Frontiers in immunology · 2026
The obesity paradox in primary Sjögren's disease: immunometabolic associations of chemerin, platelet count, and statin use.
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Mezei Kincső, Orosz Viktória, Horváth Ildikó Fanny, Aradi Zsófia, Lőrincz Hajnalka, Harangi Mariann, Szántó Antónia
Аннотация
INTRODUCTION: Sjögren's disease is characterized by autoimmune destruction of exocrine glands. Obesity generally worsens the course of many diseases; however, earlier observations in our cohort suggested a paradoxically lower disease activity (ESSDAI) in overweight/obese patients. This cross-sectional study aimed to investigate potential mechanisms underlying these findings.
METHODS: Chemerin and oxidized low-density lipoprotein (oxLDL) levels were measured in a subset of regularly followed patients (n=75). Patients were stratified by body mass index (BMI): BMI <25 kg/m² ("non-obese", n=27) and BMI ≥25 kg/m² ("overweight/obese", n=48). Demographic, laboratory, and immunological parameters, disease activity (ESSDAI), extraglandular manifestations, and treatments were compared using biostatistical analyses.
RESULTS: Chemerin and oxLDL levels did not differ significantly between groups. ESSDAI was significantly lower in overweight/obese patients (5.04 vs. 2.76; p=0.04), while complement c3 levels were higher (1.20 vs. 1.46 g/L; p<0.001). Across all patients, chemerin positively correlated with BMI, age at diagnosis, c3, c4, CRP, platelet count, and leukocyte count. Hemoglobin and hematocrit were higher in overweight/obese patients, whereas neutrophil ratio was lower and lymphocyte ratio slightly higher. Statin therapy was also more frequent in the overweight/obese group (p=0.04). In this group, BMI and platelet count independently predicted chemerin levels, while platelet count predicted chemerin in normal-weight patients.
CONCLUSION: Despite its positive correlation with BMI, chemerin levels were not significantly higher in overweight/obese patients, suggesting relatively lower levels. This may partly explain their more favorable immunological profile. Increased statin use may also contribute through anti-inflammatory effects.
METHODS: Chemerin and oxidized low-density lipoprotein (oxLDL) levels were measured in a subset of regularly followed patients (n=75). Patients were stratified by body mass index (BMI): BMI <25 kg/m² ("non-obese", n=27) and BMI ≥25 kg/m² ("overweight/obese", n=48). Demographic, laboratory, and immunological parameters, disease activity (ESSDAI), extraglandular manifestations, and treatments were compared using biostatistical analyses.
RESULTS: Chemerin and oxLDL levels did not differ significantly between groups. ESSDAI was significantly lower in overweight/obese patients (5.04 vs. 2.76; p=0.04), while complement c3 levels were higher (1.20 vs. 1.46 g/L; p<0.001). Across all patients, chemerin positively correlated with BMI, age at diagnosis, c3, c4, CRP, platelet count, and leukocyte count. Hemoglobin and hematocrit were higher in overweight/obese patients, whereas neutrophil ratio was lower and lymphocyte ratio slightly higher. Statin therapy was also more frequent in the overweight/obese group (p=0.04). In this group, BMI and platelet count independently predicted chemerin levels, while platelet count predicted chemerin in normal-weight patients.
CONCLUSION: Despite its positive correlation with BMI, chemerin levels were not significantly higher in overweight/obese patients, suggesting relatively lower levels. This may partly explain their more favorable immunological profile. Increased statin use may also contribute through anti-inflammatory effects.