Association of inflammatory markers and multimorbidity in young adults: cross-sectional findings from the Pelotas (Brazil) birth cohort, 1993

Oliveira, Isabel Oliveira de; Correa, Tulio L.; Ferreira, Gustavo Dias; Nunes, Bruno Pereira; Gonçalves, Helen; Wehrmeister, Fernando César; Menezes, Ana Maria Baptista

doi:10.1590/0102-311XEN191623

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ARTICLE • Cad. Saúde Pública 41 (1) • 2025 • https://doi.org/10.1590/0102-311XEN191623 linkcopy

Association of inflammatory markers and multimorbidity in young adults: cross-sectional findings from the Pelotas (Brazil) birth cohort, 1993

Associação de marcadores inflamatórios e multimorbidade em jovens adultos: resultados transversais da coorte de nascimentos de Pelotas, Rio Grande do Sul, Brasil, 1993

Asociación de marcadores inflamatorios y multimorbilidad en adultos jóvenes: resultados transversales de la cohorte de nacimientos de Pelotas, Rio Grande do Sul, Brasil, 1993

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

Early diagnosis can be a beneficial factor for minimizing health risks related to multimorbidity. This study aims to assess the association of multimorbidity with interleukin 6 (IL-6), C-reactive protein (CRP), and adiponectin in 22-year-old participants of the Pelotas (Brazil) birth cohort. A total of 3,578 subjects had serum measurements of IL-6, CRP, and adiponectin at the 22-year-old visit. For multimorbidity evaluation, a list of 15 morbidities was used and divided into subgroups (cardiometabolic, pulmonary, allergic diseases, and mental disorders). The occurrence of ≥ 2 morbidities was higher in females (55.1%) than in males (45.2%). A negative association between multimorbidity and adiponectin was found in females, whereas positive associations between the number of diseases and IL-6 and CRP were observed in males. For both sexes, cardiometabolic problem was the morbidity most associated with the markers. The analysis for isolated diseases identified dyslipidemia was the only cardiometabolic condition associated with physiological markers. Our findings suggest an inverse association between multimorbidity and adiponectin in females, as well as a direct cumulative association between the number of diseases and IL-6 and CRP in males at a young age.

Keywords:
Gender and Health; Gender-inclusive Policies; Evidence-informed Policies

Parameter	Total	Male	Female
Parameter	n (%)	n (%)	n (%)
Skin color	3,301	1,560	1,741
White	2,082 (63.1)	992 (63.6)	1,090 (62.6)
Black	503 (15.2)	232 (14.9)	271 (15.6)
Others	716 (21.7)	336 (21.5)	380 (22.8)
Asset index (quintiles)	3,477	1,659	1,818
1st	699 (20.1)	271 (16.3)	428 (23.5)
2nd	690 (19.8)	304 (18.3)	386 (21.2)
3rd	706 (20.3)	340 (20.6)	366 (20.1)
4th	697 (20.1)	369 (22.2)	328 (18.1)
5th	685 (19.7)	375 (22.6)	310 (17.1)
Number of diseases	3,167	1,509	1,658
0	598 (18.9)	342 (22.7)	256 (15.4)
1	973 (30.7)	485 (32.1)	488 (29.5)
2	794 (25.1)	374 (24.8)	420 (25.3)
3	446 (14.1)	181 (12.0)	265 (16.0)
4	226 (7.1)	83 (5.5)	143 (8.6)
5+	130 (4.1)	44 (2.9)	86 (5.2)
Cardiometabolic problems	3,458	1,650	1,808
Yes	1,848 (53.4)	862 (52.2)	986 (54.5)
Respiratory problems	3,213	1,530	1,683
Yes	943 (29.3)	448 (29.3)	495 (29.4)
Allergic problems	3,453	1,648	1,805
Yes	1,208 (35.0)	455 (27.6)	753 (41.7)
Mental disorders	3,459	1,647	1,812
Yes	795 (23.0)	285 (17.3)	510 (28.1)
Smoking status	3,478	1,660	1,818
Never smoker	2,535 (72.9)	1,149 (69.2)	1,386 (76.3)
Former smoker	351 (10.1)	167 (10.1)	184 (10.1)
Current smoker	592 (17.0)	344 (20.7)	248 (13.6)
Harmful alcohol intake	3,477	1,659	1,818
No	2,715 (78.1)	1,158 (69.8)	1,557 (85.6)
Yes (AUDIT > 8 points)	762 (21.9)	501 (30.2)	261 (14.4)
Total physical activity *	3,472	1,655	1,817
Inactive	1,183 (34.1)	421 (25.4)	762 (41.9)
Active	2,289 (65.9)	1,234 (74.6)	1,055 (58.1)
Fat mass index DXA [mean (95%CI)]	3,225	20.8 (20.3; 21.3)	38.0 (37.5; 38.4)
IL-6 (pg/mL) [median (25-75 IQR)]	3,138	1.1 (0.8; 1.7)	1.3 (0.8; 2.0)
CRP (mg/dL) [median (25-75 IQR)]	3,481	0.6 (0.3; 1.4)	1.6 (0.6; 4.1)
Adiponectin (µg/mL) [mean (95%CI)]	3,481	8.0 (7.8; 8.2)	10.7 (10.5; 10.9)

Physiological marker/Exposure	Male				Female
	Crude		Adjusted		Crude		Adjusted
	Mean	95%CI	Mean	95%CI	Mean	95%CI	Mean	95%CI
IL-6 (pg/mL)		p = 0.001		p = 0.109		p = 0.001		p = 0.819
Multimorbidity
No	1.14	1.09; 1.19	1.15	1.10; 1.20	1.27	1.21; 1.34	1.42	1.35; 1.48
Yes	1.28	1.22; 1.35	1.22	1.16; 1.28	1.44	1.37; 1.50	1.43	1.37; 1.49
CRP (mg/L)		p < 0.001		p = 0.121		p = 0.020		p = 0.325
Multimorbidity
No	0.63	0.58; 0.68	0.70	0.64; 0.76	1.45	1.32; 1.60	1.85	1.68; 2.03
Yes	0.81	0.74; 0.88	0.77	0.70; 0.84	1.69	1.55; 1.84	1.96	1.80; 2.13
Adiponectin (µg/dL)		p = 0.009		p = 0.247		p < 0.001		p = 0.003
Multimorbidity
No	8.15	7.88; 8.42	8.01	7.73; 8.29	11.22	10.88; 11.55	11.06	10.72; 11.39
Yes	7.62	7.33; 7.92	7.76	7.45; 8.07	10.22	9.91; 10.52	10.37	10.06; 10.67

Physiological marker/Exposure	Male				Female
	Crude		Adjusted		Crude		Adjusted
	Coefficient	95%CI	Coefficient	95%CI	Coefficient	95%CI	Coefficient	95%CI
IL-6 (pg/mL)
Cardiometabolic		p < 0.001		p < 0.001		p < 0.001		p < 0.001
No	1.06	1.01; 1.11	1.08	1.02; 1.13	1.20	1.14; 1.26	1.33	1.27; 1.39
Yes	1.36	1.30; 1.42	1.29	1.23; 1.36	1.54	1.48; 1.61	1.52	1.46; 1.58
Allergic		p = 0.210		p = 0.071		p = 0.046		p = 0.047
No	1.22	1.17; 1.27	1.21	1.16; 1.25	1.42	1.36; 1.48	1.47	1.41; 1.53
Yes	1.16	1.09; 1.24	1.12	1.05; 1.20	1.32	1.26; 1.39	1.38	1.31; 1.45
Respiratory		p = 0.054		p = 0.213		p = 0.011		p = 0.397
No	1.18	1.13; 1.22	1.16	1.12; 1.21	1.32	1.27; 1.38	1.41	1.36; 1.46
Yes	1.26	1.19; 1.34	1.22	1.14; 1.29	1.45	1.37; 1.55	1.45	1.37; 1.53
Mental		p = 0.811		p = 0.588		p = 0.213		p = 0.719
No	1.20	1.16; 1.25	1.19	1.14; 1.23	1.36	1.30; 1.41	1.44	1.39; 1.49
Yes	1.19	1.10; 1.29	1.16	1.06; 1.25	1.42	1.33; 1.51	1.42	1.34; 1.50
CRP (mg/L)
Cardiometabolic		p < 0.001		p < 0.001		p < 0.001		p = 0.002
No	0.56	0.51; 0.60	0.62	0.56; 0.68	1.38	1.26; 1.51	1.73	1.57; 1.89
Yes	0.89	0.82; 0.97	0.85	0.78; 0.92	1.85	1.71; 2.01	2.08	1.91; 2.25
Allergic		p = 0.504		p = 0.111		p = 0.860		p = 0.354
No	0.72	0.67; 0.77	0.76	0.70; 0.82	1.61	1.49; 1.74	1.97	1.81; 2.14
Yes	0.69	0.62; 0.77	0.68	0.60; 0.76	1.63	1.48; 1.79	1.87	1.69; 2.04
Respiratory		p = 0.004		p = 0.102		p = 0.580		p = 0.785
No	0.66	0.62; 0.71	0.71	0.65; 0.76	1.56	1.45; 1.69	1.92	1.78; 2.0
Yes	0.80	0.72; 0.90	0.79	0.70; 0.88	1.63	1.45; 1.83	1.89	1.68; 2.10
Mental		p = 0.648		p = 0.495		p = 0.482		p = 0.938
No	0.70	0.66; 0.75	0.74	0.69; 0.79	1.64	1.52; 1.76	1.93	1.78; 2.07
Yes	0.73	0.63; 0.84	0.70	0.60; 0.80	1.56	1.39; 1.75	1.92	1.70; 2.14
Adiponectin (µg/dL)
Cardiometabolic		p < 0.001		p < 0.001		p < 0.001		p < 0.001
No	8.64	8.37; 8.91	8.46	8.16; 8.76	11.95	11.64; 12.26	11.65	11.33; 11.98
Yes	7.35	7.09; 7.62	7.42	7.14; 7.72	9.69	9.40; 9.97	9.83	9.53; 10.12
Allergic		p = 0.786		p = 0.637		p = 0.001		p = 0.010
No	7.98	7.76; 8.21	7.90	7.66; 8.14	10.40	10.12; 10.69	10.42	10.13; 10.71
Yes	7.92	7.56; 8.29	8.02	7.61; 8.43	11.15	10.82; 11.49	11.02	10.68; 11.37
Respiratory		p = 0.940		p = 0.720		p = 0.243		p = 0.620
No	7.90	7.66; 8.13	7.86	7.62; 8.10	10.75	10.49; 11.02	10.64	10.38; 10.91
Yes	7.91	7.55; 8.28	7.94	7.57; 8.32	10.46	10.05; 10.88	10.77	10.35; 11.18
Mental		p = 0.025		p = 0.022		p = 0.569		p = 0.852
No	7.86	7.65; 8.07	7.81	7.58; 8.03	10.75	10.49; 11.00	10.67	10.41; 10.92
Yes	8.44	7.98; 8.90	8.45	7.95; 8.95	10.61	10.20; 11.01	10.62	10.20; 11.04

Physiological marker/Exposure	Male				Female
	Crude		Adjusted		Crude		Adjusted
	Coefficient	95%CI	Coefficient	95%CI	Coefficient	95%CI	Coefficient	95%CI
IL-6 (pg/mL)
Hypertension		p < 0.001		p = 0.450		p < 0.001		p = 0.148
No	1.16	1.12; 1.21	1.17	1.13; 1.22	1.33	1.28; 1.38	1.42	1.37; 1.47
Yes	1.32	1.24; 1.40	1.21	1.13; 1.29	1.74	1.58; 1.92	1.53	1.39; 1.66
Dyslipidemia		p < 0.001		p < 0.001		p < 0.001		p < 0.001
No	1.07	1.03; 1.12	1.08	1.03; 1.12	1.23	1.18; 1.29	1.35	1.29; 1.41
Yes	1.50	1.42; 1.58	1.40	1.32; 1.48	1.56	1.48; 1.63	1.53	1.46; 1.60
Diabetes		p = 0.486		p = 0.668		p = 0.255		p = 0.043
No	1.21	1.17; 1.25	1.19	1.14; 1.22	1.37	1.32; 1.42	1.42	1.38; 1.47
Yes	1.14	0.96; 1.35	1.14	0.94; 1.34	1.50	1.29; 1.75	1.65	1.42; 1.88
CRP (mg/L)
Hypertension		p < 0.001		p = 0.307		p < 0.001		p = 0.178
No	0.66	0.62; 0.71	0.72	0.67; 0.78	1.54	1.44; 1.64	1.89	1.76; 2.02
Yes	0.85	0.76; 0.95	0.77	0.69; 0.86	2.38	2.00; 2.83	2.14	1.78; 2.50
Dyslipidemia		p < 0.001		p < 0.001		p < 0.001		p = 0.005
No	0.59	0.55; 0.63	0.64	0.59; 0.69	1.44	1.32; 1.56	1.76	1.61; 1.92
Yes	1.03	0.93; 1.13	0.92	0.83; 1.02	1.84	1.69; 2.01	2.09	1.91; 2.28
Diabetes		p = 0.844		p = 0.452		p = 0.255		p = 0.145
No	0.71	0.67; 0.76	0.73	0.69; 0.78	1.61	1.51; 1.71	1.90	1.78; 2.04
Yes	0.69	0.52; 0.92	0.83	0.58; 1.07	1.90	1.43; 2.53	2.33	1.71; 2.95
Adiponectin (µg/dL)
Hypertension		p = 0.004		p = 0.244		p < 0.001		p = 0.208
No	8.15	7.92; 8.37	8.00	7.76; 8.25	10.87	10.64; 11.10	10.72	10.49; 10.95
Yes	7.52	7.16; 7.88	7.72	7.32; 8.12	9.65	9.02; 10.27	10.27	9.62; 10.93
Dyslipidemia		p < 0.001		p < 0.001		p < 0.001		p < 0.001
No	8.59	8.36; 8.82	8.46	8.21; 8.71	11.92	11.63; 12.21	11.67	11.37; 11.97
Yes	6.79	6.47; 7.11	6.88	6.53; 7.24	9.40	9.10; 9.70	9.55	9.23; 9.86
Diabetes		p = 0.438		p = 0.613		p = 0.654		p = 0.132
No	7.96	7.76; 8.15	7.92	7.71; 8.13	10.72	10.50; 10.95	10.70	10.48; 10.92
Yes	8.34	7.39; 9.29	8.19	7.15; 9.23	10.49	9.47; 11.50	9.90	8.88; 10.91

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[TFN1] 95%CI: 95% confidence interval; AUDIT: Alcohol Use Disorder Identification Test; DXA: dual-energy X-ray absorptiometry; IQR: interquartile range.

[TFN2] * Classified as inactive those who do not reach 150 minutes per week of physical activities in leisure time.