Proteína C reativa e risco cardiovascular em crianças e adolescentes: estudo caso-coorte

Abstract

Witness the increasing worldwide prevalence of childhood obesity. Excess weight leads to metabolic disorders, which added to a low-grade inflammatory state initiate the atherosclerotic process. The high sensitivity C-reactive protein (hs-CRP) is a marker of inflammation and has been associated with traditional risk factors for cardiovascular disease. The present study was a case-cohort, and main objective was to investigate the association of hs-CRP with cardiovascular risk factors in children and adolescents of both sexes, with and without overweight. The sample consisted of students from two schools of Niterói, Rio de Janeiro. Participants had 6-14 years old. We measured the weight, height, waist circumference (WC) and blood pressure (BP). Were also measured total cholesterol, high density lipoprotein cholesterol, triglycerides, glucose, insulin, and hs-CRP. We calculated the low density lipoprotein cholesterol and body mass index for age and sex. Information about sexual maturation was obtained through self-administered questionnaires. For comparison of categorical variables we used the chi-square or Fisher's exact test. Associations were observed in this study through the prevalence ratio. For multivariate analysis was used log-linear model. In total, 361 children and adolescents were evaluated: 170 have 6-9 years old, and 191 have 10-14 years old. Excess weight was detected in 82 children (48,2%) and 79 adolescents (41,4%). The 161 children and adolescents with excess weight comprised the case group, and 289 were part of the control group. We observed that excess weight was associated significantly with increased WC (PR = 1,96, CI95% [1,62 - 2,37]), increased BP (PR = 1,11, CI95% [1,00 - 1,22]), hyperinsulinemia (PR = 1,07, CI95% [1,01 - 1,14]), hypertriglyceridemia (PR = 1,15, CI95% [1,06 - 1,24]), and elevated hs-CRP (PR = 1,14, CI95% [1,03 1,25]). In those with elevated hs-CRP, we found an association between excess weight with high WC (PR = 2,35, CI95% [1,45 3,82]). But , we didn t observe interactions between excess weight and elevated hs-CRP and increased WC(p = 0,31). The results of this study point to a higher frequency of cardiovascular risk factors in children and adolescents with excess weight. Additionally, we found association between increased WC and overweight, those with high hs-CRP. Preventing childhood obesity is critical, because the metabolic disorders caused by excessive weight, may be present at an early age and initiating the atherosclerotic process. More research is needed to demonstrate the association of hs-CRP with the comorbidities related to overweight in this age group. Furthermore, it is important to set a cutoff risk for hs-CRP in this population.