Poor fetal growth and elevated low-grade systemic inflammation are two putative independent risk factors for cardiovascular disease. It has been suggested that poor fetal growth may contribute towards elevated low-grade systemic inflammation. This research provides novel data on the determinants of low-grade systemic inflammation in Gambians and investigates whether patterns of early growth predict levels of inflammatory markers in Gambian adults. In a cross-sectional study of 180 healthy male and female Gambians (aged 3 -82 years) no single measure of anthropometry, body composition, chronic or infectious disease, or lifestyle explained more than 12% of the variance in any inflammatory marker. Inflammatory markers fell into three distinct groups: those predominately explained by (i) adiposity or leptin (C-reactive protein (CRP), Serum Amyloid A (SAA), orosomucoid, fibrinogen and sialic acid (SA)); (ii) chronic or infectious disease (neopterin) and (iii) markers with no predominant determinants (a l-antichymotypsin (ACT) and β2-microglobulin (β~2M)). In a study of 320 Gambians (51.9% males) aged 18-30 years there was no evidence that birth weight, low birth weight, season of birth or weight at one year predicted levels of eight inflammatory markers (CRP, SAA, orosomucoid, fibrinogen, ACT, SA, Interleukin-6 (IL-6) and neopterin). In analyses adjusted for age and sex more rapid growth between birth and three months of age was associated with higher levels of fibrinogen, orosomucoid and SA. These relationships persisted after further adjustment for body mass index but after full adjustment only the association with fibrinogen remained; fibrinogen increased by 0.09 (95% Cl 0.02,0.16) g/L per one unit increase in change in standard deviation score from birth to three months (p=0.008). In this relatively lean population adiposity is an important determinant of a number of inflammatory markers.