1. In this serial, cross-sectional analysis, US youths had improved triglycerides, LDL, HDL, and total cholesterol from 1999 to 2016.
2. While half of all US youths had ideal lipid levels, nearly a quarter had at least one unfavorable lipid measure.
Evidence Rating Level: 2 (Good)
Study Rundown: Optimal lipid levels help define cardiovascular health in childhood, and data on lipid levels for US youths can provide key insight into current and future cardiovascular health. While public health efforts have targeted improving overall nutrition for youths, there has not been a study to address trends in the prevalence of ideal levels for lipids and apolipoprotein B. In this serial, cross-sectional analysis, US youth had improved triglycerides, LDL, HDL, and total cholesterol from 1999 to 2016. While half of all US youths had ideal lipid levels, nearly a quarter had at least one unfavorable lipid measure.
While the results shows favorable trends for lipids and apolipoprotein B in US youth, the study has several limitations. For example, blood was drawn in the non-fasting state for adolescents. Also, youths taking lipid lowering medications were not excluded, thus making it even more difficult to attribute the improvement in lipid measures to non-pharmacological interventions. Still, this is an encouraging study overall and suggests that further improvements in US pediatric health may be achieved with concerted public health efforts.
In-Depth [cross-sectional study]: 26,047 US youths aged 6 to 10 years who attended any exam during any National Health and Nutrition Examination Survey (NHANES) from 1999-2000 to 2015-2016 were used in this cross-sectional study. NHANES uses a complex, multistage probability sampling design to select a representative sample of the civilian noninstitutionalized US population. NHANES utilizes in-home interviews with mobile examinations and laboratory tests, including HDL and total cholesterol in youths aged 6 to 19 years and fasting triglycerides and apolipoprotein B in a subset of adolescents aged 12 to 19 years. Levels of lipids and apolipoprotein B were classified as ideal, borderline, or adverse according to the most recent pediatric lipid guidelines. In all youths, total cholesterol levels decreased linearly during the 18-year period from 164mg/dL (CI95 161 to 167mg/dL) in 1999-2000 to 155mg/dL (CI95 154 to 157 mg/dL) in 2015-2016 (β −0.6 mg/dL; CI95, -0.7 to -0.4 mg/dL per year). The proportion of youths with at least 1 adverse level of HDL, non-HDL, or total cholesterol decreased significantly for all youths from 23.1% to 19.2% (p = 0.002) and for children from 22.2% to 15.2% (p < 0.001), but not for adolescents (23.7% to 21.8%; p = .27). Secondary analyses were done for race/ethnicity and BMI. In these exploratory analyses, temporal trends in mean levels and in the prevalence of ideal and adverse levels were generally consistent across racial/ethnic groups and BMI categories. However, these trends were variable in magnitude and whether statistical significance was reached.
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