Kit Brian K, Kuklina Elena, Carroll Margaret D, Ostchega Yechiam, Freedman David S, Ogden Cynthia L
US Public Health Service, Rockville, Maryland2Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland.
Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia.
JAMA Pediatr. 2015 Mar;169(3):272-9. doi: 10.1001/jamapediatrics.2014.3216.
Recent national data suggest there were improvements in serum lipid concentrations among US children and adolescents between 1988 and 2010 but an increase in or stable blood pressure (BP) during a similar period.
To describe the prevalence of and trends in dyslipidemia and adverse BP among US children and adolescents.
The National Health and Nutrition Examination Survey, a cross-sectional survey.
Noninstitutionalized US population.
Children and adolescents aged 8 to 17 years with measured lipid concentrations (n = 1482) and BP (n = 1665).
Adverse concentrations of total cholesterol (TC) (≥ 200 mg/dL), high-density lipoprotein cholesterol (HDL-C) (<40 mg/dL), and non-HDL-C (≥ 145 mg/dL) (to convert TC, HDL-C, and non-HDL-C to millimoles per liter, multiply by 0.0259) and high or borderline BP were examined. Definitions of BP were informed by the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents by the National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. Analyses of linear trends in dyslipidemias and BP were conducted overall and separately by sex across 7 periods (1999-2000, 2001-2002, 2003-2004, 2005-2006, 2007-2008, 2009-2010, and 2011-2012).
In 2011-2012, 20.2% (95% CI, 16.3-24.6) of youths had an adverse concentration of TC, HDL-C, or non-HDL-C and 11.0% (95% CI, 8.8-13.4) had either high or borderline BP. The prevalences of adverse concentrations decreased between 1999-2000 and 2011-2012 for TC (10.6% [95% CI, 8.3-13.2] vs 7.8% [95% CI, 5.7-10.4]; P = .006), HDL-C (17.9% [95% CI, 15.0-21.0] vs 12.8% [95% CI, 9.8-16.2]; P = .003), and non-HDL-C (13.6% [95% CI, 11.3-16.2] vs 8.4% [95% CI, 5.9-11.5]; P < .001). There was a decrease in high BP between 1999-2000 (3.0% [95% CI, 2.0-4.3]) and 2011-2012 (1.6% [95% CI, 1.0-2.4]) (P = .003). There was no change from 1999-2000 to 2011-2012 in borderline high BP (7.6% [95% CI, 5.8-9.8] vs 9.4% [95% CI, 7.2-11.9]; P = .90) or either high or borderline high BP (10.6% [8.4-13.1] vs 11.0% [95% CI, 8.8-13.4]; P = .26).
In 2011-2012, approximately 1 in 5 children and adolescents aged 8 to 17 years had an adverse lipid concentration of TC, HDL-C, or non-HDL-C and slightly more than 1 in 10 had either borderline high or high BP. The prevalence of dyslipidemia modestly decreased between 1999-2000 and 2011-2012, but either high or borderline high BP remained stable. The reasons for these trends require further study.
近期全国数据表明，1988年至2010年间美国儿童和青少年的血脂浓度有所改善，但同期血压（BP）有所上升或保持稳定。
描述美国儿童和青少年血脂异常及不良血压的患病率和趋势。
全国健康与营养检查调查，一项横断面调查。
美国非机构化人群。
年龄在8至17岁之间且测量了血脂浓度（n = 1482）和血压（n = 1665）的儿童和青少年。
检查总胆固醇（TC）（≥200mg/dL）、高密度脂蛋白胆固醇（HDL-C）（<40mg/dL）和非HDL-C（≥145mg/dL）（将TC、HDL-C和非HDL-C转换为毫摩尔每升，乘以0.0259）的不良浓度以及高血压或临界高血压。血压的定义参考了国家高血压教育计划儿童和青少年高血压工作组发布的《儿童和青少年高血压诊断、评估和治疗第四次报告》。对血脂异常和血压的线性趋势进行了总体分析，并按性别在7个时间段（1999 - 2000年、2001 - 2002年、2003 - 2004年、2005 - 2006年、2007 - 2008年、2009 - 2010年和2011 - 2012年）分别进行了分析。
在2011 - 2012年，20.2%（95%CI，16.3 - 24.6）的青少年存在TC、HDL-C或非HDL-C的不良浓度，11.0%（95%CI，8.8 - 13.4）的青少年患有高血压或临界高血压。1999 - 2000年至2011 - 2012年间，TC不良浓度的患病率下降（10.6%[95%CI，8.3 - 13.2]对7.8%[95%CI，5.7 - 10.4]；P = 0.006），HDL-C不良浓度的患病率下降（17.9%[95%CI，15.0 - 21.0]对12.8%[95%CI，9.8 - 16.2]；P = 0.003），非HDL-C不良浓度的患病率下降（13.6%[95%CI，11.3 - 16.2]对8.4%[95%CI，5.9 - 11.5]；P < 0.001）。1999 - 2000年（3.0%[95%CI，2.0 - 4.3]）至2011 - 2012年（1.6%[95%CI，1.0 - 2.4]）高血压患病率下降（P = 0.003）。1999 - 2000年至2011 - 2012年临界高血压患病率无变化（7.6%[95%CI，5.8 - 9.8]对9.4%[95%CI，7.2 - 11.9]；P = 0.90），高血压或临界高血压患病率也无变化（10.6%[8.4 - 13.1]对11.0%[95%CI，8.8 - 13.4]；P = 0.26）。
在2011 - 2012年，8至17岁的儿童和青少年中约五分之一存在TC、HDL-C或非HDL-C的不良血脂浓度，十分之一以上的儿童和青少年患有临界高血压或高血压。1999 - 2000年至2011 - 2012年间血脂异常患病率略有下降，但高血压或临界高血压患病率保持稳定。这些趋势的原因需要进一步研究。
