C-Reactive Protein and Diet Quality in Children

Part of the Nutrition and Health book series (NH)


This review examines the relationship(s) between several dietary aspects (i.e. food consumption, dietary biochemical markers and nutrient intake through food or supplements) and C-reactive protein (CRP) concentration in childhood populations. The first paper published on this topic was in 2005, and until 2011, only ten papers have been published, all of which are reviewed here.

The sample sizes of studies reviewed varied from less than 100 (three studies) to more than 1,000 participants (three studies). The remaining four studies included between about 100–300 participants. Nine of the ten studies were cross-sectional, and one was an intervention study. In the majority of the reviewed studies, foods and nutrients that are generally considered as health-protecting (e.g. grains, vegetables, fruit, dairy fatty acids, eicosapentaenoic acid, zinc, iron, magnesium and folate) were inversely related to CRP concentration (in 7 out of the 10 reviewed studies), whereas foods and nutrients that are generally considered as unhealthy (e.g. saturated fat, meat and French fries) were not significantly related to CRP concentration (in four out of six studies that reported such associations). In the remaining two studies reviewed, there was a positive effect of total and different types of fatty acids to CRP and an additive effect of foods, assessed via dietary indices, considered ‘unhealthy’, to increasing CRP concentration. In summary, preliminary evidence shows that a healthy diet may be protective against inflammation as shown by the lower CRP concentration; nevertheless, since the number of studies conducted is limited and there is considerable heterogeneity in the dietary markers used, the participants’ age and the sample sizes, definitive conclusions cannot be drawn. With regard to ‘unhealthy’ dietary components or markers, the evidence is less clear; nevertheless, there is some evidence pointing to the direction of focusing research on the additive role of foods or components, generally considered ‘unhealthy’. In conclusion, although there is some evidence on the role of diet on CRP concentration in children, more research is needed in order to better understand this relationship.


hs-CRP Adiposity Inflammation Atherosclerosis Diet Children Dietary indices 



Body fat percentage


Bioelectrical impedance analysis


Body mass index


Cholesterol esters


C-reactive protein


Cardiovascular disease






Mediterranean Diet Quality Index for children








Odds ratio




Recommended Daily Allowance


Standard deviation score


Socioeconomic status


Waist circumference


Waist to hip ratio


  1. 1.
    Williams CL, Hayman LL, Daniels SR, et al. Cardiovascular health in childhood: a statement for health professionals from the Committee on Atherosclerosis, Hypertension, and Obesity in the Young (AHOY) of the Council on Cardiovascular Disease in the Young, American Heart Association. Circulation. 2002;106(1):143–60.PubMedCrossRefGoogle Scholar
  2. 2.
    Jarvisalo MJ, Harmoinen A, Hakanen M, et al. Elevated serum C-reactive protein levels and early arterial changes in healthy children. Arterioscler Thromb Vasc Biol. 2002;22(8):1323–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation. 2002;105(9):1135–43.PubMedCrossRefGoogle Scholar
  4. 4.
    Warnberg J, Marcos A. Low-grade inflammation and the metabolic syndrome in children and adolescents. Curr Opin Lipidol. 2008;19(1):11–5.PubMedCrossRefGoogle Scholar
  5. 5.
    Pearson TA, Mensah GA, Alexander RW, 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. 2003;107(3):499–511.PubMedCrossRefGoogle Scholar
  6. 6.
    Ridker PM, Danielson E, Fonseca FA, et al. Reduction in C-reactive protein and LDL cholesterol and cardiovascular event rates after initiation of rosuvastatin: a prospective study of the JUPITER trial. Lancet. 2009;373(9670):1175–82.PubMedCrossRefGoogle Scholar
  7. 7.
    Lavoie ME, Faraj M, Strychar I, et al. Synergistic associations of physical activity and diet quality on cardiometabolic risk factors in overweight and obese postmenopausal women. Br J Nutr. 2012;109:1–10.Google Scholar
  8. 8.
    Visser M, Bouter LM, McQuillan GM, Wener MH, Harris TB. Elevated C-reactive protein levels in overweight and obese adults. JAMA. 1999;282(22):2131–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Cook DG, Mendall MA, Whincup PH, et al. C-reactive protein concentration in children: relationship to adiposity and other cardiovascular risk factors. Atherosclerosis. 2000;149(1):139–50.PubMedCrossRefGoogle Scholar
  10. 10.
    Rolfes SR, Pinna K, Whitney E. Nutrition care and assessment. In: Rolfes SR, Pinna K, Whitney E, editors. Understanding normal and clinical nutrition. 7th ed. Belmont: Thomson-Wadsworth; 2006. p. 580–605.Google Scholar
  11. 11.
    Carlson TH. Laboratory data in nutrition assessment. In: Mahan LM, Escott-Stump S, editors. Krause’s food, nutrition and diet therapy. 11th ed. Philadelphia: Saunders; 2004. p. 436–54.Google Scholar
  12. 12.
    Visser M, Bouter LM, McQuillan GM, Wener MH, Harris TB. Low-grade systemic inflammation in overweight children. Pediatrics. 2001;107(1):E13.PubMedCrossRefGoogle Scholar
  13. 13.
    Quijada Z, Paoli M, Zerpa Y, et al. The triglyceride/HDL-cholesterol ratio as a marker of cardiovascular risk in obese children; association with traditional and emergent risk factors. Pediatr Diabetes. 2008;9(5):464–71.PubMedCrossRefGoogle Scholar
  14. 14.
    Brasil AR, Norton RC, Rossetti MB, Leao E, Mendes RP. C-reactive protein as an indicator of low intensity inflammation in children and adolescents with and without obesity. J Pediatr (Rio J). 2007;83(5):477–80.CrossRefGoogle Scholar
  15. 15.
    Lazarou C, Panagiotakos DB, Chrysohoou C, Andronikou C, Matalas AL. C-reactive protein levels are associated with adiposity and a high inflammatory foods index in mountainous Cypriot children. Clin Nutr. 2010;29(6):779–83.PubMedCrossRefGoogle Scholar
  16. 16.
    Klein-Platat C, Drai J, Oujaa M, Schlienger JL, Simon C. Plasma fatty acid composition is associated with the metabolic syndrome and low-grade inflammation in overweight adolescents. Am J Clin Nutr. 2005;82(6):1178–84.PubMedGoogle Scholar
  17. 17.
    Aeberli I, Molinari L, Spinas G, Lehmann R, l’Allemand D, Zimmermann MB. Dietary intakes of fat and antioxidant vitamins are predictors of subclinical inflammation in overweight Swiss children. Am J Clin Nutr. 2006;84(4):748–55.PubMedGoogle Scholar
  18. 18.
    King DE, Mainous III AG, Geesey ME, Ellis T. Magnesium intake and serum C-reactive protein levels in children. Magnes Res. 2007;20(1):32–6.PubMedGoogle Scholar
  19. 19.
    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(5):357–60.PubMedCrossRefGoogle Scholar
  20. 20.
    Kelishadi R, Hashemipour M, Adeli K, et al. Effect of zinc supplementation on markers of insulin resistance, oxidative stress, and inflammation among prepubescent children with metabolic syndrome. Metab Syndr Relat Disord. 2010;8(6):505–10.PubMedCrossRefGoogle Scholar
  21. 21.
    Qureshi MM, Singer MR, Moore LL. A cross-sectional study of food group intake and C-reactive protein among children. Nutr Metab (Lond). 2009;6:40.CrossRefGoogle Scholar
  22. 22.
    Holt EM, Steffen LM, Moran A, et al. Fruit and vegetable consumption and its relation to markers of inflammation and oxidative stress in adolescents. J Am Diet Assoc. 2009;109(3):414–21.PubMedCrossRefGoogle Scholar
  23. 23.
    Cepeda-Lopez AC, Osendarp SJ, Melse-Boonstra A, et al. Sharply higher rates of iron deficiency in obese Mexican women and children are predicted by obesity-related inflammation rather than by differences in dietary iron intake. Am J Clin Nutr. 2011;93(5):975–83.PubMedCrossRefGoogle Scholar
  24. 24.
    Wang H, Steffen LM, Vessby B, et al. Obesity modifies the relations between serum markers of dairy fats and inflammation and oxidative stress among adolescents. Obesity (Silver Spring). 2011;19(12):2404–10.CrossRefGoogle Scholar
  25. 25.
    Serra-Majem L, Ribas L, Ngo J, et al. Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in children and adolescents. Public Health Nutr. 2004;7(7):931–5.PubMedGoogle Scholar
  26. 26.
    Steinberger J, Daniels SR, Eckel RH, et al. Progress and challenges in metabolic syndrome in children and adolescents: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in the Young Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular Nursing; and Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2009;119(4):628–47.PubMedCrossRefGoogle Scholar
  27. 27.
    Cavicchia PP, Steck SE, Hurley TG, et al. A new dietary inflammatory index predicts interval changes in serum high-sensitivity C-reactive protein. J Nutr. 2009;139(12):2365–72.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Ministry of Education and Culture, Cyprus Food & Nutrition MuseumEngomi, NicosiaCyprus
  2. 2.Department of Life and Health Sciences, School of SciencesUniversity of NicosiaNicosiaCyprus

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