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Lipid levels improving among US adolescents
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An analysis of more than 16,000 children and adolescents highlighted significant improvements in the lipid profiles of American youths during the past 2 decades. Researchers noted, however, that one in 10 adolescents had elevated total cholesterol levels during 2007 to 2010.
Using National Health and Nutrition Examination Survey (NHANES) data from 1988 to 1994, 1999 to 2002 and 2007 to 2010, researchers examined trends over time in mean serum total cholesterol and non-HDL among 16,116 children aged 6 to 19 years. They also evaluated LDL and geometric mean triglyceride levels among adolescents only (ages 12 to 19 years).
Between 1988 to 1994 and 2007 to 2010, mean total cholesterol decreased from 165 mg/dL to 160 mg/dL and the prevalence of elevated total cholesterol also declined from 11.3% to 8.1%. Additionally, there were considerable reductions in both mean non-HDL and the prevalence of elevated non-HDL among children and adolescents. The researchers also reported a significant increase in mean HDL from 50.5 mg/dL to 52.2 mg/dL between these two time periods, yet prevalence of low HDL remained unchanged.
Among adolescents, mean LDL declined from 95 mg/dL to 90 mg/dL and geometric mean triglycerides fell from 82 mg/dL to 73 mg/dL between 1988 to 1994 and 2007 to 2010. These decreases accompanied a significant drop in the prevalence of elevated LDL and triglycerides.
The researchers also found a lower prevalence of youths with either low HDL or high non-HDL during 2007 to 2010 when compared with 1988 to 1994 (22% vs. 27.2%).
Sex-, age- and race/ethnicity-specific trends were generally favorable and consistent with overall trends in direction, although the trend was not always significant for each group.
After adjusting for age and race/ethnicity, data showed that total cholesterol was 4.3 mg/dL lower for boys and 6.5 mg/dL lower for girls during 2007 to 2010 than during 1988 to 1994. Further, black or Mexican American boys and white girls had lower age-adjusted total cholesterol during 2007 to 2010 than during 1988 to 1994, and age-adjusted HDL was higher for boys and girls during 2007 to 2010 than during 1988 to 1994.
“Further research is needed to investigate the hypothesized contributors to change in childhood and adolescent lipid levels. Better understanding is needed about dietary trends and physical activity during childhood, areas that were not explored in the study by Kit et al but could be assessed using NHANES data,” Sarah D. de Ferranti, MD, MPH, of Harvard Medical School and Boston Children’s Hospital, wrote in an accompanying editorial.
“However, it seems clear that population-wide efforts to alter CVD risk have potential to influence health risks … Improvements in child and adolescent lipid values over the past 2 decades are significant and may portend improved CVD outcomes for the future, but much work should be done to better understand the changes and to build upon them.”
For more information:
- de Ferranti SD. JAMA. 2012;308:621-622.
- Kit BK. JAMA. 2012;308:591-600.
Disclosure: The researchers report no relevant financial disclosures. Dr. de Ferranti reports receipt of grants or pending grants from the NIH/National Heart, Lung, and Blood Institute; payment for lectures including service on speakers bureaus from the Pediatric Endocrine Society, the Pediatric Rheumatology Society and Covidien; and receipt of royalties from UpToDate.
Perspective
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C. Noel Bairey Merz, MD
These demographic trend findings are clinically relevant and would be expected to result in less CVD in these subjects as they age if sustained. While the study did not address it, the likely contributing factors responsible for these trends could include public health measures undertaken to reduce/eliminate calorie-dense foods from school campuses, stabilizing childhood obesity levels and possibly increased physical activity levels. More work and more declines in serum cholesterol are needed.
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