Lipid Screening and Cardiovascular Health in Childhood

PEDIATRICS (Impact Factor: 5.47). 08/2008; 122(1):198-208. DOI: 10.1542/peds.2008-1349
Source: PubMed


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.

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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 [8]; ALAT > 40 (U.l-1); TSH: > 4 (mUl.-1) [9]; insulin > 15 (μU·ml-1); HOMA-IR > 4 [10]. "
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    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.
    Full-text · Article · Sep 2014 · BMC Pediatrics
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    • "Patients diagnosed as having MS were required at presentation to have at least 3 of the 5 following findings on a gender specific basis: (1) systolic or diastolic blood pressure > 90th percentile of normal for age [20], (2) waist circumference > 90th percentile of normal for age [21], (3) triglycerides > 150 mg/dL, (4) HDL < 20th percentile of normal for age [22], and (5) evidence of fasting hyperglycemia > 100 mg/dL, or evidence of fasting hyperinsulinemia > the upper limit of normal, or definite acanthosis nigricans suggesting hyperinsulinemia. Diagnosis of heFH required evidence of the Simon-Broome criteria [23] except that we did not require evidence of tendinous xanthoma in family members since xanthomas are prevented by early treatment and somewhat uncommon in young family members. "
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    ABSTRACT: Background. Our goal was to compare the carotid intimal-medial thickness (CIMT) of untreated pediatric patients with metabolic syndrome (MS), heterozygous familial hyperlipidemia (heFH), and MS+heFH against one another and against a control group consisting of healthy, normal body habitus children. Methods. Our population consisted of untreated pediatric patients (ages 5-20 yrs) who had CIMT measured in a standardized manner. Results. Our population included 57 with MS, 23 with heFH, and 10 with MS+heFH. The control group consisted of 84 children of the same age range. Mean CIMT for the MS group was 469.8 μ m (SD = 67), 443.8 μ m (SD = 61) for the heFH group, 478.3 μ m (SD = 70) for the MS+heFH group, and 423.2 μ m (SD = 45) for the normal control group. Significance differences between groups occurred for heFH versus MS (P = 0.022), heFH versus control (P = 0.038), MS versus control (P = 9.0E - 10), and MS+heFH versus control (P = 0.003). Analysis showed significant negative correlation between HDL and CIMT (r = -0.32, P = 0.03) but not for LDL, triglycerides, BP, waist circumference, or BMI. Conclusion. For pediatric patients, the thickest CIMT occurred for patients with MS alone or for those with MS+heFH. This indicates that MS, rather than just elevated LDL, accounts for more rapid thickening of CIMT in this population.
    Full-text · Article · May 2014
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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 . "
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    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.
    Full-text · Article · Nov 2013 · Chemosphere
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