Pediatric lipid reference values in the general population: The Dutch lifelines cohort study
J W Balder1, P J Lansberg2, M H Hof3
1Department of Pediatrics, Section Molecular Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Vascular Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Insights
Identifying children with high LDL-c is crucial for preventing atherosclerosis. This study provides updated pediatric lipid reference values to aid in detecting conditions like familial hypercholesterolemia (FH) early.
Area of Science:
- Pediatric cardiology
- Clinical lipidology
- Public health
Background:
- Atherosclerosis begins in childhood, influenced by lifelong low-density lipoprotein cholesterol (LDL-c) exposure.
- Early identification of severely elevated LDL-c in children is critical, particularly for familial hypercholesterolemia (FH).
- Understanding pediatric lipid level distribution is essential for identifying children at risk.
Purpose of the Study:
- To establish contemporary, age- and gender-specific pediatric reference values for lipid and lipoprotein levels.
- To assist healthcare professionals in identifying dyslipidemia and FH in children.
- To provide data supporting early intervention for cardiovascular risk.
Main Methods:
- Utilized data from the large, prospective, population-based Lifelines cohort study in the Netherlands.
- Included 8071 children aged 8–18 years with measured fasting lipid levels.
- Generated smoothed reference curves and percentiles using Generalized Additive Models in R.
Main Results:
- Observed significant age-related and gender-specific changes in lipid and lipoprotein levels.
- Identified a high and unexpected prevalence of severely elevated LDL-c (>190 mg/dL) in both boys and girls.
- Data from 8071 children (3823 boys, 4248 girls) were analyzed.
Conclusions:
- The study provides contemporary plasma lipid reference ranges for children.
- These ranges can aid physicians in identifying children at risk for premature atherosclerosis, including FH.
- Highlights the need for early screening and management of dyslipidemia in pediatric populations.
Background:
Atherosclerosis starts in childhood and its progression is influenced by lifelong low-density lipoprotein cholesterol (LDL-c) exposure, the so-called cholesterol burden. Early identification of children and adolescents with severely elevated LDL-c is thus of major clinical significance. This is especially true for children with familial hypercholesterolemia (FH), a frequent but undertreated genetic disorder. To identify children with possible FH, insight in the distribution of lipid levels in children is a prerequisite.
Objective:
To provide health care professionals with contemporary age- and gender-based pediatric reference values for lipid and lipoprotein levels to help the identification of children with dyslipidemia, especially FH.
Methods:
Lifelines is a large prospective population-based Dutch cohort study. Children from 8 till 18 years of age were included and fasting lipid levels were measured. Smoothed reference curves and percentiles (5th, 10th, 25th, 50th, 75th, 90th, and 95th) were generated using the Generalized Additive Models for Location, Scale and Shape package in the statistical software R.
Results:
A total of 8071 children (3823 boys and 4248 girls) were included. In the total cohort we noted marked dynamic changes in lipid and lipoprotein levels over age, which were in part gender specific. Our data highlight a high and unexpected prevalence of severely elevated LDL-c (>190 mg/dL) in both boys and girls.
Conclusion:
Our cross-sectional data provide contemporary reference ranges for plasma lipids that can assist physicians in identifying children at increased risk of premature atherosclerosis, especially FH.
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