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The Importance of Nutrition in Inflammation
Dietary interventions are some of the most important tools for preventative healthcare, maintaining good health, and treatment of disease, and they can be especially effective at modulating levels of systemic inflammation. This has been demonstrated in a number of studies using C-reactive protein (CRP) (1–4), a protein produced by the liver that has been established as a marker for systemic inflammation (5). Because elevated levels of CRP have been associated with inadequate nutrition intake and unhealthy diets (3,6,7), understanding the link between CRP and nutrition can be instrumental for health professionals to provide effective care to clients.
Dietary patterns can play an important role in the prevention of chronic conditions by modulating inflammation levels in the body, and CRP can be an adequate biomarker to monitor fluctuations in health status during dietary interventions.
Importance of nutrition in managing inflammation and overall health
Healthy dietary patterns have been associated with a reduced risk of some of the most common chronic diseases such as metabolic syndrome, cardiovascular disease (CVD), and Type 2 Diabetes (T2D). Inflammation is a common denominator in these conditions, and elevated levels can often be seen preceding the development of chronic conditions. For example, chronic, low-grade inflammation plays a role in metabolic syndrome, which is the predecessor to T2D and CVD. Therefore, tracking inflammation levels can be a way to determine the risk for developing these conditions, helping to inform the necessity and efficacy of dietary interventions.
In fact, this is exactly what some researchers based in Australia have decided to explore. In their 2016 a meta-analysis, Neale et al. analyzed 17 studies looking at the effect of dietary interventions (Nordic Diet, Tibetan Diet, Mediterranean Diet, and Dietary Approaches to Stop Hypertension) on a number of different inflammatory biomarkers of inflammation. What they found was that CRP was the only biomarker with enough evidence to an association between it and the dietary interventions, meaning that CRP could adequately reflect the decrease in inflammation levels following the interventions (3). This suggests that dietary patterns can play an important role in the prevention of chronic conditions by modulating inflammation levels in the body, and that CRP can be an adequate biomarker to monitor fluctuations in health status during dietary interventions.
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The inflammatory processes are built on the foundations of nutrition, so it is not surprising that inflammation levels have been flagged as a valuable indicator of nutrition status.
Exploring the relationship between CRP and nutrition
As mentioned previously, the CRP biomarker has been significantly associated with nutrition levels (3). However, inflammation is not always bad and as with most systems in the body, there is an evolutionary reason we still have it. The inflammatory immune response has been highly conserved throughout human history, speaking to its importance to our survival as a species. The inflammatory processes are built on the foundations of nutrition (8), so it is not surprising that inflammation levels have been flagged as a valuable indicator of nutrition status.
Furthermore, CRP has been identified as a potential tool for the Global Leadership Initiative on Malnutrition (GLIM). The GLIM was created to provide agreed-upon guidelines for the diagnosis of malnutrition in adults. The criteria outlined are non-volatile weight loss, BMI, reduced muscle mass, reduced food intake or assimilation, and disease burden/inflammation (5,9). CRP has been utilized in research to determine its efficacy in describing the disease burden/inflammation criteria of GLIM in older adults with acute illness. It was found that those with lower food intake had higher CRP levels (>3 mg/dl) than those with high food intake (5). Its association with the Global Leadership Initiative on Malnutrition (GLIM) criteria highlights its importance in assessing inflammation in adults with acute illness.
Additionally, many studies have shown that not only are certain dietary patterns associated with CRP levels, but diet changes can effectively change CRP levels, whether that be for better or worse. Nutrition and inflammation are extremely interlinked systems. Inflammation can contribute to the development of malnutrition which can lead to other health effects, but it can also be a result of certain dietary patterns (10). This suggests that diet is an important tool for disease prevention and also for the duration of a disease course.
Impact of pro-inflammatory and anti-inflammatory foods on CRP levels
Some specific food groups can be either pro-inflammatory or anti-inflammatory. However, not everyone has the same metabolism, therefore it is important to work together with a nutritionist to find what works for a specific condition, lifestyle, and person. That being said, some general foods that have inflammatory properties are sweets (particularly commercial packaged ones), fried foods, processed meats and cheeses, sugary beverages, and snack foods like chips. On the other hand, anti-inflammatory foods include whole foods such as brown rice, chicken, eggs, fish, legumes, nuts and seeds, and oats (11).
The Benefits of CRP Biomarker Testing in the Clinic and At-home
It is difficult to provide preventative care to patients that already have been diagnosed with a condition, this is why biomarkers are so important. Biomarkers allow us to get a measure of one’s health status by measuring indicators of biological processes that can inform us about health status, disease progression, and in some cases, they can even be used for diagnosis (12). The CRP biomarker in particular has been associated with various inflammatory and infectious conditions including arthritis, type 2 diabetes, gut inflammation, and viral and bacterial infections (13–15). CRP is used as a biomarker in clinical practice to help diagnose and monitor the progression of these conditions (13,16,17). For example, in patients with suspected rheumatoid arthritis, elevated levels of CRP may indicate the presence of inflammation and reflect disease severity. In addition, serial monitoring of CRP levels can help health practitioners assess the response to treatment and adjust therapy accordingly (16).
It may be beneficial to monitor CRP levels, especially if a patient has risk factors or is in the early stages of inflammation-related chronic conditions because CRP elevation can precede the development of certain conditions (3). Having concrete data on inflammation levels to attribute to health symptoms and dietary habits can help determine the effectiveness of dietary interventions as well as what those interventions should be (1,2). At-home CRP biomarker testing offers several advantages that can benefit both health professionals and their clients. One of the key benefits is convenience. At-home testing allows individuals to monitor their CRP levels from the comfort of their own homes, eliminating the need for frequent visits to medical facilities. This convenience can be particularly valuable for individuals with chronic conditions or those at risk of inflammatory-related diseases who require regular monitoring of their CRP levels (18). Moreover, the accessibility of at-home CRP testing can encourage proactive health management and empower individuals to take charge of their own health by making informed dietary choices and lifestyle adjustments based on their CRP results (19).
Combining the convenience of at-home CRP biomarker testing with the accuracy and expertise of clinical monitoring provides a robust approach to managing inflammation and optimizing overall health.
Regular monitoring of CRP levels in the clinic allows healthcare practitioners to assess the effectiveness of dietary interventions and other treatment plans over time. It also helps in identifying potential flare-ups or changes in inflammatory status, allowing for timely adjustments to the management strategies (16,20,21). Furthermore, POC biomarker testing allows patients and health practitioners alike to avoid long laboratory waiting times and reduces the number of scheduled visits since the test can be done on the spot at the initial consultation (22). This personalized approach enables health practitioners to tailor personalized dietary and lifestyle recommendations for their patients, considering individual health conditions, metabolism, and specific needs.
In conclusion, combining the convenience of at-home CRP biomarker testing with the accuracy and expertise of clinical monitoring provides a robust approach to managing inflammation and optimizing overall health. Both at-home and clinic-based CRP testing are valuable tools that can aid health professionals in assessing disease risk, tracking progress, and guiding effective dietary interventions to promote better health outcomes for their clients (16,18,20,21).
References 1. King DE, Egan BM, Woolson RF, Mainous AG III, Al-Solaiman Y, Jesri A. Effect of a High-Fiber Diet vs a Fiber-Supplemented Diet on C-Reactive Protein Level. Arch Intern Med. 2007 Mar 12;167(5):502–6. 2. Khanna S, Jaiswal KS, Gupta B. Managing Rheumatoid Arthritis with Dietary Interventions. Front Nutr [Internet]. 2017 [cited 2023 Aug 8];4. Available from: https://www.frontiersin.org/articles/10.3389/fnut.2017.00052 3. Neale EP, Batterham MJ, Tapsell LC. Consumption of a healthy dietary pattern results in significant reductions in C-reactive protein levels in adults: a meta-analysis. Nutr Res. 2016 May 1;36(5):391–401. 4. Alehagen U, Lindahl TL, Aaseth J, Svensson E, Johansson P. Levels of sP-selectin and hs-CRP Decrease with Dietary Intervention with Selenium and Coenzyme Q10 Combined: A Secondary Analysis of a Randomized Clinical Trial. PLOS ONE. 2015 Sep 16;10(9):e0137680. 5. Pourhassan M, Cederholm T, Trampisch U, Volkert D, Wirth R. Inflammation as a diagnostic criterion in the GLIM definition of malnutrition—what CRP-threshold relates to reduced food intake in older patients with acute disease? Eur J Clin Nutr. 2022 Mar;76(3):397–400. 6. Kuczmarski MF, Mason MA, Allegro D, Zonderman AB, Evans MK. Diet quality inversely associated with C-reactive protein levels in urban, low-income African American and White adults. J Acad Nutr Diet [Internet]. 2013 Dec [cited 2023 Aug 15];113(12). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3833870/ 7. Ebrahimi Z, Shojaeian Z, Amiri F, Esmaillzadeh A, Sadeghi O, Esteghamati A, et al. Association of major dietary patterns with advanced glycation end products and high-sensitivity C-reactive protein in people with type 1 diabetes mellitus. Nutr J. 2023 Jul 26;22(1):37. 8. Hébert JR. Chapter 2 - History of nutrition and inflammation. In: Hébert JR, Hofseth LJ, editors. Diet, Inflammation, and Health [Internet]. Academic Press; 2022 [cited 2023 Jul 31]. p. 39–83. Available from: https://www.sciencedirect.com/science/article/pii/B978012822130300003X 9. Cederholm T, Jensen GL, Correia MITD, Gonzalez MC, Fukushima R, Higashiguchi T, et al. GLIM criteria for the diagnosis of malnutrition – A consensus report from the global clinical nutrition community. Clin Nutr. 2019 Feb;38(1):1–9. 10. Smidowicz A, Regula J. Effect of Nutritional Status and Dietary Patterns on Human Serum C-Reactive Protein and Interleukin-6 Concentrations12. Adv Nutr. 2015 Nov 10;6(6):738–47. 11. Cleveland Clinic [Internet]. 2022 [cited 2022 Sep 30]. Anti-Inflammatory Diet: What To Eat (and Avoid). Available from: https://health.clevelandclinic.org/anti-inflammatory-diet/ 12. Strimbu K, Tavel JA. What are Biomarkers? Curr Opin HIV AIDS. 2010 Nov;5(6):463–6. 13. Sproston NR, Ashworth JJ. Role of C-Reactive Protein at Sites of Inflammation and Infection. Front Immunol. 2018 Apr 13;9:754. 14. Henriksen M, Jahnsen J, Lygren I, Stray N, Sauar J, Vatn MH, et al. C-reactive protein: a predictive factor and marker of inflammation in inflammatory bowel disease. Results from a prospective population-based study. Gut. 2008 Nov 1;57(11):1518–23. 15.Ma W, Nguyen LH, Song M, Wang DD, Franzosa EA, Cao Y, et al. Dietary fiber intake, the gut microbiome, and chronic systemic inflammation in a cohort of adult men. Genome Med. 2021 Jun 17;13(1):102. 16. Pope JE, Choy EH. C-reactive protein and implications in rheumatoid arthritis and associated comorbidities. Semin Arthritis Rheum. 2021 Feb 1;51(1):219–29. 17. Luan Y yi, Yao Y ming. The Clinical Significance and Potential Role of C-Reactive Protein in Chronic Inflammatory and Neurodegenerative Diseases. Front Immunol. 2018 Jun 7;9:1302. 18. Wilkens R, Dolinger M, Burisch J, Maaser C. Point-of-Care Testing and Home Testing: Pragmatic Considerations for Widespread Incorporation of Stool Tests, Serum Tests, and Intestinal Ultrasound. Gastroenterology. 2022 Apr 1;162(5):1476–92. 19. Daruwalla Z, Thakkar V, Aggarwal M, Kiasatdolatabadi A, Guergachi A, Keshavjee K. Patient Empowerment: The Role of Technology. Stud Health Technol Inform. 2019;257:70–4. 20. Wagenaar CA, van de Put M, Bisschops M, Walrabenstein W, de Jonge CS, Herrema H, et al. The Effect of Dietary Interventions on Chronic Inflammatory Diseases in Relation to the Microbiome: A Systematic Review. Nutrients. 2021 Sep;13(9):3208. 21. Kovell LC, Yeung EH, Miller ER, Appel LJ, Christenson RH, Rebuck H, et al. Healthy diet reduces markers of cardiac injury and inflammation regardless of macronutrients: Results from the OmniHeart trial. Int J Cardiol. 2020 Jan 15;299:282–8. 22. Shephard OAM M. A Practical Guide to Global Point-Of-Care Testing [Internet]. Collingwood, AUSTRALIA: CSIRO Publishing; 2017 [cited 2023 May 8]. Available from: http://ebookcentral.proquest.com/lib/kbdk/detail.action?docID=4746878
