Are Youth Lipid Levels Improving?

June 21, 2019

Article Citation

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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First Dose

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.

Key Points to Remember

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.

Link to Research Article

Summary Author

Matthew M. Davis, MD, MAPP 

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