Muscular and cardiorespiratory fitness (MF and CRF) have been related to inflammation. Thus, the aim of this study was to assess the relationship between fitness and high-sensitivity C-reactive protein (hs-CRP) in European children both in the cross-sectional and longitudinal analysis.
Three hundred and fifty-seven children (46.2% males) aged 2–9 years with hs-CRP measured, data from MF and CRF, diet quality, objectively measured physical activity (PA) and screen time at baseline and follow-up after 2 years were included. Body mass index z-score (zBMI), waist circumference (WC) and fat mass index (FMI) were assessed. MF and CRF were also dichotomized as follows: low-medium quartiles (Q1–Q3) and highest quartile (Q4).
At follow-up, children with the highest CRF (Q4) showed a lower probability of having high hs-CRP. In the longitudinal analysis, children who improved their CRF over time showed a significantly lower probability (p < 0.05) of being in the highest hs-CRP category at follow-up, independently of the body composition index considered: odds ratio (OR) = 0.22 for zBMI, OR = 0.17 for WC, and OR = 0.21 for FMI.
Improving CRF during childhood reduces the odds of an inflammatory profile, independently of body composition and lifestyle behaviours. These highlight the importance of enhancing fitness, especially CRF, to avoid an inflammatory state in children.
Improvements in the cardiorespiratory profile during childhood could reverse an unfavourable inflammatory status.
There is a longitudinal and inverse association between CRF and inflammation in children.
This is the first longitudinal study assessing the relationship between fitness and inflammation during childhood that takes also into account the lifestyle behaviours.
Results from the present study suggest a protective role of fitness already in childhood.
Efforts to improve fitness in children should be aimed at as inflammation could trigger future cardiovascular disease.
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Insull, W. Jr. The pathology of atherosclerosis: plaque development and plaque responses to medical treatment. Am. J. Med. 122, S3–S14 (2009).
Libby, P. Inflammation and cardiovascular disease mechanisms. Am. J. Clin. Nutr. 83, 456S–460S (2006).
Cook, D. G. et al. C-reactive protein concentration in children: relationship to adiposity and other cardiovascular risk factors. Atherosclerosis 149, 139–150 (2000).
Dowd, J. B., Zajacova, A. & Aiello, A. E. Predictors of inflammation in U.S. children aged 3–16 years. Am. J. Prev. Med. 39, 314–320 (2010).
Ford, E. S. & National, H. C-reactive protein concentration and cardiovascular disease risk factors in children: findings from the National Health and Nutrition Examination Survey 1999–2000. Circulation 108, 1053–1058 (2003).
Hamer, M. & Stamatakis, E. Physical activity and risk of cardiovascular disease events: inflammatory and metabolic mechanisms. Med. Sci. Sports Exerc. 41, 1206–1211 (2009).
Ortega, F. B., Ruiz, J. R., Castillo, M. J. & Sjostrom, M. Physical fitness in childhood and adolescence: a powerful marker of health. Int. J. Obes. 32, 1–11 (2008).
Steene-Johannessen, J., Anderssen, S. A., Kolle, E. & Andersen, L. B. Low muscle fitness is associated with metabolic risk in youth. Med. Sci. Sports Exerc. 41, 1361–1367 (2009).
Steene-Johannessen, J., Kolle, E., Andersen, L. B. & Anderssen, S. A. Adiposity, aerobic fitness, muscle fitness, and markers of inflammation in children. Med. Sci. Sports Exerc. 45, 714–721 (2013).
Ruiz, J. R. et al. Inflammatory proteins and muscle strength in adolescents: the Avena study. Arch. Pediatr. Adolesc. Med. 162, 462–468 (2008).
De Miguel-Etayo, P. et al. Physical fitness reference standards in European children: the IDEFICS study. Int. J. Obes. 38, S57–S66 (2014).
Garcia-Hermoso, A. et al. Adiposity as a full mediator of the influence of cardiorespiratory fitness and inflammation in schoolchildren: the FUPRECOL Study. Nutr. Metab. Cardiovasc. Dis. 27, 525–533 (2017).
Ruiz, J. R., Ortega, F. B., Warnberg, J. & Sjostrom, M. Associations of low-grade inflammation with physical activity, fitness and fatness in prepubertal children; the European Youth Heart Study. Int. J. Obes. 31, 1545–1551 (2007).
Martinez-Gomez, D. et al. Associations of physical activity, cardiorespiratory fitness and fatness with low-grade inflammation in adolescents: the AFINOS Study. Int. J. Obes. 34, 1501–1507 (2010).
Gonzalez-Gil, E. M. et al. Prospective associations between dietary patterns and high sensitivity C-reactive protein in European children: the IDEFICS study. Eur. J. Nutr. 57, 1397–1407 (2018).
Harmse, B. & Kruger, H. S. Significant differences between serum CRP levels in children in different categories of physical activity: the PLAY study. Cardiovasc. J. Afr. 21, 316–322 (2010).
Gabel, L. et al. Associations of sedentary time patterns and TV viewing time with inflammatory and endothelial function biomarkers in children. Pediatr. Obes. 11, 194–201 (2016).
Pigeot, I., Baranowski, T., De Henauw, S., Group, I. I. S. & consortium, I. The IDEFICS intervention trial to prevent childhood obesity: design and study methods. Obes. Rev. 16, 4–15 (2015).
Ahrens, W. et al. The IDEFICS cohort: design, characteristics and participation in the baseline survey. Int. J. Obes. 35, S3–S15 (2011).
Bammann, K. et al. Validation of anthropometry and foot-to-foot bioelectrical resistance against a three-component model to assess total body fat in children: the IDEFICS study. Int. J. Obes. 37, 520–526 (2013).
Cole, T. J., Bellizzi, M. C., Flegal, K. M. & Dietz, W. H. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320, 1240–1243 (2000).
UNESCO. International Standard Classification of Education (ISCED) (UNESCO, 2006).
Espana-Romero, V. et al. Hand span influences optimal grip span in boys and girls aged 6 to 12 years. J. Hand Surg. Am. 33, 378–384 (2008).
Gil-Cosano, J. J. et al. Muscular fitness mediates the association between 25-hydroxyvitamin D and areal bone mineral density in children with overweight/obesity. Nutrients 11, 2760 (2019).
Ruiz, J. R. et al. Field-based fitness assessment in young people: the ALPHA health-related fitness test battery for children and adolescents. Br. J. Sports Med. 45, 518–524 (2011).
Leger, L. A., Mercier, D., Gadoury, C. & Lambert, J. The multistage 20 metre shuttle run test for aerobic fitness. J. Sports Sci. 6, 93–101 (1988).
Peplies, J., Fraterman, A., Scott, R., Russo, P. & Bammann, K. Quality management for the collection of biological samples in multicentre studies. Eur. J. Epidemiol. 25, 607–617 (2010).
Pearson, T. A. et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 107, 499–511 (2003).
Verbestel, V. et al. Are context-specific measures of parental-reported physical activity and sedentary behaviour associated with accelerometer data in 2-9-year-old European children? Public Health Nutr. 18, 860–868 (2015).
Evenson, K. R., Catellier, D. J., Gill, K., Ondrak, K. S. & McMurray, R. G. Calibration of two objective measures of physical activity for children. J. Sports Sci. 26, 1557–1565 (2008).
Bel-Serrat, S. et al. Relative validity of the Children’s Eating Habits Questionnaire-food frequency section among young European children: the IDEFICS Study. Public Health Nutr. 17, 266–276 (2014).
Lanfer, A. et al. Reproducibility of food consumption frequencies derived from the Children’s Eating Habits Questionnaire used in the IDEFICS study. Int. J. Obes. 35, S61–S68 (2011).
Vereecken, C. A. et al. Development and evaluation of a self-administered computerized 24-h dietary recall method for adolescents in Europe. Int. J. Obes. 32, S26–S34 (2008).
Huybrechts, I. et al. Reproducibility and validity of a diet quality index for children assessed using a FFQ. Br. J. Nutr. 104, 135–144 (2010).
Iglesia, I. et al. Dairy consumption at snack meal occasions and the overall quality of diet during childhood. Prospective and cross-sectional analyses from the IDEFICS/I.Family Cohort. Nutrients 12, 642 (2020).
Vyncke, K. et al. Validation of the Diet Quality Index for Adolescents by comparison with biomarkers, nutrient and food intakes: the HELENA study. Br. J. Nutr. 109, 2067–2078 (2013).
Santaliestra-Pasias, A. M. et al. Physical activity and sedentary behaviour in European children: the IDEFICS study. Public Health Nutr. 17, 2295–2306 (2014).
Ortega, F. B. et al. Role of socio-cultural factors on changes in fitness and adiposity in youth: a 6-year follow-up study. Nutr. Metab. Cardiovasc. Dis. 23, 883–890 (2013).
Isasi, C. R. et al. Physical fitness and C-reactive protein level in children and young adults: the Columbia University BioMarkers Study. Pediatrics 111, 332–338 (2003).
Kwon, S., Burns, T. L. & Janz, K. Associations of cardiorespiratory fitness and fatness with cardiovascular risk factors among adolescents: the NHANES 1999-2002. J. Phys. Act. Health 7, 746–753 (2010).
Llorente-Cantarero, F. J. et al. Non-traditional markers of metabolic risk in prepubertal children with different levels of cardiorespiratory fitness. Public Health Nutr. 15, 1827–1834 (2012).
Christodoulos, A. D., Douda, H. T. & Tokmakidis, S. P. Cardiorespiratory fitness, metabolic risk, and inflammation in children. Int. J. Pediatr. 2012, 270515 (2012).
Sun, C. et al. The contribution of childhood cardiorespiratory fitness and adiposity to inflammation in young adults. Obesity 22, 2598–2605 (2014).
Martinez-Gomez, D. et al. Objectively-measured and self-reported physical activity and fitness in relation to inflammatory markers in European adolescents: the HELENA Study. Atherosclerosis 221, 260–267 (2012).
Kasapis, C. & Thompson, P. D. The effects of physical activity on serum C-reactive protein and inflammatory markers: a systematic review. J. Am. Coll. Cardiol. 45, 1563–1569 (2005).
Galland, L. Diet and inflammation. Nutr. Clin. Pract. 25, 634–640 (2010).
Marshall, S., Burrows, T. & Collins, C. E. Systematic review of diet quality indices and their associations with health-related outcomes in children and adolescents. J. Hum. Nutr. Diet. 27, 577–598 (2014).
Carter, S., Hartman, Y., Holder, S., Thijssen, D. H. & Hopkins, N. D. Sedentary behavior and cardiovascular disease risk: mediating mechanisms. Exerc. Sport Sci. Rev. 45, 80–86 (2017).
This work was done as part of the IDEFICS study (www.idefics.eu). We gratefully acknowledge the financial support of the European Community within the Sixth RTD Framework Programme Contract No. 016181 (FOOD). E.M.G.-G. was supported by the Ministerio de Ciencia and innovación (Juan de la Cierva Formación grant, FJCI-2017-34967G).
The authors declare no competing interests.
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González-Gil, E.M., Santaliestra-Pasías, A.M., Buck, C. et al. Improving cardiorespiratory fitness protects against inflammation in children: the IDEFICS study. Pediatr Res 91, 681–689 (2022). https://doi.org/10.1038/s41390-021-01471-0