Lipid Screening and Cardiovascular Health in Childhood
ABSTRACT This clinical report replaces the 1998 policy statement from the American Academy of Pediatrics on cholesterol in childhood, which has been retired. This report has taken on new urgency given the current epidemic of childhood obesity with the subsequent increasing risk of type 2 diabetes mellitus, hypertension, and cardiovascular disease in older children and adults. The approach to screening children and adolescents with a fasting lipid profile remains a targeted approach. Overweight children belong to a special risk category of children and are in need of cholesterol screening regardless of family history or other risk factors. This report reemphasizes the need for prevention of cardiovascular disease by following Dietary Guidelines for Americans and increasing physical activity and also includes a review of the pharmacologic agents and indications for treating dyslipidemia in children.
- SourceAvailable from: Catherine Tamsin Saunders Gasser
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- "Results were considered abnormal if: TC, LDL-C, and TG levels were > 95th percentile and HDL-C < 5th percentile for age and gender according to pediatric guidelines ; ALAT > 40 (U.l-1); TSH: > 4 (mUl.-1) ; insulin > 15 (μU·ml-1); HOMA-IR > 4 . "
ABSTRACT: The burden of disease from childhood obesity is considerable worldwide, as it is associated with several co-morbidities, such as dyslipidemia, hypertension, type 2 diabetes (T2DM), orthopedic and psychosocial problems. We aimed at determining the prevalence of these complications in a population of children and adolescents with body weight excess. This is a cohort study including 774 new patients (1.7 - 17.9 yrs, mean 11.1 ± 3.0) attending a pediatric obesity care center. We assessed personal and family medical histories, physical examination, systemic blood pressure, biochemical screening tests. We found that the great majority of the children suffered from at least one medical complication. Orthopedic pathologies were the most frequent (54%), followed by metabolic (42%) and cardiovascular disturbances (31%). However, non-medical conditions related to well-being, such as bullying, psychological complaints, shortness of breath or abnormal sleeping patterns, were present in the vast majority of the children (79.4%). Family history of dyslipidemia tends to correlate with the child’s lipids disturbance (p = .053), and ischemic events or T2DM were correlated with cardiovascular risk factors present in the child (p = .046; p = .038, respectively). The vast majority of obese children suffer from medical and non-medical co-morbidities which must be actively screened. A positive family history for cardiovascular diseases or T2DM should be warning signs to perform further complementary tests. Furthermore, well-being related-complaints should not be underestimated as they were extremely frequent.BMC Pediatrics 09/2014; 14(1):232. DOI:10.1186/1471-2431-14-232 · 1.93 Impact Factor
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- "Abnormal lipid levels in the young have been shown to be associated with increased risk of early CVD ( Berenson et al . , 1998 ; Daniels and Greer , 2008 ) and are a target for initiating phar - macological treatment ( Stein , 1989 ) . However , unlike in adults , there is limited available research into the role of environmental PFAS exposure and dyslipidemia in children and adolescents . "
ABSTRACT: Dyslipidemia in children is associated with accelerated atherosclerosis and earlier cardiovascular disease development. Environmental exposure to perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) have been shown to be associated with dyslipidemia in adults. However, there are few general population studies examining this association in children or adolescents. In this context, we examined the association between serum PFOA and PFOS levels and dyslipidemia in a nationally representative sample of US adolescents. A cross-sectional study was performed on 815 participants ⩽18years of age from the National Health and Nutrition Examination Survey 1999-2008. The main outcome was dyslipidemia, defined as total cholesterol >170mg/dL, low-density lipoprotein cholesterol (LDL-C) >110mg/dL, high-density lipoprotein cholesterol (HDL-C) <40mg/dL or triglycerides >150mg/dL. We found that serum PFOA and PFOS were positively associated with high total cholesterol and LDL-C, independent of age, sex, race-ethnicity, body mass index, annual household income, physical activity and serum cotinine levels. Compared to subjects in quartile 1 (referent), the multivariable-adjusted odds ratio (95% confidence interval) for high total cholesterol among children in quartile 4 was 1.16 (1.05-2.12) for PFOA and 1.53 (1.11-1.64) for PFOS. PFOA and PFOS were not significantly associated with abnormal HDL-C and triglyceride levels. Our findings indicate that serum PFOA and PFOS are significantly associated with dyslipidemia in adolescents, even at the lower "background" exposure levels of the US general population.Chemosphere 11/2013; 98. DOI:10.1016/j.chemosphere.2013.10.005 · 3.34 Impact Factor
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- "Pediatrics (AAP), American Heart Association (AHA), and National Heart, Lung, and Blood Institute (Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents, 2011; Daniels et al., 2008; Weintraub et al., 2011). However, lipid levels change with age, puberty, race, and gender among children and adolescents (Hickman et al., 1998). "
ABSTRACT: Cardiovascular risk factors and atherosclerosis precursors were examined in 365 Turkish children and adolescents. Study participants were recruited at five different state schools. We tested single and multi-locus effects of six polymorphisms from five candidate genes, chosen based on prior known association with lipid levels in adults, for association with low (≤10th percentile) high density lipoprotein cholesterol (HDL-C) and high (≥90th percentile) triglycerides (TG), and the related continuous outcomes. We observed an association between CETP variant rs708272 and low HDL-C (allelic p=0.020, genotypic p=0.046), which was supported by an independent analysis, PRAT (PRAT control p=0.027). Sex-stratified logistic regression analysis showed that the B2 allele of rs708272 decreased odds of being in the lower tenth percentile of HDL-C measurements (OR=0.36, p=0.02) in girls; this direction of effect was also seen in boys but was not significant (OR=0.64, p=0.21). Logistic regression analysis also revealed that the T allele of rs6257 (SHBG) decreased odds of being in the top tenth percentile of TG measurements in boys (OR=0.43, p=0.03). Analysis of lipid levels as a continuous trait revealed a significant association between rs708272 (CETP) and LDL-C levels in males (p=0.02) with the B2B2 genotype group having the lowest mean LDL-C; the same direction of effect was also seen in females (p=0.05). An effect was also seen between rs708272 and HDL-C levels in girls (p=0.01), with the B2B2 genotype having the highest mean HDL-C levels. Multi-locus analysis, using quantitative multifactor dimensionality reduction (qMDR) identified the previously mentioned CETP variant as the best single locus model, and overall model, for predicting HDL-C levels in children. This study provides evidence for association between CETP and low HDL-C phenotype in children, but the results appear to be weaker in children than previous results in adults and may also be subject to gender effects.Omics: a journal of integrative biology 08/2013; 17(12). DOI:10.1089/omi.2013.0066 · 2.36 Impact Factor