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Maternal and pediatric nutrition

C-reactive protein in Brazilian adolescents: distribution and association with metabolic syndrome in ERICA survey



C-reactive protein (CRP) is a marker of inflammation that has been shown to be predictive of cardiovascular diseases in adults. To evaluate the distribution of CRP as well as its association with metabolic syndrome and its components.


This is a cross-sectional study on adolescents aged 12–17, participants in the Study of Cardiovascular Risk in Adolescents (ERICA). Anthropometric, biochemical and blood pressure data were collected from 6316 adolescents, selected from a random sample of students in the cities of Brasilia, Fortaleza, João Pessoa, Manaus, Porto Alegre and Rio de Janeiro. Metabolic syndrome was defined by the criteria proposed by International Diabetes Federation for adolescent. Poisson regression model with robust variance, taking into consideration the study’s complex sampling design, was used to determine multivariate-adjusted prevalence rate ratios expressing the relationship of metabolic syndrome with CRP.


In adolescents with metabolic syndrome, CRP concentrations were five times higher (1.01 mg/l; interquartile range (IQR): 0.54–3.47) compared with those without metabolic syndrome (0.19 mg/l; IQR: 0.10–0.78). In multivariate Poisson regression analysis adjusted by sex, age and skin color, the prevalence of elevated CRP (>3.0 mg/l) was almost three times higher in adolescents with metabolic syndrome than in those without this condition (prevalence ratio (PR): 2.9; 95%CI: 2.0–4.3; P<0.001). Of the metabolic syndrome components, elevated waist circumference, low high-density lipoprotein-cholesterol and high triglycerides were significantly related to CRP in a graded (dose–response) manner.


The association of CRP with metabolic syndrome and its components suggests that inflammation may be useful in assessing cardiovascular risk in adolescents.

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The study ERICA was supported by the Brazilian Ministry of Health (Science and Technology Department) and the Brazilian Ministry of Science and Technology (Financiadora de Estudos e Projetos/FINEP and Conselho Nacional de Pesquisa/CNPq) (grants FINEP: 01090421, CNPq: 565037/2010-2, 405009/2012-7 and 457050/2013-6).

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Correspondence to D T Giannini.

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Giannini, D., Kuschnir, M., de Oliveira, C. et al. C-reactive protein in Brazilian adolescents: distribution and association with metabolic syndrome in ERICA survey. Eur J Clin Nutr 71, 1206–1211 (2017).

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