Assessment of C-reactive protein, IL-6 and TNF-α Levels in Performance Enhancing-Substance (PES) Users Among Gym-Goers in Iraq

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Safaa Shehab Ahmed
Maryam Hekmat Abdulateef
Fatima dawood salman
Salma Hamid Issa
Baraa Hussein Abdulhadi

Abstract

The use of performance-enhancing substances (PESs) across gyms and fitness communities is a growing public health concern, particularly the evidence of their potential consequences for health in both the short and long term; Objectives: The current crosssectional study was carried out between 1st of May 2024 – 4th of January 2025 to assess the levels of CRP, IL-6 as well as TNF-α among the population of gym-goers in Dyala City/Iraq. Those using PES presented significantly higher levels of CRP (5.30 ± 0.51 mg/L) when compared to non-users (1.64 ± 0.22 mg/L) (P < 0.001), showing an increased inflammatory response. Moreover, IL-6and TNF-αconcentrations were significantly increased among PES users than those non-users (55.67 ± 9.91 pg/ml vs. 40.82 ± 2.28 pg/ml, P


<0.001 and 87.16 ± 10.39 pg/ml vs. 75.11 ± 2.88 pg/ml, P><0.001, respectively),and may represent an immunological change induced with PES usage. >

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How to Cite
Safaa Shehab Ahmed, Maryam Hekmat Abdulateef, Fatima dawood salman, Salma Hamid Issa, & Baraa Hussein Abdulhadi. (2025). Assessment of C-reactive protein, IL-6 and TNF-α Levels in Performance Enhancing-Substance (PES) Users Among Gym-Goers in Iraq. The Peerian Journal, 39, 57–66. Retrieved from https://peerianjournal.com/index.php/tpj/article/view/1036
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References

Gomez, J., & American Academy of Pediatrics Committee on Sports Medicine and Fitness

(2005). Use of performance-enhancing substances. Pediatrics, 115(4), 1103–1106.

https://doi.org/10.1542/peds.2005-0085

Albaker, W., Alkhars, A., Elamin, Y., Jatoi, N., Boumarah, D., & Al-Hariri, M. (2021). Anabolic–

Androgenic Steroid Abuse among Gym Users, Eastern Province, Saudi Arabia. Medicina, 57(7),

https://doi.org/10.3390/medicina57070703

Hartgens, F., & Kuipers, H. (2004). Effects of androgenic-anabolic steroids in athletes. Sports

medicine (Auckland, N.Z.), 34(8), 513–554. https://doi.org/10.2165/00007256-200434080-

Tavares, A. S. R., Carolino, E., Rosado, A., Calmeiro, L., & Serpa, S. (2022). Characteristics of

Gym-Goers Performance-Enhancing Substance Use. Sustainability, 14(5), 2868.

https://doi.org/10.3390/su14052868

Mooney, R., Simonato, P., Ruparelia, R., Roman‐Urrestarazu, A., Martinotti, G., & Corazza, O.

(2017). The use of supplements and performance and image enhancing drugs in fitness

settings: A exploratory cross‐sectional investigation in the United Kingdom. Human

Psychopharmacology: Clinical and Experimental, 32(3), e2619.

Vorona, E., & Nieschlag, E. (2018). Adverse effects of doping with anabolic androgenic steroids

in competitive athletics, recreational sports and bodybuilding. Minerva

endocrinologica, 43(4), 476–488. https://doi.org/10.23736/S0391-1977.18.02810-9

Fisher, G. L., & Roget, N. A. (Eds.). (2009). Encyclopedia of substance abuse prevention,

treatment, and recovery (Vol. 1). Sage.

Hall, R. C., & Hall, R. C. (2005). Abuse of supraphysiologic doses of anabolic steroids. Southern

medical journal, 98(5), 550-555.

Lang, T., Streeper, T., Cawthon, P., Baldwin, K., Taaffe, D. R., & Harris, T. B. (2010).

Sarcopenia: etiology, clinical consequences, intervention, and assessment. Osteoporosis

international : a journal established as result of cooperation between the European

Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 21(4),

–559. https://doi.org/10.1007/s00198-009-1059-y

Al-Harbi, F. F., Gamaleddin, I., Alsubaie, E. G., & Al-Surimi, K. M. (2020). Prevalence and Risk

Factors Associated with Anabolic-androgenic Steroid Use: A Cross-sectional Study among Gym

Users in Riyadh, Saudi Arabia. Oman medical journal, 35(2), e110.

https://doi.org/10.5001/omj.2020.28

Piacentino, D., Kotzalidis, G. D., Del Casale, A., Aromatario, M. R., Pomara, C., Girardi, P., &

Sani, G. (2015). Anabolic-androgenic steroid use and psychopathology in athletes. A systematic

review. Current neuropharmacology, 13(1), 101–121.

https://doi.org/10.2174/1570159X13666141210222725

Genest J. (2010). C-reactive protein: risk factor, biomarker and/or therapeutic target?. The

Canadian journal of cardiology, 26 Suppl A, 41A–44A. https://doi.org/10.1016/s0828-

x(10)71061-813. Matsugaki, A., Matsumoto, S., & Nakano, T. (2020). A Novel Role of Interleukin-6 as a

Regulatory Factor of Inflammation-Associated Deterioration in Osteoblast Arrangement.

International Journal of Molecular Sciences, 21(18), 6659.

https://doi.org/10.3390/ijms21186659

Pelosi, L., Berardinelli, M. G., Forcina, L., Ascenzi, F., Rizzuto, E., Sandri, M., De Benedetti, F.,

Scicchitano, B. M., & Musarò, A. (2021). Sustained Systemic Levels of IL-6 Impinge Early

Muscle Growth and Induce Muscle Atrophy and Wasting in Adulthood. Cells, 10(7), 1816.

https://doi.org/10.3390/cells10071816

Jang, D.-i., Lee, A.-H., Shin, H.-Y., Song, H.-R., Park, J.-H., Kang, T.-B., Lee, S.-R., & Yang, S.-

H. (2021). The Role of Tumor Necrosis Factor Alpha (TNF-α) in Autoimmune Disease and

Current TNF-α Inhibitors in Therapeutics. International Journal of Molecular Sciences, 22(5),

https://doi.org/10.3390/ijms22052719

Ceto, E., Yigitoglu, P. H., & Yavuz, H. U. (2025). Relationship Between Anabolic–Androgenic

Steroid Use, Aggression, and Narcissism in Male Bodybuilders. Medicina, 61(2), 241.

https://doi.org/10.3390/medicina61020241

Di Girolamo, F. G., Biasinutto, C., Mangogna, A., Fiotti, N., Vinci, P., Pisot, R., Mearelli, F.,

Simunic, B., Roni, C., & Biolo, G. (2024). Metabolic Consequences of Anabolic Steroids,

Insulin, and Growth Hormone Abuse in Recreational Bodybuilders: Implications for the World

Anti-Doping Agency Passport. Sports medicine - open, 10(1), 28.

https://doi.org/10.1186/s40798-024-00697-6

Grace, F. M., & Davies, B. (2004). Raised concentrations of C reactive protein in anabolic

steroid using bodybuilders. British journal of sports medicine, 38(1), 97–98.

https://doi.org/10.1136/bjsm.2003.005991

Severo, C. B., Ribeiro, J. P., Umpierre, D., Da Silveira, A. D., Padilha, M. C., De Aquino Neto, F.

R., & Stein, R. (2013). Increased atherothrombotic markers and endothelial dysfunction in

steroid users. European journal of preventive cardiology, 20(2), 195–201.

https://doi.org/10.1177/2047487312437062

Arazi, H., Mohammadjafari, H., & Asadi, A. (2017). Use of anabolic androgenic steroids

produces greater oxidative stress responses to resistance exercise in strength-trained

men. Toxicology reports, 4, 282–286. https://doi.org/10.1016/j.toxrep.2017.05.005

Becker, L., Dupke, A., & Rohleder, N. (2021). Associations Between C-Reactive Protein Levels,

Exercise Addiction, and Athlete Burnout in Endurance Athletes. Frontiers in psychology, 12,

https://doi.org/10.3389/fpsyg.2021.615715

Hansen, M. W., Ørn, S., Erevik, C. B., Bjørkavoll-Bergseth, M. F., Skadberg, Ø., Melberg, T. H.,

Aakre, K. M., & Kleiven, Ø. (2021). Regular consumption of cod liver oil is associated with

reduced basal and exercise-induced C-reactive protein levels; a prospective observational trial :

A NEEDED (The North Sea Race Endurance Exercise Study) 2014 sub-study. Journal of the

International Society of Sports Nutrition, 18(1), 51. https://doi.org/10.1186/s12970-021-

-1

Bernecker, C., Scherr, J., Schinner, S., Braun, S., Scherbaum, W. A., & Halle, M. (2013).

Evidence for an exercise induced increase of TNF-α and IL-6 in marathon

runners. Scandinavian journal of medicine & science in sports, 23(2), 207–214.

https://doi.org/10.1111/j.1600-0838.2011.01372.x