Perak AM, Ning H, Kit BK, et al. Trends in Levels of Lipids and Apolipoprotein B in US Youths Aged 6 to 19 Years. JAMA. 2019;321:1895-1905.
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Nonoptimal levels of lipids (cholesterol and triglycerides) in childhood are associated with the extent of early atherosclerosis. Childhood apolipoprotein B levels, independent of cholesterol content, may predict subclinical atherosclerosis in adulthood even more strongly than lipid levels. In this analysis of youths 6-19 years who participated in waves of the National Health and Nutrition Examination Survey (NHANES) from 1999-2016 (n=26,047), there were several favorable trends in measures of lipids and apolipoprotein B. By 2016, 51% of youths had ideal levels for high-density lipoprotein (HDL), non-HDL, and total cholesterol, whereas 15% of youths 6-11 years and 25% of youths 12-19 years had at least 1 adverse level of lipid or apolipoprotein B.
The NHANES serves as the authoritative source of population-level information in the United States for prevalence of obesity and serum markers of cardiovascular health, for adults and children. Data are collected in cross-sectional waves, and individuals are not followed longitudinally. For most youth participants, blood tests were drawn in nonfasting state. During the study period, total cholesterol level decreased from 164 mg/dL (95% CI 161-167 md/dL in 1999-2000 to 155 mg/dL (154-157 mg/dL) in 2015-2016. There were also improvements in HDL and non-HDL components of lipids. The adjusted mean apolipoprotein B level decreased from 70 mg/dL (68-72 mg/dL) in 2005-2006 to 67 mg/dL (65-70 mg/dL) in 2013-2014. Overall, these results indicate continuing improvements in lipid levels among US youths since the mid-1980s, and may signal decreasing risk of cardiovascular disease as these youths age into adulthood. This is the first known study to analyze population-level trends in apolipoprotein B among US youths; although clinical management is not yet clear, apolipoprotein B levels are known to be superior to traditional lipid levels in predicting atherosclerosis and cardiovascular disease events in adults. The improving trend in apolipoprotein B among youth in this study was somewhat surprising, given that trends in childhood obesity have not improved over this same time period.