What is the clinical evidence from this study?

Study design: Observational. Population: Metabolic Syndrome (n=23148). Intervention: High-sensitivity C-reactive protein (hs-CRP) vs. Lower hs-CRP levels. Primary outcome: Prevalent Metabolic Syndrome (MetS) (OR 1.062, 95% CI 1.005-1.122, p=0.032).

What question did this study set out to answer?

The study aims to explore the link between high-sensitivity C-reactive protein and metabolic syndrome risk, assessing its role as an early biomarker.

April 19, 2026Open Access

Association of High-Sensitivity C-Reactive Protein with Metabolic Syndrome and Transitions in Metabolic Status: A Combined Cross-Sectional and Cohort Study with Gender Differences in Chinese Adults

Q: What does this research mean for the field?

Elevated high-sensitivity C-reactive protein (hs-CRP) levels are independently associated with an increased risk of prevalent and incident metabolic syndrome in Chinese adults, with a stronger and more consistent association observed in males. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Elevated high-sensitivity C-reactive protein levels were independently associated with an increased risk of prevalent metabolic syndrome (OR 1.062) in Chinese adults, with a stronger association observed in males.

Key Points

The study aims to explore the link between high-sensitivity C-reactive protein and metabolic syndrome risk, assessing its role as an early biomarker.
Combined cross-sectional and cohort study design
23,148 Chinese adults enrolled from health management departments
Follow-up of 531 participants who were initially free of metabolic syndrome over six years
Collection of demographic, clinical, and hs-CRP level data
Multivariate logistic regression analysis to evaluate associations.
32.3% prevalence of metabolic syndrome; higher rates in males than females
Higher hs-CRP levels observed in individuals with metabolic syndrome and correlated with age, BMI, and other health parameters
Hs-CRP independently linked to prevalent metabolic syndrome in the overall population and in males
16.8% of participants developed new-onset metabolic syndrome during follow-up; hs-CRP associated with this in males but not in females.

Study Design

Type

Observational (n=23,148)

Multicenter

Yes

Structured PICO

Population

23,148 Chinese adults (median age 53, 68% male) from 5 general tertiary hospitals, including a longitudinal subcohort of 531 participants free of Metabolic Syndrome (MetS) at baseline.

Outcome

Prevalence of metabolic syndrome (cross-sectional) and incidence of new-onset metabolic syndrome at 6-year follow-up (longitudinal)surrogate

Elevated hs-CRP levels are independently associated with both prevalent and incident metabolic syndrome in Chinese adults, with a stronger and more consistent association observed in males.

Main Result

Effect estimate: OR 1.062 (95% CI 1.005-1.122)

p-value: p=0.032

Limitations

Small longitudinal follow-up sample (531 individuals) introducing potential selection bias
Potential overadjustment in the fully adjusted model (Model 3)
Relatively short observation period for MetS status transition
Residual confounding from unmeasured factors such as dietary patterns and physical activity
Observational design precludes causal inference
Study population predominantly recruited from tertiary hospitals with a higher proportion of male participants
Unexpectedly low reported rates of medication use may limit generalizability

Abstract

Objective: To investigate the association between high-sensitivity C-reactive protein (hs-CRP) and the risk of metabolic syndrome (MetS) as well as its outcome development, and to evaluate its potential value as an early biomarker for MetS. Methods: From August 2017 to December 2023, a total of 23,148 participants were enrolled from the Health Management Departments of five general tertiary hospitals in northern and southern China. Their basic demographic data, clinical information, and hs-CRP levels were collected. Among them, 531 participants who were free of MetS at baseline were followed up, and the incidence of MetS was analyzed at their second physical examination six years later. Multivariate logistic regression models were employed to evaluate the association between hs-CRP and the risk of prevalent and incident MetS. Results: The prevalence of MetS was 32.3%, significantly higher in males than females. MetS-positive individuals exhibited elevated hs-CRP levels and higher age, BMI, blood pressure, lipid, and glucose parameters. Multivariate logistic regression analysis showed that hs-CRP was independently and positively associated with the risk of prevalent MetS in the overall population and in males. In females, this association was attenuated but remained statistically significant after adjusting for confounding factors. Among the 531 participants without MetS at baseline, 16.8% (89 individuals) developed new-onset MetS during the six-year follow-up period. Elevated baseline hs-CRP levels were significantly associated with the risk of incident MetS in males, but the association did not reach statistical significance in females. Conclusion: Higher hs-CRP levels were associated with both prevalent and incident MetS in this Chinese adult population, with a stronger and more consistent association observed in males. These findings suggest that the relationship between inflammation and MetS may differ by gender. Given the observational design, further studies are needed to confirm these associations and explore underlying mechanisms. Keywords: metabolic syndrome, high-sensitivity C-reactive protein, inflammatory marker, multivariate logistic regression

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