***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: CONTEXT Associations between adiposity and circulating inflammation markers are assumed to be causal , although the direction of the relationship has not been proven . OBJECTIVE The aim of the study was to explore the causal direction of the relationship between adiposity and inflammation using a bidirectional Mendelian r and omization approach . METHODS In the PROSPER study of 5804 elderly patients , we related C-reactive protein ( CRP ) single nucleotide polymorphisms ( SNPs ) ( rs1800947 and rs1205 ) and adiposity SNPs ( FTO and MC4R ) to body mass index ( BMI ) as well as circulating levels of CRP and leptin . We gave each individual two allele scores ranging from zero to 4 , counting each pair of alleles related to CRP levels or BMI . RESULTS With increasing CRP allele score , there was a stepwise decrease in CRP levels ( P for trend < 0.0001 ) and a 1.98 mg/liter difference between extremes of the allele score distribution , but there was no associated change in BMI or leptin levels ( P > or= 0.89 ) . By contrast , adiposity allele score was associated with 1 ) an increase in BMI ( 1.2 kg/m(2 ) difference between extremes ; P for trend 0.002 ) ; 2 ) an increase in circulating leptin ( 5.77 ng/ml difference between extremes ; P for trend 0.0027 ) ; and 3 ) increased CRP levels ( 1.24 mg/liter difference between extremes ; P for trend 0.002 ) . CONCLUSIONS Greater adiposity conferred by FTO and MC4R SNPs led to higher CRP levels , with no evidence for any reverse pathway . Future studies should extend our findings to other circulating inflammatory parameters . This study illustrates the potential power of Mendelian r and omization to dissect directions of causality between intercorrelated metabolic factors This study was performed to evaluate the relation of high-sensitivity C-reactive protein ( hsCRP ) with several cardiovascular risk factors such as age , blood pressure , smoking habit and serum lipids , body mass index , blood glucose , regular exercise , alcohol drinking , white blood cell counts in a cross-sectional survey .  Plasma hsCRP  was measured by immunoturbidimetry in 202 subjects , aged over 50 yr , who participated in health-check survey in a rural area of Jeollanamdo , Korea .  Plasma hsCRP level was 1.9±3.0 mg/dL. There were significant associations between  hsCRP levels and age , white blood cell counts , blood glucose , diastolic blood pressure , HDL-cholesterol , body mass index and smoking status . In stepwise multivariate regression analysis , white blood cell counts , age , blood glucose , smoking status and body mass index were independent correlates of hsCRP levels . In conclusion , plasma hsCRP levels were associated with several cardiovascular risk factors , and these data are compatible with the hypothesis that CRP levels may be a marker for pre clinical cardiovascular disease . Further what we need now are prospect i ve studies to evaluate the association of C-reactive protein concentrations with subsequent cardiac events CONTEXT There are few data directly comparing the effects of physical activity and body weight on cardiovascular biomarkers . OBJECTIVE To examine the association of physical activity  and body mass index ( BMI , defined as weight in kilograms divided by the square of height in meters ) alone and in combination with cardiovascular biomarkers . DESIGN , SETTING , AND PARTICIPANTS Cross-sectional analysis of 27,158 apparently healthy US women ( mean age , 54.7 years ) at the time of enrollment ( 1992 - 1995 ) in the Women 's Health Study , a r and omized , double-blind , placebo-controlled trial of low-dose aspirin and vitamin E in the primary prevention of cardiovascular disease and cancer . MAIN OUTCOME MEASURES The association of physical activity and BMI with high-sensitivity C-reactive protein ( CRP ) , fibrinogen , soluble intracellular adhesion molecule 1 ( ICAM-1 ) , homocysteine , low- and high-density lipoprotein ( LDL and HDL ) cholesterol , total cholesterol , apolipoprotein A-1 and B100 , lipoprotein(a ) , and creatinine . RESULTS Lower levels of physical activity and higher levels of BMI were independently associated ( P for trend < .001 ) with adverse levels of nearly all lipid and inflammatory biomarkers . High BMI showed stronger associations with these biomarkers than physical inactivity . For example , using the reference group of physically active , normal weight women ( energy expenditure > or = 1000 kcal/week ; BMI , 18.5 - 24.9 ) and adjusting for age , race , smoking , blood pressure , diabetes , menopausal status , and hormone use , the odds ratios ( 95 % confidence intervals [ CIs ] ) for having CRP > 3 mg/L were : for inactive , normal weight women 1.26 ( 1.15 - 1.37 ) ; active , overweight 2.68 ( 2.41 - 2.98 ) ; inactive , overweight 3.11 ( 2.84 - 3.41 ) ; active , obese 8.25 ( 7.15 - 9.51 ) ; and inactive , obese 9.86 ( 8.84 - 10.99 ) . In similar analyses , the odds ratios ( 95 % CIs ) for having HDL cholesterol < 50 mg/dL were 1.20 ( 1.11 - 1.30 ) ; 2.25 ( 2.04 - 2.49 ) ; 2.62 ( 2.41 - 2.85 ) ; 4.21 ( 3.68 - 4.81 ) ; and 5.27 ( 4.77 - 5.84 ) , respectively , and for having apolipoprotein B100 > 120 mg/dL they were 1.21 ( 1.11 - 1.33 ) ; 1.86 ( 1.66 - 2.08 ) ; 2.06 ( 1.88 - 2.67 ) ; 2.35 ( 2.04 - 2.70 ) ; and 2.33 ( 2.09 - 2.59 ) . Fibrinogen , ICAM-1 , apolipoprotein A1 , total cholesterol , and LDL cholesterol showed similar associations . By contrast , homocysteine , lipoprotein ( a ) , and creatinine showed weak or nonsignificant associations . CONCLUSIONS High BMI was more strongly related to adverse cardiovascular biomarker levels than physical inactivity . However , within BMI categories , physical activity was generally associated with more favorable cardiovascular biomarker levels than inactivity BACKGROUND Recent prospect i ve data suggest that intake of rapidly digested and absorbed carbohydrates with a high dietary glycemic load is associated with an increased risk of ischemic heart disease . OBJECTIVE We examined whether a high dietary glycemic load was associated with elevated hs-CRP concentrations and whether this association was modified by body mass index ( BMI ; in kg/m(2 ) ) . DESIGN In 244 apparently healthy women , we measured plasma hs-CRP concentrations and determined average dietary glycemic loads with a vali date d semiquantitative food-frequency question naire . Using multiple regression models , we evaluated the association between dietary glycemic load and plasma hs-CRP after adjusting for age ; treatment status ; smoking status ; BMI ; physical activity level ; parental history of myocardial infa rct ion ; history of hypertension , diabetes , and high cholesterol ; postmenopausal hormone use ; alcohol intake ; and other dietary variables . RESULTS We found a strong and statistically significant positive association between dietary glycemic load and plasma hs-CRP . The median hs-CRP concentration for the lowest quintile of dietary glycemic load was 1.9 mg/L and for the highest quintile was 3.7 mg/L ; corresponding multivariate-adjusted geometric means were 1.4 and 3.8 mg/L , respectively ( P for trend < 0.01 ) . This association was significantly modified by BMI . Among women with a BMI greater-than-or-equal 25 , the multivariate-adjusted geometric mean hs-CRP concentration in the lowest quintile was 1.6 mg/L and in the highest quintile was 5.0 mg/L ; however , among women with a BMI < 25 , the corresponding means were 1.1 and 3.1 mg/L , respectively ( P = 0.01 for interaction ) . CONCLUSIONS Dietary glycemic load is significantly and positively associated with plasma hs-CRP  in healthy middle-aged women , independent of conventional risk factors for ischemic heart disease . Exacerbation of the proinflammatory process may be a mechanism whereby a high intake of rapidly digested and absorbed carbohydrates increases the risk of ischemic heart disease , especially in overweight women prone to insulin resistance CONTEXT The link between C-reactive protein ( CRP ) and adiposity deserves to be further explored , considering the controversial diabetogenic role of CRP . OBJECTIVE We explored the potential causal role of CRP on measures of adiposity . DESIGN We used a Mendelian r and omization approach with the CRP and LEPR genes as instrumental variables in a cross-sectional Caucasian population -based study comprising 2526 men and 2836 women .  Adiposity was measured using  body mass index ( BMI ) , fat and lean mass estimated by bioelectrical impedance , and waist circumference . RESULTS Log-transformed CRP explained by the rs7553007 single-nucleotide polymorphism tagging the CRP gene was significantly associated with BMI [ regression coefficient : 1.22 ( 0.18 ; 2.25 ) , P = 0.02 ] and fat mass [ 2.67 ( 0.65 ; 4.68 ) , P = 0.01 ] but not with lean mass in women , whereas no association was found in men . Log-transformed CRP explained by the rs1805096 LEPR single-nucleotide polymorphism was also positively associated , although not significantly , with BMI or fat mass . The combined CRP-LEPR instrument explained 2.24 and 0.77 % of CRP variance in women and men , respectively . Log-transformed CRP explained by this combined instrument was significantly associated with BMI [ 0.98 ( 0.32 ; 1.63 ) , P = 0.004 ] , fat mass [ 2.07 ( 0.79 ; 3.34 ) , P = 0.001 ] , and waist [ 2.09 ( 0.39 ; 3.78 ) , P = 0.01 ] in women but not men . CONCLUSION Our data suggest that CRP is causally and positively related to BMI in women and that this is mainly due to fat mass . Results on the combined CRP-LEPR instrument suggest that leptin may play a role in the causal association between CRP and adiposity in women . Results in men were not significant OBJECTIVE We evaluated the association of obesity with various markers of chronic inflammation , in a population -based sample of 3,042 adults . METHODS During 2001 - 2002 , we r and omly enrolled 1,514 men ( 18 - 87 years old ) and 1,528 women ( 18 - 89 years old ) , from the Attica area , Greece ; the sampling was stratified by the age-sex distribution of the region ( census 2001 ) . Among several variables , we also measured various inflammatory markers ( C-reactive protein , tumor necrosis factor alpha , amyloid A , white blood cells and interleukin-6 ) and anthropometric variables ( weight , height , waist and hip circumferences ) . Central fat was defined as waist-to-hip ratio > or=0.95 in men and > or=0.8 in women , while obesity as body mass index ( BMI ) > 29.9 kg/m(2 ) . RESULTS Central fat prevailed in 36 % of men and 43 % of women ( p<0.001 ) , while obesity prevailed in 20 % of men and 15 % of women , respectively . Compared to participants with normal body fat distribution , those with central fat exhibited 53 % higher C-reactive protein levels , 30 % higher tumor necrosis factor , alpha levels , 26 % higher amyloid A levels , 17 % higher white blood cell counts and 42 % higher interleukin-6 levels ( all p<0.05 ) . We observed that all inflammation markers were related to BMI ( index for obesity ) , waist and to waist-to-hip ratio ( indices for central fat ) , in both genders . Moreover , the models that included waist or waist-to-hip ratio as independent variable had higher explanatory ability ( i.e. R(2 ) ) than the models included BMI , especially in women , even after adjusting for age and various other potential confounders . CONCLUSION Our results suggest a relationship between central adiposity and inflammation process , irrespective of age and other potential confounders . This association was more prominent than the relationship between total obesity and inflammation . It could be hypothesized that a 
    Output:
    
Obesity is associated with elevated levels of CRP and the association is stronger in women and North Americans/Europeans .
The sex difference only emerges in adulthood