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Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Multiple markers of inflammation and weight status: cross-sectional analyses throughout childhood
Asheley Cockrell Skinner1, Michael J Steiner, Frederick W Henderson
1Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA.
Insights
Childhood obesity is linked to higher inflammation. Very obese children, even as young as age 3, show increased inflammatory markers, raising concerns for long-term vascular damage.
Area of Science:
- Pediatric Health
- Inflammation Research
- Obesity Studies
Background:
- Adult obesity is associated with inflammatory markers like C-reactive protein (CRP).
- The relationship between inflammation and weight status in children is less understood.
- This study investigates multiple inflammation markers in relation to pediatric weight categories.
Purpose of the Study:
- To examine the association between various inflammatory markers and weight status in children.
- To test the hypothesis that inflammatory marker prevalence increases with weight status in children.
- To identify the age at which these associations become significant in pediatric populations.
Main Methods:
- Cross-sectional analysis of US children (1-17 years) from NHANES (1999-2006).
- Weight status categorized by weight-for-length (<2 years) and BMI (≥2 years): very obese, obese, overweight, healthy weight.
- Inflammatory markers included high-sensitivity CRP, absolute neutrophil count, and ferritin/transferrin ratio.
Main Results:
- Increased risk of elevated CRP (>1.0 mg/L) in very obese children aged 3-17 years (HR 2.29-4.73).
- Abnormal neutrophil counts observed in very obese children starting at ages 6-8 years (HR 2.00).
- Elevated ferritin/transferrin ratio in very obese children began at ages 9-11 years (HR 7.06).
Conclusions:
- Multiple inflammatory markers are strongly associated with increasing weight status in children.
- The positive association between inflammation and weight begins as early as age 3.
- Elevated inflammation in young obese children is concerning for potential long-term vascular damage, warranting further longitudinal research.
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.