Lipid Screening and Cardiovascular Health in Childhood

ArticleinPEDIATRICS 122(1):198-208 · August 2008with32 Reads
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.
    • "This trend appears to have been caused by the adoption of a more Westernized diet rich in fat, sugar, and cholesterol following recent economic development [21][22][23]. Because dyslipidemia is considered an important modifiable risk factor for CVD [16,17], the relationship between dyslipidemia and serum ferritin levels may serve as a predictive factor for cardiometabolic disease in adolescents. While a previous study has shown an association between serum ferritin levels and obesity in Korean male adolescents [24] , few studies have examined the relationship between serum ferritin levels and dyslipidemia. "
    [Show abstract] [Hide abstract] ABSTRACT: Background Ferritin is associated with various cardiometabolic risk factors such as dyslipidemia, hypertension, obesity, and insulin resistance in adults. We aimed to study the association between serum ferritin levels and dyslipidemia in adolescents, because dyslipidemia is considered an important modifiable cardiovascular risk factor in the young. Methods We analyzed 1,879 subjects (1,026 boys and 853 girls) from the 2009–2010 Korean National Health and Nutrition Examination Survey IV. Subjects were categorized into quartiles according to their lipid parameters, which were classified according to age and gender. Those in the highest quartile groups for total cholesterol, low-density lipoprotein cholesterol (LDL-C), and triglyceride concentrations were diagnosed as having dyslipidemia. Those in the lowest quartile for high-density lipoprotein cholesterol (HDL-C) values were diagnosed with abnormal levels. Results In boys, total cholesterol, LDL-C, and triglyceride concentrations were significantly correlated with serum ferritin levels. In both boys and girls, serum ferritin levels were negatively associated with HDL-C values, even after adjusting for all covariates. Furthermore, there was no significant correlation between serum ferritin levels and total cholesterol, LDL, and triglyceride concentrations in girls. Conclusion Serum ferritin levels were significantly associated with major dyslipidemia parameters, more prominently in boys than in girls, and this association represents a cardiometabolic risk factor.
    Full-text · Article · Apr 2016
    • "As no pediatric reference values are available for HOMA-IR and/or fasting insulin levels, we used the cut-off points defined by García-Cuartero et al. [19] as the 90th percentile adjusted for sex and Tanner stage for pediatric reference population in Spain. Hypertriglyceridemia was defined by the presence of plasma triglycerides ≥ 150 mg/dl, hypercholesterolemia by total cholesterol ≥ 200 mg/dl, increased LDL-c ≥ 130 mg/dl, and low HDL-c if levels < 35 mg/dl based on current recommendations of the American Academy of Pediatrics [20]. "
    [Show abstract] [Hide abstract] ABSTRACT: Successful antiretroviral therapy (ART) has dramatically reduced mortality among HIV-infected children. However, there is growing concern about long-term effects associated to ART. The aim of this study was to determine the prevalence of metabolic abnormalities in a cohort of perinatally HIV-infected adolescents and young adults and to identify associated factors. We present results from a cross-sectional analysis including individuals 12 to 20 years of age, from a prospective, longitudinal cohort of perinatally-acquired HIV-infected children, adolescents and young adults in Madrid. Clinical and immunological data were recorded and complete lipid and glycemic profiles were determined. Ninety-nine adolescents were included, with a median age of 15.3 years [13.6-16.7]. Patients with abnormal levels of lipids were as follows: 27.2% total cholesterol ≥200 mg/dl, 25.9% LDL cholesterol (LDL-c) ≥ 130 mg/dl, 14.1% HDL-C < 35 mg/dl and 39.8% triglycerides ≥ 150 mg/dl. Current use of protease inhibitors (PI) was associated with higher triglyceride values (p = 0.022). Four (4.6%) patients showed fasting glucose ≥ 100 mg/dl and 30.6% presented with insulin resistance (IR) (HOMA-IR over the 90th centile). In the multivariate logistic regression analysis adjusted for sex, age, weight, Tanner stage, protease inhibitors (PI) and nucleoside reverse transcriptase inhibitors (NRTI) treatment length and CD4 nadir, IR was associated with higher waist circumference Z score; OR: 3.92(CI95%: 1.15-13.4) (p = 0.03). There was a high prevalence of insulin resistance and lipid abnormalities in this cohort of perinatally-acquired HIV-infected adolescents. A simple clinical measurement like waist circumference Z score might be a reliable marker and predictor of insulin resistance in these patients.
    Full-text · Article · Dec 2015
    • "As with adults, children are routinely assessed using anthropometric measures. This is done to identify individuals with abnormal growth due to malnutrition, endocrine disorders, or those at risk for premature cardiovascular disease and mortality [3] . Childhood overweight and obesity , defined respectively by the Centers for Disease Control as a BMI ≥ the 85 th and 95 th percentile for age and sex [14], is a growing problem around the world. "
    [Show abstract] [Hide abstract] ABSTRACT: While body mass index percentiles (BMI%) are commonly used to assess childhood cardiovascular risk, waist circumference percentiles (WC%) are not commonly used nor universally accepted. We tested whether BMI% or WC% should be used to identify risk factor patterns in children at high-risk for developing cardiovascular disease (CVD). A total of 107 children (8-19 years) with cardiovascular risk factors or a family history of CVD were studied. Tobacco exposure, screen-time, blood pressure and anthropometric measures were made, as well as serum risk markers. Principal component analysis (PCA) was used to identify patterns explaining risk factor variance. Multiple linear regression was used to test for associations between risk factor patterns, BMI% and WC%. An adverse lipid pattern (low HDL, high triglycerides and LDL), a pro-inflammatory pattern (high ICAM and TNFαR2), a high blood pressure pattern (high SBP and DBP) and a high Lp(a) pattern were identified. Higher BMI% and WC% were associated with significantly higher levels of the lipid pattern (p < 0.05). BMI% explained 20% of variance in this pattern, whereas WC% explained 22%. When both BMI% and WC% were used together, neither BMI% nor WC% were significantly associated with the lipid pattern. However, BMI% was significantly associated with lower levels of the pro-inflammatory pattern, and WC% was associated higher levels of the pro-inflammatory pattern - together explaining 12% of variance. In children at high-risk for CVD, BMI% or WC% explained similar variance in an adverse lipid pattern; however, the combination of BMI% and WC% explained greater variance in a pro-inflammatory pattern than either alone. Both WC% and BMI% should both be used in anthropometric assessments of high-risk children.
    Full-text · Article · Dec 2015
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