis and low-grade inflammation. These factors in combination place patients at risk of protein and energy mainourishment. Plasma albumin is often used as a marker of malnutrition even though it is a relatively poor nutritional marker. However, there is good evidence that the lower the plasma concentration of albumin, the worse the long-... 

In view of successful animal experiments (20 see also Chapter 14), a sustained-release dexamethasone device was implanted in one eye of a patient with bilateral severe uveitis associated with multiple sclerosis (20,21). The patient had previously undergone pars plana lensectomy and vitrectomy in the right eye for decreased vision associated with cataract. Despite chronic topical corticosteroids, the patient had persistent bilateral low-grade inflammation and recurrent severe bilateral iridocyclitis. Best corrected visual acuity was 20/400 in both eyes. Systemic corticosteroids and methotrexate controlled the intraocular inflammation but the patient was intolerant of these medications because of systemic side effects. The nondegradable dexamethasone device was inserted into the patient s left eye. 

Stimulant laxatives have direct effects on enterocytes, enteric neurons, and G1 smooth muscle and probably induce a limited low-grade inflammation in the small and large bowel to promote accumulation of water and electrolytes and stimulate intestinal motility. Included in this group are diphenylmethane derivatives, anthraquinones, and ricinoleic acid. 

Low-grade inflammation is closely associated with the metabolic syndrome and is an accepted new cardiovascular risk factor. Reductions in postprandial glucose excursion by treatment with acarbose in patients with type 2 diabetes have shown to reduce the activity (p = 0.045) and nuclear localization (p = 0.02) of the proinflammatory transcription factor NFkB, suggesting a mechanism by which the anti-inflammatory effects of acarbose may be mediated [8]. This mechanism would be consistent with reductions in the level of coagulation factors seen with acarbose treatment. For example, acarbose has been shown to reduce the level of fibrinogen in patients with type 2 diabetes (p = 0.013 vs. placebo) [42] and serum C-reactive protein levels in individuals with IGT (p < 0.01 vs. placebo) [43]. We found a significant reduction in postprandial leukocyte excursion another indicator... 

During recent years numerous prospective studies have identified several modifiable risk factors for CVD in patients with type 2 diabetes. On top of hyperglycaemia these factors include hypertension, dyslipidaemia, microalbuminuria, a pro-thrombotic state, visceral fat accumulation, and associated chronic low-grade inflammation, smoking, diets... 

Chassaing, B. and Gewirtz, A.T. 2014. Gut microbiota, low grade inflammation and metabolic syndrome. Toxicol Pathol, 42 49-53. 

Klein-Platat C, Drai J, Oujaa M, Schlienger JS, Chantal S. Plasma fatty acid composition is associated with the metabolic syndrome and low-grade inflammation in overweight adolescents, ylw J C//n Awtr. 2005,52 1178-1184. 

Cani PD, Delzenne NM. Involvement of the gut microbiota in the development of low grade inflammation associated with obesity focus on this neglected partner. Acta Gastroenterol Belg. 2010 73 267-269. 

FIGURE 9.1 A schematic representation of diet microbe interactions and how they shape immune function within the gut. Key metabolic processes within the human gut microbiota, especially carbohydrate fermentation, the enterohepatic circulation of bile acids and biotransformation of plant bioactive polyphenols by the gut microbiota play important roles in regulating both inflammatory and metabolic processes within the intestine, but also in other body tissues, like the liver, adipose tissue and brain, which are intimately involved in regulating whole-body glucose, lipid and energy metabolism, and also the chronic low-grade inflammation characteristic of metabolic diseases like diabetes, CVD, Alzheimer s and metabolic syndrome. 

Cani PD, Osto M, Geurts L, Everard A. Involvement of gut microbiota in the development of low-grade inflammation and type 2 diabetes associated with obesity. Gut Microbes. 2012 3(4) 279—288. 

Calder PC, Ahluwalia N, Brouns F, et al. Dietary factors and low-grade inflammation in relation to overweight and obesity. Br J Nutr. 2011 106(S1) S5-S78. 

Recent evidence from observational studies indicates that vitamin Bg status, particularly blood level, is highly likely to be associated with reduced vascular disease. However, clinical trials has not supported those observational findings, possibly indicating that low blood levels of vitamin Bg may be a consequence of low-grade inflammation or smoking rather than the cause of cardiovascular disease. 

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