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

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 ≥2 years, as very obese (≥99th percentile), obese (< 99th and ≥95th percentile), overweight (< 95th and ≥85th percentile), and healthy weight (> 5th to ≤85 thpercentile)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.

Altered Distribution and Increased IL-17 Production by Mucosal-Associated Invariant T Cells in Adult and Childhood Obesity

“…Proinflammatory cytokine profiles have been previously described in obese children (23,33,34), and the increased IL-17 production by MAIT cells from obese children may contribute to the observed inflammatory profile and increased risk for development of obesity-related diseases such as T2DM. Unlike our adult population, the majority of whom are insulin resistant and have T2DM, none of the obese children in this study has developed T2DM, but significant proportions are hyperinsulinemic and insulin resistant.…”

Circulating proinflammatory peptides related to abdominal adiposity and cardiometabolic risk factors in healthy prepubertal children

“…It is worth mentioning that most of the studies reporting similar findings have used population-based samples of children and adolescents of a greater age range (10,12) or entirely clinically based study groups (25). Moreover, some authors investigated the relationships with the overall adiposity measures (25,27) or measured non-sensitive CRP (28).…”

Effects of a multi-component camp-based intervention on inflammatory markers and adipokines in children: A randomized controlled trial

“…The observations of CRP≥10 mg/L were excluded from analyses, because the high values likely indicated acute clinical infection (Skinner et al, 2010). Therefore, 13 observations of CRP were excluded from analysis.…”