Dyslipidemia and reference values for fasting plasma lipid concentrations in Danish/North-European White children and adolescents

Tenna Ruest Haarmark Nielsen, Ulrik Lausten-Thomsen, Cilius Esmann Fonvig, Christine Bøjsøe, Lise Pedersen, Palle Skov Bratholm, Torben Hansen, Oluf Pedersen, Jens-Christian Holm, Tenna Ruest Haarmark Nielsen, Ulrik Lausten-Thomsen, Cilius Esmann Fonvig, Christine Bøjsøe, Lise Pedersen, Palle Skov Bratholm, Torben Hansen, Oluf Pedersen, Jens-Christian Holm

Abstract

Background: Dyslipidemia is reported in 27 - 43% of children and adolescents with overweight/obesity and tracks into adulthood, increasing the risk of cardiovascular morbidity. Cut-off values for fasting plasma lipid concentrations are typically set at fixed levels throughout childhood. The objective of this cross-sectional study was to generate fasting plasma lipid references for a Danish/North-European White population-based cohort of children and adolescents, and investigate the prevalence of dyslipidemia in this cohort as well as in a cohort with overweight/obesity.

Methods: A population-based cohort of 2141 (1275 girls) children and adolescents aged 6 - 19 (median 11.5) years was recruited from 11 municipalities in Denmark. Additionally, a cohort of children and adolescents of 1421 (774 girls) with overweight/obesity aged 6 - 19 years (median 11.8) was recruited for the study. Height, weight, and fasting plasma lipid concentrations were measured on all participants. Smoothed reference curves and percentiles were generated using the Generalized Additive Models for Location Scale and Shape package in the statistical software R.

Results: In the population-based cohort, plasma concentrations of total cholesterol (TC) (P < 0.05), low-density lipoprotein cholesterol (LDL) (P < 0.005), and high-density lipoprotein cholesterol (HDL) (P < 0.005) were higher in the youngest compared to the oldest tertile. Fasting plasma levels of triglycerides (TG) (P < 0.005) increased with age in both sexes. In boys, non-HDL was lower in the oldest compared to the youngest tertile (P < 0.0005). Concentrations of TC, LDL, non-HDL, and TG were higher (P < 0.05), and HDL lower (P < 0.05) in the cohort with overweight/obesity in both sexes and for all ages except for TC in the youngest girls. The overall prevalence of dyslipidemia was 6.4% in the population-based cohort and 28.0% in the cohort with overweight/obesity. The odds ratio for exhibiting dyslipidemia in the cohort with overweight/obesity compared with the population-based cohort was 6.2 (95% CI: 4.9 - 8.1, P < 2*10-16).

Conclusion: Fasting plasma lipid concentrations change during childhood and adolescence and differ with sex and age. Children and adolescents with obesity have increased concentrations of circulating lipids and exhibit an increased prevalence of dyslipidemia.

Trial registration: The study is part of The Danish Childhood Obesity Biobank; ClinicalTrials.gov ID-no.: NCT00928473 retrospectively registered on June 25th 2009.

Keywords: Adolescent; Child; Dyslipidemias; Lipids; Obesity; Reference values.

Figures

Fig. 1
Fig. 1
Age distribution. Number of children and adolescents within each age group in the population-based cohort generating the fasting plasma lipid reference intervals. a Girls. b Boys
Fig. 2
Fig. 2
Percentile curves for concentrations of fasting plasma total cholesterol. Smoothed 2.5th, 5th, 50th, 90th, 95th and 97.5th percentile curves for TC in girls (a) and boys (b). Full lines represent the total reference population, and dotted lines represent the cohort from The Children’s Obesity Clinic with overweight/obesity. The dots represent the participants from the population-based cohort. Concentrations of TC are in mmol/L
Fig. 3
Fig. 3
Percentile curves for concentrations of fasting plasma low-density lipoprotein. Smoothed 2.5th, 5th, 50th, 90th, 95th and 97.5th percentile curves for LDL in girls (a) and boys (b). Full lines represent the total reference population, and dotted lines represent the cohort from The Children’s Obesity Clinic with overweight/obesity. The dots represent the participants from the population-based cohort. Concentrations of LDL are in mmol/L
Fig. 4
Fig. 4
Percentile curves for concentrations of fasting plasma high-density lipoprotein. Smoothed 2.5th, 5th, 50th, 90th, 95th and 97.5th percentile curves for HDL in girls (a) and boys (b). Full lines represent the total reference population, and dotted lines represent the cohort from The Children’s Obesity Clinic with overweight/obesity. The dots represent the participants from the population-based cohort. Concentrations of HDL are in mmol/L
Fig. 5
Fig. 5
Percentile curves for concentrations of fasting plasma non-high-density lipoprotein. Smoothed 2.5th, 5th, 50th, 90th, 95th and 97.5th percentile curves for non-HDL in girls (a) and boys (b). Full lines represent the total reference population, and dotted lines represent the cohort from The Children’s Obesity Clinic with overweight/obesity. The dots represent the participants from the population-based cohort. Concentrations of non-HDL are in mmol/L
Fig. 6
Fig. 6
Percentile curves for concentrations of fasting plasma triglycerides. Smoothed 2.5th, 5th, 50th, 90th, 95th and 97.5th percentile curves for TG in girls (a) and boys (b). Full lines represent the total reference population, and dotted lines represent the cohort from The Children’s Obesity Clinic with overweight/obesity. The dots represent the participants from the population-based cohort. Concentrations of TG are in mmol/L

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