Non-HDL Cholesterol in Dyslipidemia Screening Among Korean Adolescents: A National Population-Based Survey

In pediatric lipid screening, non-high-density lipoprotein (non-HDL) cholesterol has gained relevance as a clinically feasible indicator that is increasingly applied. We assessed the population-level diagnostic performance and the influence of familial lipid risk in Korean adolescents.

A nationally representative sample of 6989 adolescents aged 10-19 years (3684 boys and 3305 girls) was examined from the Korean National Health and Nutrition Examination Survey. We analyzed this nationally representative data to evaluate weighted and adjusted associations among non-HDL cholesterol level at or above 145 mg/dL, dyslipidemia, and parental lipid status.

The overall prevalence of dyslipidemia was 28.2% and 26.3% in Korean adolescent boys and girls, respectively. The prevalence of non-HDL cholesterol at or above 145 mg/dL was 7.2% and 9.2% in adolescent boys and girls, respectively. Elevated non-HDL cholesterol levels detected high directly measured or calculated low-density lipoprotein (LDL) cholesterol levels with a sensitivity of 72.9% and 54.0%, and a specificity of 99.7% and 99.8%, respectively, in adolescent boys, and a sensitivity of 77.5% and 64.8%, and a specificity of 99.5% and 99.2%, respectively, in adolescent girls. Compared with total cholesterol, non-HDL cholesterol more accurately identified adolescents with elevated LDL cholesterol in both sexes. These associations remained stable regardless of familial dyslipidemia history in adjusted weighted logistic regression models.

Non-HDL cholesterol consistently distinguished adolescents with dyslipidemia independent of familial lipid status. Although a positive parental history increased the risk, non-HDL cholesterol remained a feasible pediatric screening tool in population-based evaluation.