Ideal cardiovascular health and inflammation in European adolescents: The HELENA study

Nutr Metab Cardiovasc Dis. 2017 May;27(5):447-455. doi: 10.1016/j.numecd.2016.12.003. Epub 2016 Dec 23.


Background and aims: Inflammation plays a key role in atherosclerosis and this process seems to appear in childhood. The ideal cardiovascular health index (ICHI) has been inversely related to atherosclerotic plaque in adults. However, evidence regarding inflammation and ICHI in adolescents is scarce. The aim is to assess the association between ICHI and inflammation in European adolescents.

Methods and results: As many as 543 adolescents (251 boys and 292 girls) from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study, a cross-sectional multi-center study including 9 European countries, were measured. C-reactive protein (CRP), complement factors C3 and C4, leptin and white blood cell counts were used to compute an inflammatory score. Multilevel linear models and multilevel logistic regression were used to assess the association between ICHI and inflammation controlling by covariates. Higher ICHI was associated with a lower inflammatory score, as well as with several individual components, both in boys and girls (p < 0.01). In addition, adolescents with at least 4 ideal components of the ICHI had significantly lower inflammatory score and lower levels of the study biomarkers, except CRP. Finally, the multilevel logistic regression showed that for every unit increase in the ICHI, the probability of having an inflammatory profile decreased by 28.1% in girls.

Conclusion: Results from this study suggest that a better ICHI is associated with a lower inflammatory profile already in adolescence. Improving these health behaviors, and health factors included in the ICHI, could play an important role in CVD prevention.

Keywords: Cardiovascular health; European adolescents; Inflammation.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Age Factors
  • Biomarkers / blood
  • C-Reactive Protein / analysis
  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / prevention & control*
  • Chi-Square Distribution
  • Complement C3 / analysis
  • Complement C4 / analysis
  • Cross-Sectional Studies
  • Diet / adverse effects
  • Europe
  • Female
  • Health Status*
  • Humans
  • Inflammation / diagnosis
  • Inflammation / epidemiology
  • Inflammation / prevention & control*
  • Inflammation Mediators / blood
  • Leptin / blood
  • Leukocyte Count
  • Life Style
  • Linear Models
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Nutrition Surveys
  • Odds Ratio
  • Risk Assessment
  • Risk Factors
  • Risk Reduction Behavior


  • Biomarkers
  • C3 protein, human
  • Complement C3
  • Complement C4
  • Inflammation Mediators
  • Leptin
  • C-Reactive Protein