the global prevalence of overweight and obesity in children and adolescents has increased substantially over the past several decades .
many studies done previously , suggest that children and adolescents with risk factors such as obesity , dyslipidemia , elevated blood pressure and impaired glucose metabolism are at increased risk of developing atherosclerosis in adulthood .
high - sensitivity c - reactive protein ( hscrp ) has been emerged as a novel biomarker for vascular inflammation associated with atherosclerosis .
accumulating evidence suggests that hscrp , which is also found within macrophages of atheromatous plaques . however , there is no much data available that guarantee its utility as a marker of cardiovascular risk in obese children and adolescents .
hence , the present study was taken up to assess the metabolic abnormalities and its association with hscrp in obese children and adolescents .
a total of 62 obese children and adolescents were consecutively recruited from our department of endocrinology and metabolism , nellore , andhra pradesh , india over a period of 14 months ( october 2011 to december 2012 ) .
obesity was defined based on reference values stated in the centers for disease control and prevention growth chart ( cdc charts ) .
children with body mass index ( bmi ) greater than the 95 percentile for age and gender were classified as obese . those with bmi equal to or exceeding 85 percentile but , below the 95 percentile are defined as overweight .
secondary causes of obesity such as hypothyroidism , cushing 's disease and other causes were excluded .
none of the patients was taking any medication at the time of evaluation for the presence of insulin resistance ( ir ) and impaired glucose tolerance / diabetes mellitus .
the criteria for healthy control group were no major medical illness and normal glucose tolerance test according to the american diabetes association criteria .
the study was approved by the institutional ethical committee and informed consent was taken from parents .
physical examination included measurements of height ( by a stadiometer measuring with accuracy of 0.1 cm ) , weight ( by electronic weighing machine ) and blood pressure were obtained .
bmi was calculated as the weight in kilograms divided by the height in meters squared .
systolic blood pressure ( sbp ) and diastolic blood pressure ( dbp ) were measured at the right arm after 15-min rest in sitting position using manual sphygmomanometer . after a 10-h overnight fast , venous blood samples were collected for laboratory evaluation of fasting glucose and insulin , triglycerides , total cholesterol and high - density lipoprotein ( hdl ) cholesterol and hscrp .
glucose levels were measured by glucose oxidase and peroxidase method ; triglycerides , total cholesterol were measured by the enzymatic and cholesterol oxidase methods respectively , hdl - cholesterol ( hdl - c ) were measured by direct immunoturbidimetry method . low - density lipoprotein ( ldl )
were calculated by friedewald 's formula ( ldl = tc  [ tgl/5 + hdl ] ) . glucose and lipid levels were measured by commercially available in vitro assay kits from human gmbh on humastar 600 ( fully automated chemistry analyzer ) , max - planck - ring 21 , wiesbaden , germany .
hscrp was measured by immunoturbidimetric method ( aptec technologies ) on humastar 600 ( fully automated chemistry analyzer ) .
insulin was measured by chemilumniscence using beckman immunoassays on beckman coulter access 2 , ca , usa . both intra - assay and inter - assay coefficient of variations were lesser than 3.6% and 4.8% , respectively .
ir was calculated using homeostatic model assessment - ir ( homa - ir ) according to the formula ( homa - ir = plasma glucose [ mg / dl ]  insulin [ miu / l]/405 ) .
pearson 's correlation analysis was performed to assess the relationship between hscrp and other metabolic variables .
after a 10-h overnight fast , venous blood samples were collected for laboratory evaluation of fasting glucose and insulin , triglycerides , total cholesterol and high - density lipoprotein ( hdl ) cholesterol and hscrp .
glucose levels were measured by glucose oxidase and peroxidase method ; triglycerides , total cholesterol were measured by the enzymatic and cholesterol oxidase methods respectively , hdl - cholesterol ( hdl - c ) were measured by direct immunoturbidimetry method .
low - density lipoprotein ( ldl ) were calculated by friedewald 's formula ( ldl = tc  [ tgl/5 + hdl ] ) .
glucose and lipid levels were measured by commercially available in vitro assay kits from human gmbh on humastar 600 ( fully automated chemistry analyzer ) , max - planck - ring 21 , wiesbaden , germany .
hscrp was measured by immunoturbidimetric method ( aptec technologies ) on humastar 600 ( fully automated chemistry analyzer ) .
insulin was measured by chemilumniscence using beckman immunoassays on beckman coulter access 2 , ca , usa . both intra - assay and inter - assay coefficient of variations were lesser than 3.6% and 4.8% , respectively .
ir was calculated using homeostatic model assessment - ir ( homa - ir ) according to the formula ( homa - ir = plasma glucose [ mg / dl ]  insulin [ miu / l]/405 ) .
pearson 's correlation analysis was performed to assess the relationship between hscrp and other metabolic variables . a p < 0.05 was considered to be statistically significant .
table 1 shows anthropometrical and biochemical characteristics of the study subjects . there is no significant difference between the study groups in terms of age and fasting plasma glucose .
bmi , sbp and dbp were significantly elevated in obese children and adolescents compared to healthy controls .
fasting insulin levels ( p < 0.001 ) and ir calculated by homa - ir ( p < 0.001 ) and hscrp ( p <
0.001 ) were significantly higher in obese children and adolescents when compared with the healthy control group .
obese children and adolescents had significantly higher serum total cholesterol ( p = 0.005 ) , triglycerides ( p < 0.001 ) , ldl - cholesterol ( ldl - c ) ( p = 0.006 ) and decreased hdl - c ( p < 0.001 ) compared to control group .
anthropometric and biochemical variables of the study subjects table 2 shows pearson 's correlation analysis between hscrp and metabolic variables .
hscrp showed a positive correlation with bmi ( r = 0.357 ; p = 0.028 ) , total cholesterol ( r = 0.367 ; p = 0.008 ) , ldl - c ( r = 0.356 ; p = 0.01 ) , insulin ( r = 0.311 ; p = 0.026 ) and not with homa - ir ( r = 0.244 ; p = 0.084 ) .
no significant association was found with bmi , triglycerides , hdl - c and homa - ir .
this study is first of its kind from the indian subcontinent , which shows the evidence for the presence of early cardiovascular risk factors in obese children and adolescents .
many studies , have demonstrated a high cardiovascular risk profile in overweight and obese children and adolescents compared with a normal weight children . in this study , compared with age matched and normal weight subjects , obese children and adolescents had higher sbp and dbp , total cholesterol , triglycerides , ldl - c , insulin , ir and hscrp . in agreement with our study , meyer et al . , showed higher sbp and dbp , higher concentrations of fasting triglycerides , insulin and hscrp in obese children compared with the normal weight controls .
, demonstrated that obese children had higher levels of blood pressure , triglycerides , glucose , insulin , ir and crp compared to the control group ( 100 obese children with 50 non - obese children ) .
the probable mechanisms underlying this association with obesity is as follows ; the cytokines such as tumor necrosis factor- and interleukin-6 are released from adipose tissue and these cytokines stimulate the production of acute - phase proteins such as crp in the liver .
elevated hscrp levels may be associated with the development of cardiovascular diseases and diabetes by means of a variety of mechanisms : altered sensitivity to insulin , increased liberation of adhesion molecules by endothelium , increase in hepatic production of fibrinogen and platelet coagulation factor . in our study , hscrp showed a positive correlation with bmi ( r = 0.357 ; p = 0.028 ) , total cholesterol ( r = 0.367 ; p = 0.008 ) and ldl - c ( r = 0.356 ; p = 0.01 ) , insulin ( r = 0.311 ; p = 0.026 ) and not with homa - ir ( r = 0.244 ; p = 0.084 ) .
, showed a positive correlation between hscrp with bmi ( r = 0.35 ; p  0.01 ) and insulin ( r = 0.30 ; p = 0.01 ) .
however , in our study , there is no significant association between hscrp and blood pressure , triglycerides and hdl - c . in another study done by weiss et al .
, showed that there exists no statistical relationship between hscrp levels and metabolic risk factors .
the limitations of this study are : ( 1 ) small sample size , ( 2 ) measurement of ir by homa - ir , not by the gold standard euglycemic glucose clamp technique .
therefore , hscrp seems to be an excellent cardiovascular marker in obese children and adolescents and could be a useful tool for the early diagnosis of cardiovascular risk factors among this population
. early intervention in these obese individuals can reduce the incidence of comorbidities in adulthood .
 obesity in children and adolescents predispose to the development of obesity in adulthood and subsequent cardiovascular disease . 
 high - sensitivity c - reactive protein ( hscrp ) is a marker of low grade inflammatory state , which characterizes an atherosclerotic process . 
 the aim of this study was to assess the metabolic abnormalities and its association with hscrp in obese children and adolescents . 
 a total of 62 obese children and adolescents and 24 healthy children and adolescents with a normal weight were recruited . in all subjects , anthropometric and 
 biochemical parameters were measured . 
 body mass index ( bmi ) and blood pressure were significantly higher in the obese children and adolescents than the control . 
 obese children had significantly higher hscrp levels ( p < 0.001 ) , total cholesterol , triglyceride , low - density lipoprotein - cholesterol ( ldl - c ) and lower high - density lipoprotein - cholesterol than the control group . furthermore , homeostatic model assessment - insulin resistance ( homa - ir ) was significantly higher in obese children compared with the normal weight children . 
 furthermore , hscrp showed a positive correlation with bmi ( r = 0.357 ; p = 0.028 ) , total cholesterol ( r = 0.367 ; p = 0.008 ) and ldl - c ( r = 0.356 ; p = 0.01 ) , insulin ( r = 0.311 ; p = 0.026 ) and not with homa - ir ( r = 0.244 ; p = 0.084 ) ) . in conclusion , 
 obese children and adolescents have significantly increased hscrp compared with a normal weight group . 
 early intervention and prevention of obesity in children and adolescents decreases cardiovascular disease in later life . 
I
M
Biochemical measurements
Statistical analysis
R
D
C