Biomarker in Adolescence Linked to Early Mortality

Despite increasing interest in the role of childhood and adolescent exposures in later-life disease, little is known about the long-term implications of early inflammation.

An international team of scientists led by the Memorial Sloan Kettering Cancer Center (New York, NY, USA) investigated the potential link between inflammation in late adolescence and death. The study included 106,120 seemingly Swedish healthy men who had undergone medical examination to assess their ability to carry out military service. Of these, 105,460 (99.4%) were aged 18 to 20 years at the time of examination.

Inflammation was measured by erythrocyte sedimentation rate (ESR), a nonspecific marker of inflammation. Erythrocyte sedimentation rate was categorized as low (≤10 mm/h), moderate (>10-<15 mm/h), and high (≥15 mm/h); the threshold from moderate to high ESR corresponds to the clinical cutoff for normal ESR among adolescents and men in this age group. Men were observed for death until January 1, 2010, unless censored because of emigration. Underlying causes of death included cancer (n = 1,105), cardiovascular disease (CVD) (n = 874), alcohol or drugs (n = 280), and suicide, traffic accidents, or falls (n = 1,502).

The team reported that after adjusting for potential confounders including age, erythrocyte volume fraction, household crowding, systolic and diastolic blood pressure, muscular strength, physical working capacity, cognitive function, and body mass index, ESR was associated with overall mortality (high versus low ESR: multivariable-adjusted hazard ratio [HR], 1.36; 95% confidence interval [CI], 1.11 - 1.67). ESR was also linked to death from cancer (HR, 1.78; 95% CI, 1.23 - 2.59) and CVD (HR, 1.54; 95% CI, 0.97 - 2.43).

The authors concluded that their results suggest that ESR among ostensibly healthy men in late adolescence marks something beyond that captured by manifested adolescent health conditions. Results demonstrate the need to better understand the role of subclinical early-life inflammation in relation to later-life health outcomes.

Elizabeth D. Kantor, PhD, MPH, the lead author of the study, said, “While the exact underlying mechanisms are unclear, inflammation has been implicated in the development of both cancer and atherosclerosis, and these data highlight the existence of detectable markers of premature mortality at an early stage of life.” The study was published on September 3, 2019, in the journal JAMA Pediatrics.

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Memorial Sloan Kettering Cancer Center