Tracking of serum total cholesterol during childhood: an 8-year follow-up population-based family study in eastern Finland

Associations of total urinary arsenic with total cholesterol and high-density lipoprotein among 12-17-year-old participants from the 2009-2016 NHANES cycles: A cross-sectional study

INTRODUCTION

Hypertension and diabetes are highly prevalent among US adults. Arsenic exposure is associated with these cardiometabolic morbidities but the relationship between arsenic exposure and cholesterol markers of cardiometabolic disease has not been elucidated, especially at younger ages, when many chronic diseases may initiate. This study examined the association of total urinary arsenic with total cholesterol (TC) and high-density lipoprotein cholesterol (HDL) and explored effect modification by weight status.

METHODS

The study sample consisted of 12-17-year-old participants with complete data from the 2009-2016 National Health and Nutrition Examination Survey cycles. The cross-sectional associations of creatinine-adjusted total urinary arsenic with TC and HDL were assessed using multivariable linear regression models with survey weights. Three models were built, adjusting for varying combinations of age, gender, race/ethnicity, weight status, survey cycle, family income to poverty ratio, reference person education level, arsenobetaine, and dimethylarsinic acid (DMA). Model adjustments for arsenobetaine approximated inorganic arsenic exposure, and further adjustment for DMA approximated unmethylated inorganic arsenic exposure. We also explored weight status (underweight/healthy, overweight, and obese) as a potential effect modifier of these relationships using stratified analyses and interaction tests.

RESULTS

The final analytical sample consisted of 1,177 12-17-year-old participants. After adjusting for covariates and arsenobetaine, creatinine-adjusted arsenic was positively associated with HDL levels (β = 0.063; 95% CI: 0.007, 0.119). Upon further adjustment for DMA, creatinine-adjusted arsenic was positively associated with HDL levels (β = 0.079; 95% CI: 0.015, 0.143) and TC levels (β = 0.258; 95% CI: 0.002, 0.515). No effect modification by weight status was observed.

CONCLUSIONS

We found a positive association of approximated unmethylated inorganic arsenic exposure with TC, and contrary to our expectation, with HDL. There was no effect modification by weight status. Our findings should be confirmed by conducting longitudinal studies among adolescents exposed to low-level arsenic and focusing specifically on urinary inorganic arsenic concentrations.

Relationship between copper and lipids and atherogenic indices soon after birth in Japanese preterm infants of 32–35 weeks

Several studies have reported association of altered levels of lipids and some trace elements with risk factors for cardiovascular disease development in adulthood. Accordingly, the present study aimed to determine the relationship among the serum levels of copper (Cu), zinc (Zn), lipids, lipoproteins and apolipoproteins in preterm infants through an assessment of atherogenic indices shortly after birth. Blood samples were collected within 20 min of birth from 45 preterm infants with gestational ages ranging from 32 to 35 weeks. Serum Cu, Zn, total cholesterol (TC), low-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc), apolipoprotein-A1 (apoA1) and apolipoprotein-B (apoB) levels were measured, and the TC/HDLc, LDLc/HDLc and apoB/apoA1 ratios were calculated. Upon determining the correlation between the levels of Cu, Zn and these indices of lipid metabolism, triglyceride (TG) and Cu were found to correlate negatively with birth weight (BW) and the standard deviation (s.d.) score for body weight. Furthermore, Cu levels correlated positively with the TG level and TC/HDLc, LDLc/HDLc and apoB/apoA1 ratios and negatively with the HDLc level and HDLc/apoA1 ratios. However, a stepwise multiple regression analysis indicated that the s.d. score for BW and TG level were significant independent determinants of the Cu level. In contrast, Zn did not correlate with any of these indices. In conclusion, intrauterine growth restriction and the TG level at birth influence Cu levels in preterm infants, whereas atherogenic indices do not affect this parameter.

Lipid profile and atherogenic indices soon after birth in Japanese preterm infants

AIM

The intra-uterine environment affects the risk of development of cardiovascular disease in adulthood. The aim of this study was to determine the influence of prematurity and foetal growth restriction on lipid metabolism, by assessing atherogenic indices soon after birth in preterm infants.

METHODS

Blood samples were collected within 20 min of birth from 80 preterm infants with a gestational age of ≤35 weeks. Serum total cholesterol (TC), low-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc), apolipoprotein-A1 (apoA1) and apolipoprotein-B (apoB) levels were measured. The ratio of TC/HDLc, LDLc/HDLc and apoB/apoA1 were also calculated. Correlations between these indices and gestational age, birth weight and the standard deviation (SD) score for birth weight were also determined.

RESULTS

Gestational age, birth weight and SD score for birth weight were negatively correlated with the TC/HDLc, LDLc/HDLc and apoB/apoA1 ratios.

CONCLUSION

In preterm infants, prematurity and poor foetal growth may influence lipid and apolipoprotein metabolism and affect atherogenic indices at birth.

High tracking of apolipoprotein B levels from the prepubertal age to adolescence in Spanish children

AIM

To assess tracking of lipid and apolipoproteins from the prepubertal age (baseline, 6-8 years old) to adolescence (follow-up, 13-16 years old) in Spanish children.

METHODS

The sample population included 385 healthy children (179 boys and 206 girls). Tracking was estimated by correlations between baseline and follow-up levels, multiple regression models in which the follow-up lipid was the dependent variable and analysing the percentage of individuals who remained in the same lipid levels status from prepubertal age to adolescence.

RESULTS

Correlations between baseline and follow-up levels for low density lipoprotein (LDL)-cholesterol and apolipoprotein B (apo B) were stronger in boys and for high density lipoprotein-cholesterol and apo A-I stronger in girls. Regression analyses showed that, after adjusting by body mass index (BMI), baseline LDL-cholesterol and apo B levels explain 23% and 39% of the variation of follow-up LDL-cholesterol and apo B levels, respectively, in boys and 13% and 22%, respectively, in girls. The strength of tracking for LDL-cholesterol and apo B was 79% and 89%, respectively, in boys and 72% and 82%, respectively, in girls.

CONCLUSION

Apolipoprotein B showed the strongest tracking in both sexes, stronger than for LDL-cholesterol, which supports the importance of determining apo B levels as a marker of dyslipidaemia in children.

Cord blood lipid profile in a population of Iranian term newborns

Premature coronary artery disease (CAD) and its risk factors are highly prevalent in Iran. It is well documented that atherosclerosis starts in childhood and there is evidence that this association with adult levels may originate at birth, so assessment of serum lipid levels in neonates might be of importance. In this study we aimed to measure serum lipoprotein and apolipoprotein levels in a representative sample of Iranian newborns. Cord blood lipid profile, apolipoprotein A, apolipoprotein B, and lipoprotein a (LPa) were analyzed in 378 full-term, Iranian newborns. The mean values of total cholesterol (TC), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), apolipoprotein A, apolipoprotein B, and Lpa in girls were 81.4 +/- 28.3, 35.9 +/- 22.4, 31.1 +/- 9.9, 87.9 +/- 20.2, 34.2 +/- 18.2, and 21.0 +/- 2.8 mg/dL, respectively; these values in boys were 75.2 +/- 21.1, 32.1 +/- 16.3, 28.8 +/- 8.7, 84.3 +/- 16.0, 32.6 +/- 14.2, and 19.5 +/- 2.7 mg/dL, respectively. Median values of triglycerides (TGs) in boys and girls were 61 and 62 mg/dL, respectively. Female neonates had significantly higher concentrations of TC and HDL-C than males (81.4 +/- 28.3 vs. 75.2 +/- 21.1, p = 0.02, and 31.18 +/- 9.97 vs. 28.8 +/- 8.7, p = 0.02, respectively). Other biochemical factors were not significantly different between genders. The mean and median concentrations of LPa were 20.3 and 18.7 mg/dL, respectively, which are almost five times higher than those reported in some other studies. The TG concentration was 1.5-2 times higher than those previously reported. Our findings indicate that serum concentrations of LPa and TG in Iranian neonates are higher than those in previous studies; this disorder, which is likely placing Iranians at increased risk for future CADs, needs to be assessed in longitudinal studies.

Screening and treatment for lipid disorders in children and adolescents: systematic evidence review for the US Preventive Services Task Force

OBJECTIVE

This was a systematic evidence review for the US Preventive Services Task Force, intended to synthesize the published evidence regarding the effectiveness of selecting, testing, and managing children and adolescents with dyslipidemia in the course of routine primary care.

METHODS

Literature searches were performed to identify published articles that addressed 10 key questions. The review focused on screening relevant to primary care of children without previously identified dyslipidemias, but included treatment trials of children with dyslipidemia because some drugs have only been tested in that population.

RESULTS

Normal values for lipids for children and adolescents are defined according to population levels (percentiles). Age, gender, and racial differences and temporal trends may alter these statistical cut points. Approximately 40% to 55% of children with elevated total cholesterol and low-density lipoprotein levels will continue to have elevated lipid levels on follow-up. Current screening recommendations based on family history will fail to detect substantial numbers (30%-60%) of children with elevated lipid levels. Drug treatment for dyslipidemia in children has been studied and shown to be effective only for suspected or proven familial monogenic dyslipidemias. Intensive dietary counseling and follow-up can result in improvements in lipid levels, but these results have not been sustained after the cessation of the intervention. The few trials of exercise are of fair-to-poor quality and show little or no improvements in lipid levels for children without monogenic dyslipidemias. Although reported adverse effects were not serious, studies were generally small and not of sufficient duration to determine long-term effects of either short or extended use.

CONCLUSIONS

Several key issues about screening and treatment of dyslipidemia in children and adolescents could not be addressed because of lack of studies, including effectiveness of screening on adult coronary heart disease or lipid outcomes, optimal ages and intervals for screening children, or effects of treatment of childhood lipid levels on adult coronary heart disease outcomes.

Cord blood lipoproteins and prenatal influences

PURPOSE OF REVIEW

Blood lipoprotein profiles in early life are known to be related to and predictive of those in adulthood, but little is known about their determinants. Genetic and environmental influences affect cord blood lipoproteins, but how this occurs and the relative contribution of these influences to the overall profile in healthy newborns remains uncertain.

RECENT FINDINGS

This review discusses findings from a range of earlier and more recent studies, and summarizes the key influences on cord blood lipoproteins. In particular, we review the potential contribution of maternal blood total cholesterol levels during pregnancy and the increased maternal transmission in newborns of mothers with diabetes.

SUMMARY

In cord blood, cholesterol levels are lower than in adults and the relative proportion present in HDL as opposed to LDL is much higher. The currently available evidence suggests that several factors influence the composition of cord blood lipoproteins. Although inheritance of major monogenic disorders can affect cord lipids in general, the genetic contribution appears to be minimal, although effects of the proprotein convertase subtilisin/kexine type 9 gene (PCSK9) need fuller exploration in this regard in certain ethnic groups. Evidence is summarized that maternal lipoprotein levels, particularly those due to diet or induced by pregnancy, influence cord lipid levels. Placental insufficiency and other conditions affecting fetal growth and the mode of delivery may also influence cord lipoprotein concentrations. How maternal glucose tolerance during pregnancy affects cord blood lipoproteins remains unclear. In view of increasing evidence that cardiovascular risk may have prenatal antecedents, this would seem to be an important area for further investigation.

Twenty-year dynamics in adiposity and blood lipids of Greek children: regional differences in Crete persist

AIM

To examine whether secular trends in adiposity and blood lipid profile of Greek children manifested equally among individuals from urban and rural provinces.

METHODS

Cretan boys (aged 12.1+/-2.3 y) from urban and rural areas of Crete were recruited in 1982 (n=277 and 251, respectively) and 2002 (n=440 and 180, respectively). Height, weight, and body mass index (BMI), as well as plasma lipid concentrations were measured and compared across cohorts (1982 vs 2002) and regions (urban vs rural) by two-way analysis of covariance (adjusted for age) with interaction.

RESULTS

Temporal changes in height (positive), weight (positive), and BMI (positive) manifested equally in children from urban and rural provinces, as no interaction was detected. Similar results were obtained for triacylglycerol (positive), low-density lipoprotein cholesterol (LDL-C, positive) and high-density lipoprotein cholesterol (negative) concentrations. A significant interaction was observed only for total cholesterol (TC), which increased from 1982 among rural (by 6.2%, p < 0.05) but not among urban boys. In all other instances, regional differences in 1982 persisted in 2002. More specifically, children from urban provinces were taller, heavier, and had higher BMI values than those from rural areas, while they also had higher LDL-C concentrations, whether nowadays or 20 y ago. Regional differences in TC in 1982 were not apparent in 2002.

CONCLUSION

These findings suggest that changes in anthropometric characteristics and plasma lipids during the past 20 y have occurred largely in parallel among urban and rural Cretan children, and they emphasize the importance of developing a common national strategy for the prevention and treatment of childhood obesity in Greece.