Relative contribution of health-related behaviours and chronic diseases to the socioeconomic patterning of low-grade inflammation
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To test the association of low-grade inflammation with socioeconomic status (SES) and determine the relative contribution of prevalent chronic diseases and health-related behaviours in explaining such association.
Cross-sectional analysis on 19,867 subjects (age ≥35, 48.1% men) recruited within the Moli-sani study from 2005 to 2010 (Italy). A score of low-grade inflammation, including platelet and leukocyte counts, the granulocyte-to-lymphocyte ratio, and C-reactive protein was applied. SES was measured by education, household income, and occupational social class.
Low SES was associated with elevated levels of low-grade inflammation. Health behaviours (including adiposity, smoking, physical activity, and Mediterranean diet adherence) explained 53.5, 53.9, and 84.9% of the association between social class, income, and education with low-grade inflammation, respectively. Adiposity and body mass index showed a prominent role, while prevalent chronic diseases and conditions only marginally attenuated SES inequalities in inflammation.
Low-grade inflammation was socioeconomically patterned in a large Mediterranean population. Potentially modifiable behavioural factors explained the greatest part of this association with a leading contribution of adiposity, body mass index, and physical activity.
KeywordsMoli-sani study Socioeconomic status Low-grade inflammation Health-related behaviours Chronic diseases
The Moli-sani research group thanks the Associazione Cuore Sano Onlus (Campobasso, Italy) for its financial and cultural support.
Moli-sani Study Investigators: The enrolment phase of the Moli-sani Project was conducted at the Research Laboratories of the Catholic University in Campobasso (Italy), the follow-up of the Moli-sani cohort is being conducted at the IRCCS Neuromed, Pozzilli, Italy.
Steering Committee: Licia Iacoviello (Neuromed, Pozzilli, Italy), Chairperson, Maria Benedetta Donati, and Giovanni de Gaetano (Neuromed, Pozzilli, Italy).
Safety and data monitoring Committee: Jos Vermylen (Catholic Univesity, Leuven, Belgio), Chairman, Ignacio De Paula Carrasco (Accademia Pontificia Pro Vita, Rome, Italy), Simona Giampaoli (Istituto Superiore di Sanità, Roma, Italy), Antonio Spagnuolo (Catholic University, Rome, Italy).
Event adjudicating Committee: Deodato Assanelli (Brescia, Italy), Vincenzo Centritto (Campobasso, Italy), Pasquale Spagnuolo, and Dante Staniscia (Termoli, Italy).
Scientific and organizing secretariat: Francesco Zito (Coordinator), Americo Bonanni, Chiara Cerletti, Amalia De Curtis, Augusto Di Castelnuovo, Licia Iacoviello, Roberto Lorenzet, Antonio Mascioli, Marco Olivieri, and Domenico Rotilio.
Data management and analysis: Augusto Di Castelnuovo (Coordinator), Marialaura Bonaccio, Simona Costanzo, and Francesco Gianfagna.
Informatics: Marco Olivieri (Coordinator), Maurizio Giacci, Antonella Padulo, and Dario Petraroia.
Biobank and biomedical analyses: Amalia De Curtis (Coordinator), Sara Magnacca, Federico Marracino, Maria Spinelli, and Christian Silvestri.
Communication and Press Office: Americo Bonanni (Coordinator), Marialaura Bonaccio, and Francesca De Lucia.
Moli-family Project: Francesco Gianfagna, Branislav Vohnout.
Recruitment staff: Franco Zito (General Coordinator), Secretariat: Mariarosaria Persichillo (Coordinator), Angelita Verna, Maura Di Lillo, Irene Di Stefano, Blood sample: Agnieszka Pampuch; Branislav Vohnout, Agostino Pannichella, Antonio Rinaldo Vizzarri, Spirometry: Antonella Arcari (Coordinator), Daniela Barbato, Francesca Bracone, Simona Costanzo, Carmine Di Giorgio, Sara Magnacca, Simona Panebianco, Antonello Chiovitti, Federico Marracino, Sergio Caccamo, Vanesa Caruso; Electrocardiograms : Livia Rago (Coordinator), Daniela Cugino, Francesco Zito, Francesco Gianfagna, Alessandra Ferri, Concetta Castaldi, Marcella Mignogna; Tomasz Guszcz, Questionnaires: Romina di Giuseppe (Coordinator), Paola Barisciano, Lorena Buonaccorsi, Floriana Centritto, Antonella Cutrone, Francesca De Lucia, Francesca Fanelli, Iolanda Santimone, Anna Sciarretta, Maura Di Lillo, Isabella Sorella, Irene Di Stefano, Emanuela Plescia, Alessandra Molinaro, and Christiana Cavone.
Call Center: Giovanna Galuppo, Maura Di Lillo, Concetta Castaldi, Dolores D’Angelo, and Rosanna Ramacciato.
Follow-up: Simona Costanzo (Coordinator); Data management: Simona Costanzo, and Marco Olivieri; Event adjudication: Livia Rago (Coordinator), Simona Costanzo, Amalia de Curtis, Licia Iacoviello, and Mariarosaria Persichillo.
Regional Health Institutions: Azienda Sanitaria Regionale del Molise (ASReM, Campobasso, Italy), UOC Servizio Igiene e Sanità Pubblica - Dipartimento di Prevenzione; Offices of vital statistics of the Molise region and Molise Dati Spa (Campobasso, Italy).
Hospitals: Presidi Ospedalieri ASReM (Presidio Ospedaliero A. Cardarelli—Campobasso, Ospedale F. Veneziale—Isernia, Ospedale San Timoteo—Termoli (CB), Ospedale Ss. Rosario—Venafro (IS), Ospedale Vietri—Larino (CB), Ospedale San Francesco Caracciolo—Agnone (IS); Istituto di cura Villa Maria—Campobasso; Fondazione di Ricerca e Cura Giovanni Paolo II—Campobasso; IRCCS Neuromed—Pozzilli (IS).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The enrolment phase of the Moli-sani Study (2005–2010) was performed at the Research Laboratories, Catholic University of Campobasso, Italy, and was supported by research grants from Pfizer Foundation (Rome, Italy), the Italian Ministry of University and Research (MIUR, Rome, Italy)—Programma Triennale di Ricerca, Decreto no.1588 and Instrumentation Laboratory, Milan, Italy. Marialaura Bonaccio is presently supported by a Fondazione Umberto Veronesi Fellowship. The analyses reported here were partially supported by the Italian Ministry of Health [Grant number GR-2013-02356060]. Funders had no role in study design, collection, analysis, and interpretation of data; in the writing of the manuscript and in the decision to submit the article for publication. All authors were and are independent from funders.
All procedures performed in the present study, involving human participants, were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Written informed consent was obtained from all individual participants included in the study.
- Ambring A, Johansson M, Axelsen M, Gan L, Strandvik B, Friberg P (2006) Mediterranean-inspired diet lowers the ratio of serum phospholipid n-6 to n-3 fatty acids, the number of leukocytes and platelets, and vascular endothelial growth factor in healthy subjects. Am J Clin Nutr 83:575–581PubMedGoogle Scholar
- Casas R, Sacanella E, Urpí-Sardà M, Chiva-Blanch G, Ros E, Martínez-González MA et al (2014) The effects of the Mediterranean diet on biomarkers of vascular wall inflammation and plaque vulnerability in subjects with high risk for cardiovascular disease. a randomized trial. PLoS One 9(6):e100084CrossRefPubMedPubMedCentralGoogle Scholar
- Empana JP, Sykes DH, Luc G, Juhan-Vague I, Arveiler D, Ferrieres J et al (2005) Contributions of depressive mood and circulating inflammatory markers to coronary heart disease in healthy European men: the Prospective Epidemiological Study of Myocardial Infarction (PRIME). Circulation 111:2299–2305CrossRefPubMedGoogle Scholar
- Khang YH, Lynch JW, Yang S, Harper S, Yun SC, Jung-Choi K et al (2009) The contribution of material, psychosocial, and behavioural factors in explaining educational and occupational mortality inequalities in a nationally representative sample of South Koreans: relative and absolute perspectives. Soc Sci Med 68:858–866CrossRefPubMedGoogle Scholar
- McFadden E, Luben R, Wareham N, Bingham S, Khaw KT (2008) Occupational social class, educational level, smoking and body mass index, and cause-specific mortality in men and women: a prospective study in the European Prospective Investigation of Cancer and Nutrition in Norfolk (EPIC-Norfolk) cohort. Eur J Epidemiol 23:511–522CrossRefPubMedGoogle Scholar
- Santimone I, Di Castelnuovo A, De Curtis A, Spinelli M, Cugino D, Gianfagna F et al (2011) White blood cell count, sex and age are major determinants of heterogeneity of platelet indices in an adult general population: results from the MOLI-SANI project. Haematologica 96:1180–1188CrossRefPubMedPubMedCentralGoogle Scholar
- WHO Expert Consultation (2008) Waist circumference and waist-hip ratio. Geneva, 8–11 December. http://apps.who.int/iris/bitstream/10665/44583/1/9789241501491_eng.pdf. Accessed on June 2016