obesity is a continuously worldwide public health problem that is closely associated with chronic diseases like dyslipidemia , metabolic syndrome , type 2 diabetes , atherosclerosis , and cardiovascular diseases [ 1 , 2 ] . different studies were done in order to recognize the involved mechanisms in pathophysiology of obesity and obesity - related diseases [ 3 , 4 ] . among these mechanisms , obesity - induced inflammation proposed as the potential link of obesity - related metabolic disturbances and chronic diseases . some studies have reported the positive correlation between body fat mass and inflammation - sensitive plasma proteins or isps , along with other inflammatory markers [ 4 , 6 , 7 ] . kim et al . , in a cross - sectional study with proteomic approach , reported that ceruloplasmin and fibrinogen were overexpressed in obese subjects . in addition , in a cohort study on healthy men , aiming to study isps effects on modifying cardiovascular risk in obese subjects , there was not any association between ceruloplasmin level and bmi . proinflammatory cytokines produced in adipose tissue can increase hepatic synthesis of isps , which are known as important cardiovascular disease risk factors [ 7 , 8 ] . ceruloplasmin ( cp ) is a member of isps family that is used in clinical practice to measure the degree of inflammation . accumulating epidemiological data have reported that serum ceruloplasmin level increases in subjects with cardiovascular disorders , like atherosclerosis , abdominal aortic aneurysm , unstable angina , vasculitis , peripheral vascular diseases , and also in type 2 diabetes [ 1019 ] . most attention in recent years has been devoted to the concept that obesity elicits a chronic , low - grade systemic inflammatory response . limited studies investigated the association between serum ceruloplasmin level and obesity [ 6 , 8 ] , and mainly , these studies focused on the association of this protein and cardiovascular diseases [ 9 , 2124 ] . because serum cp levels are affected by genetic and environmental factors , we can expect different results in different population studies , on the other hand , because obesity pattern in iran is different from those in other countries , conducting such studies appears to be necessary . this study aims to investigate the association between serum ceruloplasmin level and obesity and some of the metabolic and inflammatory indexes , in order to recognize new biomarkers for obesity . the study was conducted in case - control design . the subjects with bmi above or equal to 25  kg / m were placed in case group and with bmi lower than 25  kg / m in control group . the subjects in case group ( 61 subjects ) were selected from overweight and obese subjects , referring to nutrition clinics that had the qualification to enter the study ( aged between 2560 years ) , in continuous manner and for the control group ( 61 subjects ) , we selected one subject with normal weight per each case , that again , was qualified to enter the study . subjects with diseases like coronary artery disease , stroke , peripheral vascular diseases , type 2 diabetes , liver or kidney dysfunction , history of regular use of any medication that could affect cardiovascular function , and pregnant women excluded from the study . to determine sample size , we used the following expression : 
 ( 1)n = z1/22[p1(1p1)+p2(1p2)]d2 , 
 where z1/2 is the study confidence coefficient 95% and equal to 1/96 , ( p1 ) obesity ratio 30% , ( p2 ) normal ratio 50% , and ( d ) sampling error and equal to 0/17 . body weight and height were measured by a digital scale and with the minimum clothing and without shoes . venous blood specimens after 14 hours of fasting were collected by an experienced specialist for measuring serum ceruloplasmin level , fasting blood sugar ( fbs ) , lipid profile including triglyceride , total cholesterol , ldl cholesterol ( light - density lipoprotein ) , hdl cholesterol ( high - density lipoprotein ) and high - sensitive c - reactive protein level ( hscrp ) . serum ceruloplasmin level was measured with colorimetric method , hscrp with immunoturbidimetric method and fbs , total cholesterol , ldl , and hdl cholesterol were measured with enzymatic method . before entering the study , the purpose of this study was explained for all the participants and the written consent was obtained . baseline characteristics of the participants , including demographic characteristics , anthropometric parameters , and medical history , were collected by measurement and completing a questionnaire . the spss software version 18 ( version 18 , spss inc , chicago ) was used for statistical analysis . pearson correlation coefficient was used to evaluate correlation between variables , and we used linear multiple regression to determine the relation between ceruloplasmin level with bmi and other variables . the effect of variables like age , sex , smoking , hypertension , total cholesterol , ldl and hdl cholesterol , triglyceride , and hscrp was adjusted as confounder variables . 122 subjects ( 55 male and 67 female ) were investigated , 61 subjects were in case group and 61 subjects in control group . there was a significant difference in ldl cholesterol level between two groups , as we see in table 1 . 5% of subjects was found with hypertension ( subjects with blood pressure 140/90  mmhg ) and 15/6% with hyperlipidemia ( subjects with serum triglyceride level 200  mg / dl , or total cholesterol level 200  mg / dl , or ldl cholesterol level 130  mg / dl were considered hyperlipidemic ) . there was no significant difference between sex , hypertension , hyperlipidemia , hyperthyroidism ratios , and also drug consumption between the two groups . the mean serum cp level in control group was 29/7  7/1  mg / dl and in case group was 30/8  7/6 the difference of mean serum cp level between two groups was not significant ( p = 0/4 ) . there was not any significant association between serum cp level and bmi in all subjects ( table 2 ) , and when we investigated this association in case and control groups separately , this association was not significant again ; however , in control group , this positive association was close to significance level ( table 3 ) . correlation analysis showed that there was a positive significant correlation between serum cp level and serum triglycerides ( p < 0/05 , r = 0/21 ) . but the correlation was not significant for serum cp level and other variables like fbs , total cholesterol , ldl and hdl cholesterols , hscrp , age , and sex . in multivariate analysis model , there was no significant association of serum ceruloplasmin level with waist circumference and bmi [ f(2,48 ) = 2/2 , p = 0/122 ] . also , there was not any significant association between serum ceruloplasmin level with body weight and height [ f(2,111 ) = 0/33 , p = 0/71 ] . in linear multiple regression , none of the baseline variables could predict obesity in this group of subjects , including serum cp level , fbs , total cholesterol , ldl and hdl cholesterols , and hscrp . in this case - control study , there was no significant association between serum cp level and obesity in all subjects and in case and control groups separately also , we found a significant positive correlation between serum cp level and serum triglyceride level . so far , the association between serum cp level and obesity has not been investigated in iran . cp is a copper - containing -2 glycoprotein which contains seven copper atoms per molecule and accounts for 95% of the total circulating copper in healthy adults . it is involved in coagulation , angiogenesis , defence against oxidant stress and iron homeostasis . a limited number of studies have investigated the association between serum cp and obesity , and most of them have reported a positive correlation between body fat mass and inflammation - sensitive plasma proteins or isps , like cp , along with other inflammatory markers [ 6 , 8 ] . these proteins are recognized as cardiovascular disease risk factors and some of them like haptoglobin , fibrinogen , 1-antitrypsin , and cp were used in clinical practice to measure the degree of inflammation . in this study , there was no significant association between serum cp level and obesity in all subjects , and engstrm et al . study   in ( 2004 ) supports this finding . in that study , in addition to cp , they investigated some of the other isps , among which cp and 1-antitrypsin , had not any association with bmi . serum cp level can be affected by genetic and environmental factors like diet , life style , and diseases . the mechanisms by which cp is related to obesity has not been identified ; however , it is possible that cp is involved in the inflammatory pathway linked to obesity . .   showed that cp can act , depending on its concentration , as antioxidant or prooxidant in laboratory conditions . in this study , we tried to investigate the association between serum cp level and some of the metabolic syndrome elements and also hscrp , in addition to obesity . among these indexes , one of the limitations of the study is not to measure other isps along with cp , as we explained earlier , the association between obesity and isps can differ by their types . another limitation is the small sample size of this study , due to which , perhaps the association is not significant between cp and obesity in all subjects . not measuring the dietary intakes in study subjects is considered the other limitation , because , in one hand , the intake of some micronutrients , like copper , can affect serum ceruloplasmin level , and on the other hand , it has been found that the degree of macronutrient intake affects the severity of inflammation . because the use of oral contraceptive pills or ocps can affect serum ceruloplasmin level the other limitation is not to consider their consumption in the study . we propose for future studies to consider other isps in addition to cp , to conduct intervening studies in this basis , and also to conduct this kind of investigations in children . as we discussed earlier , serum cp level is affected by genetic and environmental factors and we may find different results in the study of different populations . this study is the first one to investigate the association between serum cp level and obesity in iran .
background . 
 one of the mechanisms that has been suggested for obesity related metabolic disturbances is obesity - induced inflammation . 
 pro - inflammatory cytokines generated in adipose tissue can increase hepatic synthesis of inflammation - sensitive plasma proteins ( isps ) including ceruloplasmin ( cp ) . in this study we aimed to investigate the relation between serum cp level and obesity . 
 methods . 
 61 persons with body mass index ( bmi )  25  kg / m2 ( case group ) and 61 persons with bmi < 25  kg / m2 ( control group ) were included in this study with a case - control design . 
 serum cp levels , triglyceride level , fating blood glucose , total cholesterol , ldl - cholesterol , hdl - cholesterol and hscrp were measured in both groups . results . 
 we did not observe any significant association between serum cp level and bmi in all subjects [ or : 1.02 ( ci , 0.967 to 1.07 ) ] and in case (  = 0.012 , p = 0.86 ) and control groups (  = 0.49 , p = 0.07 ) separately . 
 however , in control group , this positive association was marginally significant . 
 we found a positive correlation between serum cp level and serum triglyceride level . 
 conclusion . 
 serum cp level was not related to obesity in this group of subjects . 
 none of the baseline variables could predict obesity in this group of subjects , including serum cp level , fbs , total cholesterol , ldl and hdl- cholesterols and hscrp .