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C-reactive protein concentration in children: relationship to adiposity and other cardiovascular risk factors
D G Cook1, M A Mendall, P H Whincup
1Department of Public Health Sciences, St George's Hospital Medical School, Cranmer Terrace, London, UK. d.cook@sghms.ac.uk
Insights
Adiposity, or body fat, is the main driver of C-reactive protein (CRP) levels in children. Higher CRP is linked to cardiovascular risk factors, suggesting inflammation
Area of Science:
- Pediatrics
- Cardiovascular Health
- Biomarkers
Background:
- C-reactive protein (CRP) is an inflammation marker, but its predictive role for heart disease in adults is confounded by existing atherosclerosis and smoking.
- Children offer a unique population to study CRP's early determinants and associations without these confounding factors.
Purpose of the Study:
- To investigate the primary determinants of CRP levels in children aged 10-11 years.
- To explore the relationship between CRP and various cardiovascular risk factors in this pediatric cohort.
Main Methods:
- Measured CRP levels in 699 children aged 10-11 years.
- Analyzed CRP associations with demographic factors (age, sex, ethnicity), anthropometric measures (Ponderal index), lifestyle factors (smoking), and cardiovascular risk factors (fibrinogen, HDL-cholesterol, heart rate, blood pressure).
- Utilized statistical adjustments to account for potential confounders.
Main Results:
- CRP levels were significantly higher in girls, increased with age, and were substantially elevated in children with higher Ponderal index (a measure of adiposity).
- Children of South Asian origin exhibited higher CRP levels even after adjustment.
- CRP showed significant correlations with fibrinogen, HDL-cholesterol, heart rate, and systolic blood pressure, which persisted after adjustment.
Conclusions:
- Adiposity is identified as the major determinant of CRP levels in children.
- Physical fitness has a minor independent effect on CRP.
- The strong associations between CRP and cardiovascular risk factors like fibrinogen and HDL-cholesterol suggest a potential role for inflammation in the early development of atherosclerosis and lifelong cardiovascular disease risk.
Abstract:
Whether or not C-reactive protein (CRP) predicts heart disease in adults because it is a marker of damage or atherosclerosis is difficult to assess. In children, there is no confounding with coronary disease or active smoking. We measured CRP in 699 children aged 10-11 years. CRP levels were 47% higher in girls than boys, and rose with age by 15%/year. CRP levels were 270% (95% CI, 155-439%) higher in the top fifth than the bottom fifth of Ponderal index (weight/height(3)). After adjustment, CRP levels remained 104% (95% CI, 23-236%) higher in the 56 children of South Asian origin. CRP was unrelated to: birth weight, height, social class, Helicobacter pylori infection or passive smoke exposure. CRP was correlated with several cardiovascular risk factors, but only fibrinogen (r = 0.33, P = 0.0001), HDL-cholesterol (r = -0.13, P = 0.0006), heart rate (r = 0.12, P = 0.002) and systolic blood pressure (r = 0.08, P = 0.02) remained statistically significant after adjustment. We conclude that adiposity is the major determinant of CRP levels in children while physical fitness has a small independent effect. The strong relationships with fibrinogen and HDL-cholesterol suggest a role for inflammation throughout life in the development of atherosclerosis and cardiovascular disease. Longitudinal studies are needed to determine whether these associations reflect long term elevations of these risk factors in some individuals, or short term fluctuations in different individuals.