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Acute-phase C-reactive protein (CRP) is well known as a sensitive marker for systemic inflammation, which is synthesized in the liver; the process is predominately regulated by interleukin-6 (IL-6).1,2 Previous prospect ive studies reported that CRP levels are associated with future coronary heart disease risks.3 Another previous study showed that elevated CRP levels significantly correlate with metabo lic abnormality features,4 such as insulin resistance,5 and low high-density lipoprotein cholesterol.6,7 Thus, CRP levels that can assist in predicting future morbidity risks are important. Obesity is a major public health problem in the world, affecting people in developed and developing countries.2,8,9 In 2016, 39% of adults aged 18 years and above (39% of men and 40% of women) were overweight; overall, approximately 13% of the world’s adult population (11% of men and 15% of women) were obese.10 Obesity is associated with metabolic syndrome, development of type II diabetes,11 and coronary heart disease.12 Inflammation is recently understood as a key pathogenic mechanism in the initiation and progression of cardiovascular disease.13 Adipose tissue is a passive storage repository for fat, but this tissue also plays an active role in metabolism by producing pro-inflammatory cytokine and IL-6. Given that IL-6 has inflammatory properties and stimulates acute phase protein production in the liver, the release of IL-6 from adipose tissue may induce low-grade systemic inflammation in person with the excess body.1 Therefore, identifying obesity markers and CRP levels to predict future morbidity risks becomes a great concern in public health. In Indonesia, the prevalence of obese adults (18 years and older) was 21.8% in 2018, higher than that in 2007 (10.5%) and 2013 (14.8%).14 In addition, the prevalence of overweight girls (15–18 years) in rural and urban areas was 10%.15 Moreover, the prevalence of obesity in Indonesia from 1993 to 1997 raised remarkably.16 Indonesia has developed a community-based noncommunicable disease control model through Integrated Health Post for Elderly-Chronic Disease for controlling Abstract C-reactive protein (CRP) is the best clinical marker for systemic inflammation. Obesity is associated with increased CRP levels. Systemic inflammation is present before morbidity occurs. This study revealed that the identification of obesity indicators and CRP levels is limited among Indonesians. The present study investigated the associations among obesity indicators (body mass index/BMI, waist circumference/WC, waist-to-hip ratio/WHR, waist-to-height ratio/WHtR, and CRP levels) among Indonesian adults. This cross-sectional study based on Indonesian Family Life Survey 5 in 2014–2015 was conducted among 3,386 adults (≥ 40 years) living in 13 provinces in Indonesia during the study period. All data were collected in 2014. Multiple logistic regression was used to estimate the odds ratio (ORs) and 95% CI for hs-CRP levels on obesity indicators by using underweight (BMI) and normal (WC, WHR, and WHtR) as references. Our multivariable logistic regression analysis indicated that respondents with increased WHR (OR: 1.278, 95% CI: 1.005–1.625, p-value < 0.001) were more likely to have high-risk hs-CRP levels than those with normal WHR. Compared to respondents with normal WHtR, those with increased WHtR were found associated with high-risk hs-CRP levels (OR: 1.980, 95% CI: 1.544–2.541, p-value < 0.001). Therefore, WHR and WHtR can predict central obesity, which is associated with hs-CRP levels.

Obesity Indicators and C-Reactive Protein in Indonesian Adults (More than Equal to 40 Years Old): The Indonesian Family Life Survey 5