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Serum C-reactive protein levels and body mass index in children and adolescents with CHD

Published online by Cambridge University Press:  16 December 2016

Maíra Ribas Goulart
Instituto de Cardiologia/Fundação Universitária de Cardiologia – IC/FUC, Porto Alegre – Rio Grande do Sul, Brasil Universidade Federal de Ciências da Saúde de Porto Alegre – UFCSPA, Porto Alegre – Rio Grande do Sul, Brasil
Daniela Schneid Schuh
Instituto de Cardiologia/Fundação Universitária de Cardiologia – IC/FUC, Porto Alegre – Rio Grande do Sul, Brasil
David W. Moraes
Instituto de Cardiologia/Fundação Universitária de Cardiologia – IC/FUC, Porto Alegre – Rio Grande do Sul, Brasil Universidade Federal de Ciências da Saúde de Porto Alegre – UFCSPA, Porto Alegre – Rio Grande do Sul, Brasil
Sandra Mari Barbiero
Instituto de Cardiologia/Fundação Universitária de Cardiologia – IC/FUC, Porto Alegre – Rio Grande do Sul, Brasil
Lucia Campos Pellanda*
Instituto de Cardiologia/Fundação Universitária de Cardiologia – IC/FUC, Porto Alegre – Rio Grande do Sul, Brasil Universidade Federal de Ciências da Saúde de Porto Alegre – UFCSPA, Porto Alegre – Rio Grande do Sul, Brasil
Correspondence to: Lucia Campos Pellanda, Unidade de Pesquisa Av. Princesa Isabel, 370 – Azenha. CEP: 90.620-000 - Porto Alegre, RS – Brazil. Tel: 55 51 3230 3757; Fax: 55 51 32303600; E-mail:



The prevalence of overweight in children with CHD is about 26.9%. Increase in adipose tissue is related to the secretion of proinflammatory markers such as C-reactive protein. Assuming that children with CHD are exposed to other inherent risk factors for heart disease, our objective was to evaluate the correlation between levels of C-reactive protein and body mass index in children and adolescents with CHD.


A cross-sectional study with 377 children and adolescents with CHD in a clinical setting of a reference hospital was carried out. C-reactive protein data were collected after 12 hours of fasting. Nutritional status was classified according to body mass index. The patients were divided into three groups: cyanotic, acyanotic, and minimal heart defects (controls).


The mean age was 9.9±4.2 years, and 53.6% of the sample included males. The cyanotic group represented 22.3%, acyanotic 42.2%, and minimal defects 35.5% of the sample. The average body mass index percentile was 57.23±32.06. The median values of C-reactive protein were as follows: cyanotic 0.340, acyanotic with clinical repercussion 0.203, and minimal defects 0.128. There was a significant difference between the minimal defects and the cyanotic groups (p=0.023). There was a significant correlation between C-reactive protein and body mass index percentile (r=0.293, p<0.01). C-reactive protein levels were higher in girls (p=0.034). There were no significant correlations between C-reactive protein and age or birth weight.


The correlation between body mass index percentile and C-reactive protein was confirmed in this population. The prevention of overweight is paramount to avoid overlapping modifiable risk factors to those already inherent to the CHD.

Original Articles
© Cambridge University Press 2016 

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1. Go, AS, Mozaffarian, D, Roger, VL, et al. Heart disease and stroke statistics – 2014 update: a report from the American Heart Association. Circulation 2014; 129: e28e292.Google Scholar
2. Huber, J, Peres, VC, Jeronimo, T, et al. Cardiopatias Congênitas em um Serviço de Referência: Evolução Clínica e Doenças Associadas. 2008; 333338.Google Scholar
3. Barbiero, SM, D’Azevedo Sica, C, Schuh, DS, Cesa, CC, de Oliveira Petkowicz, R, Pellanda, LC. Overweight and obesity in children with congenital heart disease: combination of risks for the future? BMC Pediatr 2014; 14: 271.Google Scholar
4. Hotamisligil, G, Shargill, N, Spiegelman, B. Adipose expression of tumor necrosis factor α : direct role in obesity-linked insulin resistance. Science 1993; 259: 8791.Google Scholar
5. Kim, C-S, Park, H-S, Kawada, T, et al. Circulating levels of MCP-1 and IL-8 are elevated in human obese subjects and associated with obesity-related parameters. Int J Obes (Lond) 2006; 30: 13471355.Google Scholar
6. Franco, RR, Bodanese, LC, Repetto, G, et al. Inflammatory markers and antichlamydial antibodies in patients with metabolic syndrome. Arquivos Brasileiros de Cardiologia 2009; 96: 134139.Google Scholar
7. Smidowicz, A, Regula, J. Effect of nutritional status and dietary patterns on human serum C-reactive protein and interleukin-6 concentrations. Adv Nutr 2015; 6: 738747.Google Scholar
8. Ikeoka, D, Mader, JK, Pieber, TR. Adipose tissue, inflammation and cardiovascular disease. Rev Assoc Med Bras [Internet] 2010; 56: 116121.Google Scholar
9. Hashimoto, H, Kitagawa, K, Hougaku, H, et al. C-reactive protein is an independent predictor of the rate of increase in early carotid atherosclerosis. Circulation 2001; 104: 6367.Google Scholar
10. Visser, M, Bouter, LM, McQuillan, GM, Wener, MH, Harris, TB. Elevated C-reactive protein levels in overweight and obese adults JAMA 1999; 282: 21312135.Google Scholar
11. Jialal, I, Devaraj, S, Venugopal, SK. C-reactive protein: risk marker or mediator in atherothrombosis? Hypertension 2004; 44: 611.Google Scholar
12. Ridker, PM. Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation 2003; 107: 363369.Google Scholar
13. Ridker, PM. Role of inflammatory biomarkers in prediction of coronary heart disease. Lancet 2001; 358: 946948.Google Scholar
14. Mercedes de, O, Adelheid, OW, Borghi, E, Siyam, A, Nishida, C, Siekmann, J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Heal Organ 2007; 85: 812819.Google Scholar
15. WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr 2006; 450 (Suppl): 7685.Google Scholar
16. Cook, DG, Mendall, M a, Whincup, PH, et al. C-reactive protein concentration in children: relationship to adiposity and other cardiovascular risk factors. Atherosclerosis 2000; 149: 139150.Google Scholar
17. Thomas, NE, Baker, JS, Graham, MR, Cooper, SM, Davies, B. C-reactive protein in schoolchildren and its relation to adiposity, physical activity, aerobic fitness and habitual diet. Br J Sports Med 2008; 42: 357360.Google Scholar
18. Kaplan, RC, Aviles-Santa, ML, Parrinello, CM, et al. Body mass index, sex, and cardiovascular disease risk factors among Hispanic/Latino adults: Hispanic Community Health Study/Study of Latinos. J Am Heart Assoc 2014; 3: e000923e000923.Google Scholar
19. El-Melegy, NT, Mohamed, NA. Angiogenic biomarkers in children with congenital heart disease: possible implications. Ital J Pediatr 2010; 36: 32.Google Scholar
20. Takaya, J, Ikemoto, Y, Teraguchi, M, Nogi, S, Kobayashi, Y. Plasma nitric oxide products correlate with cardiac index of congenital heart disease. Pediatr Cardiol 2000; 21: 378381.Google Scholar
21. Nassef, YE, Hamed, MA, Aly, HF. Inflammatory cytokines, apoptotic, tissue injury and remodeling biomarkers in children with congenital heart disease. Indian J Clin Biochem 2014; 29: 145149.Google Scholar
22. Sharma, R, Bolger, AP, Li, W, et al. Elevated circulating levels of inflammatory cytokines and bacterial endotoxin in adults with congenital heart disease. Am J Cardiol 2003; 92: 188193.Google Scholar
23. Yudkin, JS, Stehouwer, CDA, Emeis, JJ, Coppack, SW. C-reactive protein in healthy subjects: associations with obesity, insulin resistance, and endothelial dysfunction: a potential role for cytokines originating from adipose tissue? Arterioscler Thromb Vasc Biol 1999; 19: 972–978.Google Scholar
24. Fish, EN. The X-files in immunity: sex-based differences predispose immune responses. Nat Rev Immunol 2008; 8: 737744.Google Scholar
25. Gomes, F, Telo, DF, Souza, HP, Nicolau, JC, Halpern, A, Serrano, CV Jr. Obesidade e doença arterial coronariana: papel da inflamação vascular. Arq Bras Cardiol 2010; 94: 273279.Google Scholar
26. Weyer, C, Yudkin, JS, Stehouwer, CD a, Schalkwijk, CG, Pratley, RE, Tataranni, PA.. Humoral markers of inflammation and endothelial dysfunction in relation to adiposity and in vivo insulin action in Pima Indians. Atherosclerosis 2002; 161: 233242.Google Scholar
27. Nappo, A, Iacoviello, L, Fraterman, A, et al. High-sensitivity C-reactive protein is a predictive factor of adiposity in children: results of the identification and prevention of dietary-and lifestyle-induced health effects in children and infants (IDEFICS) study. J Am Heart Assoc 2013; 2: 19.Google Scholar
28. Massin, MM, Hövels-Gürich, H, Seghaye, MC. Atherosclerosis lifestyle risk factors in children with congenital heart disease. Eur J Cardiovasc Prev Rehabil 2007; 14: 349351.Google Scholar
29. Shustak, RJ, McGuire, SB, October, TW, Phoon, CKL, Chun, AJL. Prevalence of obesity among patients with congenital and acquired heart disease. Pediatr Cardiol 2012; 33: 814.Google Scholar
30. Chen, CA, Wang, JK, Lue, HC, Hua, YC, Chang, MH, Wu, MH. A shift from underweight to overweight and obesity in Asian children and adolescents with congenital heart disease. Paediatr Perinat Epidemiol 2012; 26: 336343.Google Scholar
31. Tamayo, C, Manlhiot, C, Patterson, K, Lalani, S, McCrindle, BW. Longitudinal evaluation of the prevalence of overweight/obesity in children with congenital heart disease. Can J Cardiol 2015; 31: 117123.Google Scholar
32. Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa de Orçamentos Familiares 2008–2009: Despesas, Rendimentos e Condições de Vida. Biblioteca do Ministerio do Planejamento, Orçamento e Gestão. IBGE, Rio de Janeiro RJ, 2010; 1222.Google Scholar
33. Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa de Orçamentos Familiares, 2008–2009: Avaliação nutricional da disponibilidade domiciliar de alimentos no Brasil. IBGE, Rio de Janeiro RJ, 2010.Google Scholar
34. Mazzoccante, RP, Moraes, FVN De, Campbell, CSG. Direct public spending on obesity and associated diseases in Brazil. Rev Ciênc Méd 2012; 21: 2534.Google Scholar
35. Wang, LY, Denniston, M, Lee, S, Galuska, D, Lowry, R. Long-term health and economic impact of preventing and reducing overweight and obesity in adolescence. J Adolesc Health 2010; 46: 467473.Google Scholar
36. Crowley, DI, Khoury, PR, Urbina, EM, Ippisch, HM, Kimball, TR. Cardiovascular impact of the pediatric obesity epidemic: Higher left ventricular mass is related to higher body mass index. J Pediatr 2011; 158: 709714.e1.Google Scholar
37. Conde, W, Borges, C. SP3-76 incidence and persistence of obesity in Brazilian adults from body mass index at end of adolescence. J Epidemiol Community Heal 2011; 65 (Suppl 1): A429A429.Google Scholar
38. Freedman, DS, Khan, LK, Serdula, MK, Dietz, WH, Srinivasan, SR, Berenson, GS. The relation of childhood BMI to adult adiposity: the Bogalusa Heart Study. Pediatrics 2005; 115: 2227.Google Scholar
39. Chiuve, SE, Cook, NR, Shay, CM, et al. Lifestyle-based prediction model for the prevention of CVD: the healthy heart score. J Am Heart Assoc 2014; 3: e000954e000954.Google Scholar
40. Victorino, SVZ, Soares, LG, Marcon, SS, Higarashi, IH. Living with childhood obesity: the experience of children enrolled in a multidisciplinary monitoring program. Rev da Rede Enferm do Nord 2014; 15: 980989.Google Scholar
41. Gall, K, van Zutven, K, Lindstrom, J, Bentley, C, Gratwick-Sarll, K, Harrison, C, Lewis, V, Mond, J. Obesity and emotional well-being in adolescents: roles of body dissatisfaction, loss of control eating, and self-rated health. Obesity (Silver Spring) 2016; 24: 837842.Google Scholar
42. Sahoo, K, Sahoo, B, Choudhury, AK, Sofi, NY, Kumar, R, Bhadoria, AS. Childhood obesity: causes and consequences. J Family Med Prim Care 2015; 4: 187192.Google Scholar
43. Kalra, G, Sousa, A, Sonavane, S, Shah, N. Psychological issues in pediatric obesity. Ind Psychiatry J 2012; 21: 1117.Google Scholar
44. Compas, B, Jaser, S, Dunn, M, Rodriguez, E. Coping with chronic illness in childhood and adolescence. Annu Rev Clin Psychol 2012; 8: 455480.Google Scholar