Multiple Markers of Inflammation and Weight Status: Cross-sectional Analyses Throughout Childhood

Overview

Journal Pediatrics

Specialty Pediatrics

Date 2010 Mar 3

PMID 20194272

Citations 102

Authors

Asheley Cockrell Skinner

Michael J Steiner

Frederick W Henderson

Eliana M Perrin

Affiliations

Soon will be listed here.

Abstract

Objective: Inflammatory markers such as C-reactive protein (CRP) are related to obesity in adults, but the association is less clear in children. Our objective was to examine relationships between multiple markers of inflammation and children's weight status; we hypothesized that the prevalence of inflammatory markers would increase as weight status increased.

Methods: We conducted a cross-sectional analysis of children in the United States aged 1 to 17 years in the National Health and Nutrition Examination Survey, 1999-2006. Children were categorized using weight-for-length when age <2 years and BMI for > or =2 years, as very obese (> or =99th percentile), obese (<99th and > or =95th percentile), overweight (<95th and > or =85th percentile), and healthy weight (>5th to < or =85th percentile) according to expert consensus. Our main outcome measures were high-sensitivity CRP and absolute neutrophil count, in addition to a novel third measure: ferritin controlled for iron status using a ferritin/transferrin ratio. We used Cox proportional hazards models to examine risk of abnormal values of inflammatory markers according to weight.

Results: Increased risk of a CRP level of >1.0 mg/L was evident among very obese children from ages 3 to 5 years (hazard ratio [HR]: 2.29; P < .01) through 15 to 17 years (HR: 4.73; P < .01). Increased risk of abnormal neutrophil count among very obese children began at 6 to 8 years (HR: 2.00; P = .049), and increased prevalence of abnormal ferritin/transferrin ratio began at 9 to 11 years (HR: 7.06; P < .001).

Conclusions: Multiple inflammatory markers are strongly and positively associated with increasing weight status in children, and this relationship starts as young as age 3. Elevated inflammatory markers in very young obese children are particularly concerning, because inflammation may cause long-term, cumulative vascular damage. This deserves additional research via longitudinal design.

Citing Articles

Prevalence and Determinants of Elevated High Sensitivity C-Reactive Protein Concentrations in Belgian Children and Adolescents With Overweight or Obesity.

Mol T, Nauwynck E, Donckerwolcke K, Vanbesien J, Anckaert E, De Schepper J Obes Sci Pract. 2025; 11(2):e70063.

PMID: 40066178 PMC: 11892738. DOI: 10.1002/osp4.70063.

Diet Biofunctionality in Modulating Cardiovascular Parameters in Obese Patients After Bioenteric Intragastric Balloon Bariatric Surgery.

Balejko E, Lichota J Nutrients. 2024; 16(23).

PMID: 39683432 PMC: 11643098. DOI: 10.3390/nu16234038.

Overview of Pediatric Obesity as a Disease.

Waldrop S, Ibrahim A, Maya J, Monthe-Dreze C, Stanford F Pediatr Clin North Am. 2024; 71(5):761-779.

PMID: 39343491 PMC: 11443063. DOI: 10.1016/j.pcl.2024.06.003.

Inflammatory markers in prepubertal children and their associations with abdominal fat.

Queiroz L, Collett-Solberg P, de Souza M, Rodrigues N, Monteiro A, Mendes C J Pediatr (Rio J). 2024; 100(5):544-551.

PMID: 38734032 PMC: 11361872. DOI: 10.1016/j.jped.2024.03.015.

Regulatory T cells and bioenergetics of peripheral blood mononuclear cells linked to pediatric obesity.

Rose S, Landes R, Vyas K, Delhey L, Blossom S Immunometabolism (Cobham). 2024; 6(2):e00040.

PMID: 38680993 PMC: 11045398. DOI: 10.1097/IN9.0000000000000040.

References

Selvin E, Paynter N, Erlinger T . The effect of weight loss on C-reactive protein: a systematic review. Arch Intern Med. 2007; 167(1):31-9. DOI: 10.1001/archinte.167.1.31. View

Ford E, Giles W, Myers G, Rifai N, Ridker P, Mannino D . C-reactive protein concentration distribution among US children and young adults: findings from the National Health and Nutrition Examination Survey, 1999-2000. Clin Chem. 2003; 49(8):1353-7. DOI: 10.1373/49.8.1353. View

Danesh J, Wheeler J, Hirschfield G, Eda S, Eiriksdottir G, Rumley A . C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease. N Engl J Med. 2004; 350(14):1387-97. DOI: 10.1056/NEJMoa032804. View

Warnberg J, Nova E, Romeo J, Moreno L, Sjostrom M, Marcos A . Lifestyle-related determinants of inflammation in adolescence. Br J Nutr. 2007; 98 Suppl 1:S116-20. DOI: 10.1017/S0007114507839614. View

Ogden C, Carroll M, Curtin L, McDowell M, Tabak C, Flegal K . Prevalence of overweight and obesity in the United States, 1999-2004. JAMA. 2006; 295(13):1549-55. DOI: 10.1001/jama.295.13.1549. View

Perneger T . What's wrong with Bonferroni adjustments. BMJ. 1998; 316(7139):1236-8. PMC: 1112991. DOI: 10.1136/bmj.316.7139.1236. View

Haarala A, Eklund C, Pessi T, Lehtimaki T, Huupponen R, Jula A . Use of combined oral contraceptives alters metabolic determinants and genetic regulation of C-reactive protein. The Cardiovascular Risk in Young Finns Study. Scand J Clin Lab Invest. 2008; 69(2):168-74. DOI: 10.1080/00365510802449642. View

Akinci G, Akinci B, Coskun S, Bayindir P, Hekimsoy Z, Ozmen B . Evaluation of markers of inflammation, insulin resistance and endothelial dysfunction in children at risk for overweight. Hormones (Athens). 2008; 7(2):156-62. DOI: 10.1007/BF03401507. View

Jarvis M, Fidler J, Mindell J, Feyerabend C, West R . Assessing smoking status in children, adolescents and adults: cotinine cut-points revisited. Addiction. 2008; 103(9):1553-61. DOI: 10.1111/j.1360-0443.2008.02297.x. View

10.

Reinehr T, Kiess W, de Sousa G, Stoffel-Wagner B, Wunsch R . Intima media thickness in childhood obesity: relations to inflammatory marker, glucose metabolism, and blood pressure. Metabolism. 2005; 55(1):113-8. DOI: 10.1016/j.metabol.2005.07.016. View

11.

Ridker P . Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation. 2003; 107(3):363-9. DOI: 10.1161/01.cir.0000053730.47739.3c. View

12.

Poirier P, Giles T, Bray G, Hong Y, Stern J, Pi-Sunyer F . Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss. Arterioscler Thromb Vasc Biol. 2006; 26(5):968-76. DOI: 10.1161/01.ATV.0000216787.85457.f3. View

13.

Ridker P, Danielson E, Fonseca F, Genest J, Gotto Jr A, Kastelein J . Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008; 359(21):2195-207. DOI: 10.1056/NEJMoa0807646. View

14.

Gabay C, Kushner I . Acute-phase proteins and other systemic responses to inflammation. N Engl J Med. 1999; 340(6):448-54. DOI: 10.1056/NEJM199902113400607. View

15.

Danesh J, Collins R, Appleby P, Peto R . Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: meta-analyses of prospective studies. JAMA. 1998; 279(18):1477-82. DOI: 10.1001/jama.279.18.1477. View

16.

Kuczmarski R, Ogden C, Guo S, Grummer-Strawn L, Flegal K, Mei Z . 2000 CDC Growth Charts for the United States: methods and development. Vital Health Stat 11. 2002; (246):1-190. View

17.

Hackam D, Anand S . Emerging risk factors for atherosclerotic vascular disease: a critical review of the evidence. JAMA. 2003; 290(7):932-40. DOI: 10.1001/jama.290.7.932. View

18.

Calabro P, Limongelli G, Pacileo G, Di Salvo G, Golino P, Calabro R . The role of adiposity as a determinant of an inflammatory milieu. J Cardiovasc Med (Hagerstown). 2008; 9(5):450-60. DOI: 10.2459/JCM.0b013e3282eee9a8. View

19.

Fogarty A, Glancy C, Jones S, Lewis S, McKeever T, Britton J . A prospective study of weight change and systemic inflammation over 9 y. Am J Clin Nutr. 2008; 87(1):30-5. DOI: 10.1093/ajcn/87.1.30. View

20.

Ford E, Galuska D, Gillespie C, Will J, Giles W, Dietz W . C-reactive protein and body mass index in children: findings from the Third National Health and Nutrition Examination Survey, 1988-1994. J Pediatr. 2001; 138(4):486-92. DOI: 10.1067/mpd.2001.112898. View