Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.
J Epidemiol Community Health. 2017 Aug;71(8):817-826. doi: 10.1136/jech-2016-208646. Epub 2017 May 10.
Inflammation plays a central role in cardiometabolic disease and may represent a mechanism linking low socioeconomic status (SES) in early life and adverse cardiometabolic health outcomes in later life. Accumulating evidence suggests an association between childhood SES and adult inflammation, but findings have been inconsistent.
We conducted a systematic review and meta-analysis of observational studies to quantify the association between childhood (age <18 years) SES and the inflammatory marker C reactive protein (CRP) in adulthood. Studies were identified in Medline and Embase databases, and by reviewing the bibliographies of articles published from 1946 to December 2015. Study-specific estimates were combined into meta-analyses using random-effects models.
15 of 21 eligible studies (n=43 629) were ultimately included in two separate meta-analyses. Compared with those from the most advantaged families, participants from the least advantaged families had 25% higher CRP levels (ratio change in geometric mean CRP: 1.25; 95% CI 1.19 to 1.32) in minimally adjusted analyses. This finding was attenuated by the inclusion of adult body mass index (BMI) in adjusted models, suggesting BMI has a strong mediating role in CRP levels.
We observed an inverse association between childhood SES and adulthood CRP, potentially mediated through BMI. Investigating how childhood SES is associated with childhood BMI and CRP would provide insight into the effective timing of social and clinical interventions to prevent cardiometabolic disease.
炎症在代谢心血管疾病中起着核心作用，它可能代表了一种将生命早期的社会经济地位（SES）较低与生命后期的不良代谢心血管健康结果联系起来的机制。越来越多的证据表明，儿童时期的 SES 与成人的炎症之间存在关联，但研究结果并不一致。
我们进行了一项系统评价和荟萃分析，以量化儿童时期（<18 岁）SES 与成人炎症标志物 C 反应蛋白（CRP）之间的关联。研究在 Medline 和 Embase 数据库中进行，并通过查阅 1946 年至 2015 年 12 月发表的文章的参考文献进行了研究。使用随机效应模型对研究特异性估计值进行合并，进行荟萃分析。
在 21 项符合条件的研究中，最终有 15 项（n=43629）被纳入了两项单独的荟萃分析。与来自最有利家庭的参与者相比，来自最不利家庭的参与者的 CRP 水平高出 25%（几何均数 CRP 的比值变化：1.25；95%CI 1.19 至 1.32），在最小调整分析中。当包括成人 BMI 时，这一发现减弱了，表明 BMI 在 CRP 水平中具有很强的中介作用。
我们观察到儿童时期 SES 与成年期 CRP 呈负相关，这种关系可能通过 BMI 介导。研究儿童 SES 与儿童期 BMI 和 CRP 的关系，可以深入了解社会和临床干预的有效时机，以预防代谢心血管疾病。
