The current state of dyslipidemia in Korean children and adolescents and its management in clinical practice

Pediatric hyperlipidemia

The leading cause of mortality worldwide is atherosclerotic cardiovascular disease. Atherosclerotic plaques are well known to originate early in the childhood. Identifying hyperlipidemia in early childhood creates an opportunity to prevent major cardiovascular events in adults. Children with identified risk factors are at an increased risk of developing cardiovascular incidents in later life. This article emphasizes the diagnosis and management of pediatric hyperlipidemia with reference to the recent guidelines. In terms of etiology pediatric hyperlipidemia are divided into primary and secondary causes. The mainstay of management includes high-risk target screening, early risk factor identification and lifestyle modifications in vulnerable population. Drug therapy is recommended in primary hyperlipidemia and in children with no response to lifestyle changes.

A new perspective on cholesterol in pediatric health: association of vitamin D metabolism, respiratory diseases, and mental health problems

Cholesterol, the main structural molecule of cell membranes, is involved in essential functions of the human body. Dyslipidemia is an established risk factor for cardiovascular diseases (CVDs) that is observed even in childhood. To reduce the risk of CVDs in children, several clinical guidelines have been published for the management of pediatric dyslipidemia. However, pediatric dyslipidemia is also associated with several health problems other than CVDs. This article reviews the current data on dyslipidemia-related pediatric health issues. There is strong evidence that low serum vitamin D levels, asthma, and mental health problems may be associated with dyslipidemia in the pediatric population regardless of body mass index. This review also highlights the need for further large-scale population-based studies in the Korean pediatric population to establish effective strategies for promoting children's health.

The determinants of lipid profiles in early adolescence in a Ugandan birth cohort

Dyslipidaemia in adolescence tracks into adulthood and is an important risk factor for cardiovascular disease. Little is known about the effects of environmental exposures and early-life exposure to infectious diseases common to tropical regions on lipids. In 1119 early adolescent participants in the Entebbe Mother and Baby Study, we used linear regression to examine whether prenatal, childhood or adolescent factors are associated with lipid levels. Reduced high-density lipoprotein (HDL) and elevated triglyceride levels were common (prevalence 31% and 14%, respectively), but elevated low-density lipoprotein (LDL) or total cholesterol (TC) were rare. Current malaria infection was associated with lower mean LDL (adjusted ß − 0.51; 95% CI − 0.81, − 0.21), HDL (adjusted ß − 0.40; 95% CI − 0.56, − 0.23), and TC levels (adjusted ß − 0.62; 95% CI − 0.97, − 0.27), but higher mean triglyceride levels (geometric mean ratio (GMR) 1.47; 95% CI 1.18–1.84). Early-life asymptomatic malaria was associated with modest reductions in HDL and TC. Body mass index (BMI) was positively associated with LDL, TC, and triglycerides. No associations with helminth infection were found. Our findings suggest that early-life factors have only marginal effects on the lipid profile. Current malaria infection and BMI are strongly associated with lipids and important to consider when trying to improve the lipid profile.

Prevalence and treatment of pediatric dyslipidemia

Background: As dyslipidemia at a young age is a risk factor for cardiovascular disease in adulthood, the screening and management of dyslipidemia in children and adolescents might be an important health issue. This review deals with issues related to the prevalence, diagnosis, screening, and treatment of pediatric dyslipidemia.Current Concepts: In Korea, the prevalence of pediatric dyslipidemia was 19.7% between 2007 and 2009. Dyslipidemia was defined according to the guidelines of the Korean Society of Pediatric Endocrinology: total cholesterol ≥200 mg/dL, low-density lipoprotein cholesterol ≥130 mg/dL, triglycerides ≥130 mg/dL, high-density lipoprotein cholesterol <40 mg/dL, or non-high-density lipoprotein cholesterol ≥145 mg/dL.Discussion and Conclusion: We recommend universal screening tests for dyslipidemia at ages 9–11 years and 17–21 years. Diet and lifestyle modifications are essential in the treatment of dyslipidemia. In children aged ≥10 years with a poor response to lifestyle modification, drug therapy is recommended. Pediatric dyslipidemia should be diagnosed and treated properly to reduce adult cardiovascular diseases and improve quality of life in this age group.

Limitations of current screening methods for lipid disorders in Korean adolescents and a proposal for an effective detection method: a nationwide, cross-sectional study

PURPOSE

To determine the limitations of current screening methods for lipid disorders and to suggest a new method that is effective for use in Korean adolescents.

METHODS

Data from the 6th Korea National Health and Nutrition Examination Survey (2013-2015) were analyzed. The diagnostic validity (sensitivity and specificity) of various cardiovascular risk factors currently used for lipid disorder screening was investigated, as was the diagnostic validity of non-HDL-cholesterol ≥145 mg/dL as a screening tool.

RESULTS

The prevalence of dyslipidemia and familial hypercholesterolemia (FH) among Korean adolescents was 20.4%±1.0% and 0.8%±0.3%, respectively. The current standard screening methods identified only 5.9%±1.4% and 30.3%±17.2% of the total number of dyslipidemia and FH cases, respectively. The diagnostic sensitivity and specificity of lipid profile analysis for dyslipidemia among obese adolescents were 19.5%±2.3% and 93.6%±0.8% and for FH were 30.3%±17.2% and 91.1%±0.8%, respectively. When adolescents with obesity, hypertension, or a family history of dyslipidemia or cardiocerebrovascular disease for over 3 generations were included in the screening, diagnostic sensitivity increased to 68.4%±2.8% for dyslipidemia and 83.5%±2.7% for FH. Universal screening of all adolescents based on non-HDL-cholesterol levels had sensitivities of 30.2%±2.7% and 100%, and specificities of 99.2%±0.3% and 94%±0.6% for dyslipidemia and FH, respectively.

CONCLUSION

New screening methods should be considered for early diagnosis and treatment of lipid disorders in Korean adolescents.

Dyslipidemia in pediatric CKD patients: results from KNOW-PedCKD (KoreaN cohort study for Outcomes in patients With Pediatric CKD)

BACKGROUND

Pediatric as well as adult patients with chronic kidney disease (CKD) are susceptible to cardiovascular disease (CVD) events, which increase their mortality. Dyslipidemia is thought to be one of the most important contributing risk factors for developing CVD. This study aimed to evaluate the prevalence of dyslipidemia and assess clinical and laboratory risk factors associated with dyslipidemia in East Asian pediatric patients with CKD.

METHODS

From April 2011 to April 2016, 469 patients with CKD aged < 20 years were enrolled in KNOW-PedCKD (the KoreaN cohort study for Outcomes in patients With Pediatric Chronic Kidney Disease); 356 patients were included in the final analysis. Using the baseline data of the cohort cross-sectionally, a multivariable logistic regression analysis was performed to assess the risk factors for dyslipidemia; a subanalysis for each lipid abnormality was also done.

RESULTS

The prevalence of dyslipidemia was 61.5% (n = 219). For dyslipidemia, nephrotic range proteinuria and 25-hydroxyvitamin D deficiency significantly increased the adjusted odds ratio. In the subanalysis, glomerulonephropathy as the origin of CKD and nephrotic range proteinuria significantly increased the risks for high total cholesterol and high low-density lipoprotein cholesterol. Overweight or obese body mass index z-score, elevated proteinuria, hypocalcemia, and 1,25-dihydroxyvitamin D deficiency were significantly associated with low high-density lipoprotein cholesterol. Glomerular filtration rate stage 3b or higher and hyperphosphatemia significantly increased the risk for high triglycerides.

CONCLUSIONS

Long-term data accumulation and prospective analysis are needed to clarify the relationship between CKD progression and dyslipidemia and to find additional risk factors for dyslipidemia.

Associations between lipid profiles of adolescents and their mothers based on a nationwide health and nutrition survey in South Korea

OBJECTIVES

Dyslipidaemia is a metabolic disease influenced by environmental and genetic factors. Especially, family history related to genetic background is a strong risk factor of lipid abnormality. The aim of this study is to evaluate the association between the lipid profiles of adolescents and their mothers.

DESIGN

A cross-sectional study.

SETTING

The data were derived from the Korea National Health and Nutrition Examination Survey (IV-VI) between 2009 and 2015.

PARTICIPANTS

2884 adolescents aged 12-18 years and their mothers were included.

PRIMARY OUTCOME MEASURES

Outcome variables were adolescents' lipid levels. Mothers' lipid levels were the interesting variables. The lipid profiles included total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). We identified partial correlation coefficients (r) between the lipids. Multiple linear regressions were performed to identify the amount of change in adolescents' lipid levels for each unit increase of their mothers' lipids. The regression models included various clinical characteristics and health behavioural factors of both adolescents and mothers.

RESULTS

The mean levels of adolescents' lipids were 156.6, 83.6, 50.4 and 89.4 mg/dL, respectively for TC, TG, HDL-C and LDL-C. Positive correlations between lipid levels of adolescents and mothers were observed for TC, TG, HDL-C and LDL-C (r, 95% CI: 0.271, 0.236 to 0.304; 0.204, 0.169 to 0.239; 0.289, 0.255 to 0.322; and 0.286, 0.252 to 0.319). The adolescent TC level was increased by 0.23 mg/dL for each unit increase of the mother's TC (SE, 0.02; p<0.001). The beta coefficients were 0.16 (SE, 0.01), 0.24 (SE, 0.02) and 0.24 (SE, 0.02), respectively, in each model of TG, HDL-C and LDL-C (all p<0.001). The linear relationships were significant regardless of sex and mother's characteristics.

CONCLUSIONS

Mothers' lipid levels are associated with adolescents' lipids; therefore, they can serve as a reference for the screening of adolescent's dyslipidaemia.

Prevalence of Dyslipidemia among Elementary School Children in Birjand, East of Iran, 2012

BACKGROUND

Various studies have indicated that dyslipidemia starts in childhood. There is a relationship between the concentration of blood lipids and atherosclerosis. In this study, we assessed the prevalence of dyslipidemia in elementary school children.

METHODS

This cross-sectional study was performed on 1,626 (882 girls and 744 boys) elementary school children aged between 6 and 11 years in Birjand in 2012. Samples were selected through multistage random sampling. The lipid profiles (i.e., cholesterol, triglyceride, high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C]) of the subjects were measured after 12 hours' fasting. The definition of dyslipidemia was based on the criteria of The American Children Academia in 2011.

RESULTS

Dyslipidemia (at least one abnormal level of a serum lipid) was detected in 31% of the children (31.3% of the girls vs. 30.6% of the boys). Total cholesterol was ≥ 200 mg/dL in 13.4% of the children, LDL-C was ≥ 130 mg/dL in 8.5%, HDL-C was < 40 mg/dL in 11.3%, and triglyceride was ≥ 130 mg/dL in 15.3%. The prevalence of hypertriglyceridemia was significantly higher in the females than in the males (16.3% in the girls vs. 13.8% in the boys; p value = 0.01) - while hypercholesterolemia (12.2% in the girls vs. 14.9% in the boys; p value = 0.16), high LDL-C (8.5% in the girls vs. 8.5% in the boys; p value = 0.05), and low HDL-C (12.7% in the girls vs. 9.5% in the boys; p value = 0.1) were not significantly different between the two sexes.

CONCLUSION

The prevalence of dyslipidemia was high in the school children in Birjand and, thus, requires preventive measures.

Lipid Profiles and Prevalence of Dyslipidemia in Eastern Iranian Adolescents, Birjand, 2012

BACKGROUND

Cardiovascular risk factors begin in childhood and adolescence. This study aimed at assessing serum lipids and prevalence of Dyslipidemia in 11-18 year old students of Birjand.

METHODS

The present cross-sectional, descriptive, and analytical study was done on 2,643 middle and high school students of Birjand aged 11-18 years (1,396 girls and 1,247 boys). Blood samples were collected for the measurement of blood lipids, including Cholesterol, Triglyceride, HDL, and LDL after a 12-hour fasting period. The defined borderline and abnormal values stated in 2011 by the American Academy of Child, was used.

RESULTS

According to our results, it is concluded that: (i) 34.3% (31.3% girls and 37.6% boys) of adolescents had at least one dyslipidemia. (ii) 24.7% of the individuals had HDL lower than 40, where 14% of them TG≥130, 6.1% of cases TC≥200, and 3.5% of cases LDL≥130. Lipid disorder within low HDL type and hypertriglyceridemia were significantly higher in boys (P<0.05) than girls. Hypercholesterolemia and hypertriglyceridemia in the age group of 11-14 years and low HDL in the age group of 15-18 years showed the highest values (P<0.05).

CONCLUSION

Adolescents of Birjand have high prevalence of dyslipidemia. Preventive measures are recommended to improve lifestyle, including healthy nutrition, encouraging adolescents to exercise, and more mobility.

Dyslipidemia in children and adolescents: when and how to diagnose and treat?

Recently, the incidence and prevalence of obesity and dyslipidemia are increasing. Dyslipidemia is associated with significant comorbidities and complications, and with cardiovascular risk factors (obesity, diabetes mellitus, hypertension and smoking). The main objectives of this article are that describe the prevalence of dyslipidemia in Korean children and adolescents and review the diagnosis and management of dyslipidemia in children and adolescents.