# hs-CRP as a Marker of Systemic Low-Grade Inflammation Is Not Associated with Steatotic Liver Disease in Adolescents: Insights from the EVA4YOU Study

## TL;DR

This study finds that systemic low-grade inflammation, measured by hs-CRP, is not independently linked to liver fat in adolescents when accounting for metabolic factors.

## Contribution

The novel finding is that the observed link between hs-CRP and liver fat in adolescents is driven by metabolic syndrome components, not liver-specific inflammation.

## Key findings

- hs-CRP was initially associated with higher liver fat content in adolescents.
- The association disappeared after adjusting for metabolic syndrome factors like insulin resistance and BMI.
- Systemic inflammation in adolescents appears to reflect overall metabolic health, not liver-specific issues.

## Abstract

Objectives: Systemic low-grade inflammation is associated with steatohepatitis in adults. We aim to explore if systemic low-grade inflammation, measured by plasma high-sensitivity C-reactive protein (hs-CRP), is also linked to steatotic liver disease in adolescents. Methods: In the cross-sectional Early Vascular Ageing in the YOUth study, systemic low-grade inflammation was measured by hs-CRP and liver fat content was quantified by the controlled attenuation parameters (CAP) derived from FibroScan® (Echosense, Paris, France) measurements in 14- to 19-year-old Austrian adolescents. Cardiovascular risk factors and anthropometric data were collected through face-to-face interviews, physical examinations, and comprehensive fasting blood analyses. Linear regression models were performed to analyze the association between hs-CRP and CAP values. Results: A total of 1300 adolescents (64.6% female) with a mean age of 17.2 ± 1.3 years were included in this analysis. hs-CRP was significantly associated with CAP values in the simple linear regression model (b = 1.35, p = 0.044) and after adjustment for sex and age (b = 1.84, p = 0.006), suggesting an increase in systemic low-grade inflammation with increasing liver fat content. However, further adjustment for major factors of the metabolic syndrome (Homeostatic Model Assessment for Insulin Resistance, non-high-density lipoprotein cholesterol, body mass index z-score, systolic blood pressure z-score) led to a loss of significance of the mentioned association (b = −0.55, p = 0.419). Conclusions: Systemic low-grade inflammation measured by hs-CRP is linked to higher liver fat content in our adolescent cohort. However, this association is largely driven by components of the metabolic syndrome and the overall metabolic milieu, rather than reflecting liver-specific inflammation.