Background and aim of the work: High-sensiti- vity C-reactive protein (hsCRP) is a marker of low grade inflammatory state, which characterises an atherosclerotic process. The metabolic syndrome is associated with insulin resistance and a systemic low-grade inflammatory state. These disorders may arise at a very early age in obese children. We aimed to assess the utility of (hsCRP) as a marker of cardiovascular risk in obese children and adolescents. Patients and methods: This study was conducted on 100 obese child and adolescents (6-16 years). 50 apparently healthy children of matched age and sex served as control. All patients and controls were subjected to: 1-complete history taking. 2-anthropometric measurements and clinical examination including body height, weight, waist circumference, body mass index and blood pressure. 3-laboratory investigations in- cluding fasting glucose, lipid profile, apolipoprotiens and (hsCRP) were assessed. Metabolic syndrome patients had to meet three out of five criteria: concentration of triglycerides (TG) ≥ 110 mg/dL, high density lipoprotein cholesterol (HDL- C) ≤ 40 mg/dL, waist circumference ≥ 90th percentile, glucose concentration ≥ 110 mg/dL, and systolic or diastolic blood pressure ≥ 90th percentile. Results, height, weight BMI and blood pressure were significantly higher in the obese than the control. Obese group had significantly higher (hsCRP) levels than control group, (p < 0.01) and significantly higher LDL-C, triglyceride (TG), and lower HDL-C than the control group. Log (hsCRP) showed a positive correlation with BMI (p < 0.001), blood pressure, and TG. The pre- valence of the metabolic syndrome was 24%. Mean concentrations of (hsCRP) were higher among patients who had the metabolic syndrome. Among whom, 35% had a concentration of (hsCRP) > 3.0 mg/L, a concentration considered to place adults at high risk for cardiovascular disease. In multiple logistic regression analysis only abdominal obesity was significantly associated with (hsCRP). Conclusion: me- tabolic syndrome and abdominal obesity among our patients predispose to cardiovascular disease later in life through early low grade inflammation. (hsCRP) is one of the inflammatory markers that can be easily estimated in these patients.
KeywordsHsCRPCardiovascular RiskObesity
Chinn S. and Rona, R.J. (2008) Prevalence and trends in overweight and obesity in three cross sectional studies of British children, 1974-1994. British Medical Journal, 322(7277), 24-26.
Bruno, G., Fornengo, P., Novelli, G., Panero, F., Perotto, M., Segre, O., et al. (2009) C-reactive protein and 5-year survival in type 2 diabetes: The casale monferrato study. Diabetes, 58(4), 926-933.
Ridker, P.M. (2007) CRP and the prediction of cardiovascular events among those at intermediate risk. Journal of the American College of Cardiology, 49(21), 2129- 2138.
Sinha, R., Fisch, G., Teague, B., Tamborlane, W.V., Banyas, B., Allen, K., et al. (2002) Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. The New England Journal of Medicine 346, 802-810.
David, M., Capuzzi, A., Jeffrey, S. and Freeman (2007) CRP and cardiovascular risk in the Metabolic Syndrome. Clinical Diabetes, 25(1), 16-22.
Chen, J. (2009) Metabolic syndrome and salt sensitivity of blood pressure in non-diabetic people in China, a dietary intervention study. Lancet, 373(9666), 829-835.
Steinberger, J., Daniels, S.R. and Eckel, R.H. (2009): Progress and challenges in metabolic syndrome in children and adolescents. Circulation, published online.
Ford, E.S., Galuska, D.A., Gillespie, C., Will, J.C., Giles, W.H. and Dietz, W.H. (2001) CRP and body mass index in children. Journal of Pediatric Surgery, 138(4), 486-492.
Shea, S., Aymong, E., Zybert, P., Shamoon, H., Tracy, R.P., Deckelbaum, R.J., et al. (2003) Obesity, fasting plasma insulin and CRP levels in healthy children. Obesity Research, 11(1), 95-103.
Vikram, N.K., Misra, A., Dwivedi, M., Sharma, R., Pandey, R.M., Luthra, K., et al. (2003) Correlations of CRP levels with anthropometric profile. Atherosclerosis, 168(2), 305-313.
Roberts, W.L., Moulton, L. and Law, T.C. (2001) Evaluation of nine automated (hsCRP) methods. Clinical Che- mistry, 47(5), 979-980.
Goldstone, L.A. (1983) Statistical tests and concepts of significance. Understanding Medical Statistics, 1st Edtion, William Heinman Medical Books Ltd., London.
Cook, D.G., Mendall, M.A., Whincup, P.H., Carey, I.M., Ballam, L., Morris, J.E., et al. (2000) C-reactive protein concentration in children: relationship to adiposity and other cardiovascular risk factors. Atherosclerosis, 149(1), 139-150.
Ryu, S.Y., Lee, Y.S., Park, J., Kang, M.G. and Kim. K.S. (2005) Relations of plasma (hsCRP) to various cardiovascular risk factors. Journal of Korean Medical Science, 20(3), 379-383.
Caballero, A.E., Bousquet-Santos, K., Robles-Osorio, K., Montagnani, V., Soodini, G., Porramatikul, S., et al. (2008) Overweight latino children and adolescents have marked endothelial dysfunction and subclinical vascular inflammation. Diabetes Care, 31(3), 576-582.
Quijada, Z., Paoli, M., Zerpa, Y., Camacho, N., Cichetti, R., Villarroel, V., et al. (2008) The triglyceride/HDL- cholesterol ratio as a marker of cardiovascular risk in obese children; association with traditional and emergent risk factors. Pediatric Diabetes, 9(5), 464-471.
Lambert, M., Delvin, E.E., Paradis, G., O’Loughlin, J., Hanley, J. and Levy, E. (2004) CRP and metabolic syndrome children and adolescents. Clinical Chemistry, 50, 1762-1768.
Ruckerl, R., Peters, A., Khuseyinova, T., Andreani, M., Koenig, W., Meisinger, C., et al. (2009) Determinants of the acute-phase protein c-reactive protein in myocardial infarction survivors. Clinical Chemistry, 55(2), 322-335.
Hiura, M., Kikuchi, T., Nagasaki, K. and Uchiyama, M. (2003) Elevation of serum CRP levels is associated with obesity in boys. Hypertension Research, 26(7), 541-546.
Martos, R., Valle, M., Morales, R.M., Ca?ete, R., Gascón, F. and Urbano, M.M. (2009) Changes in body mass index are associated with changes in inflammatory and endothelial dysfunction biomarkers in obese prepubertal children after 9 months of body mass index SD score loss. Metabolism.
Soriano-Guillén, L., Hernández-García, B., Pita, J., Do- mínguez-Garrido, N., Del Río-Camacho, G., et al. (2008) HsCRP is a good marker of cardiovascular risk in obese children and adolescents. European Journal of Endocrinology, 159(1), R1-R4.
Weiss, R., Dziura, J., Burgert, T.S., Tamborlane, W.V., Taksali, S.E., Yeckel, C.W., et al. (2004) Obesity and the metabolic syndrome in children and adolescents. The New England Journal of Medicine, 350(23), 2362-2374.
Danesh, J., Wheeler, J.G., Hirschfield, G.M., Eda, S., Eiriksdottir, G., Rumley, A., et al. (2004) CRP and other circulating markers of inflammation in the prediction of coronary heart disease. The New England Journal of Medicine, 350(14), 1387-1397.
Cizmecioglu, F.M., Etiler, N., Ergen, A., Gormus, U., Keser, A., Hekim, N., et al. (2009) Association of adiponectin, resistin and hscrp level with the metabolic syndrome in childhood and adolescence. Experimental and Clinical Endocrinology & Diabetes, 117(10), 622-627.
Kholeif, M.A. (2005) CRP for cardiovascular risk assess. Diabetes Care, 28(7), 1833-1834.
Ridker, P.M., Wilson, P.W.F. and Grundy, S.M. (2004) Should CRP be added to metabolic syndrome and to assessment of global cardiovascular risk? Circulation, 109 (23), 2818-2825.
Myers, G.L., Rifai, N., Tracy, R.P., Roberts, W.L., Alexander, R.W., Biasucci, L.M., et al. (2005) The Centers for Disease Control, the American Heart association: CDC/ AHA workshop on markers of inflammation and cardiovascular disease. Circulation, 110(6), 22-26.
Reaven, P.D., Traustadottir, T., Brennan, J. and Nader, P.R. (2005) Cardiovascular risk factors associated with insulin resistance in children persist into late adolescence. Diabetes Care, 28(1), 148-150.
Kriketos, A.D., Greenfield, J.R., Peake, P.W., Furler, S. M., Denyer, G.S., Charlesworth, J.A. and Campbell, V., et al. (2004) Inflammation, insulin resistance, and adiposity: A study of first-degree relatives of type 2 diabetes. Diabetes Care, 27(8), 2033-2040.
Mattsson, N., R?nnemaa, T., Juonala, M., Viikari, J.S. and Raitakari, O.T. (2008) Childhood predictors of the metabolic syndrome in adulthood. Annals of Medicine, 40(7), 542-552.
Roh, E.J., Lim, J.W., Kyoung, O.K. and Cheon, E.J. (2007) A useful predictor of early atherosclerosis in obese children: hsCRP. Journal of Korean Medical Science, 22(2), 192-197.