Department of Epidemiology, Capital Institute of Pediatrics, Beijing, 100020, China; Graduate School of Peking Union Medical College, Peking Union Medical College, Beijing, 100730, China.
Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China.
Atherosclerosis. 2019 Jan;280:37-44. doi: 10.1016/j.atherosclerosis.2018.11.018. Epub 2018 Nov 10.
Considerable attention is given nowadays to the presence of cardiovascular diseases risk factors in children. The current blood lipid classification system for Chinese children was based on the United States National Cholesterol Education Program (NCEP) cutpoints, which did not take the age, gender and race differences into consideration. This study aimed to develop gender- and age-specific lipid cutpoints for dyslipidemia screening in Chinese children and compare the ability of new cutpoints and NCEP pediatric cutpoints to predict obesity and unfavorable blood pressure (BP) levels.
Data were obtained from a nationwide multicenter cross-sectional study: The China Child and Adolescent Cardiovascular Health Study, comprising 12,875 Chinese children aged 6-18 years. We calculated cutpoints for abnormal levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) that were linked to Chinese adult abnormal lipid thresholds using the General Additive Model for Location Scale and Shape method.
Borderline-high and high cutpoints (TC, LDL-C and TG) as well as low cutpoints (HDL-C) were developed to classify the abnormal blood lipid levels in Chinese children. Better performance for prediction of obesity, elevated BP, and hypertension were found with the proposed cutpoints in comparison with the NCEP pediatric cutpoints (AUC for obesity: 0.612 vs. 0.597, p = 0.017; AUC for elevated BP: 0.529 vs. 0.521, p = 0.017; AUC for hypertension: 0.536 vs. 0.527, p = 0.016).
The gender- and age-specific cutpoints should improve the accuracy of dyslipidemia screening in China and be more reasonable in practice.
目前，人们非常关注儿童心血管疾病危险因素的存在。现行的中国儿童血脂分类系统基于美国国家胆固醇教育计划（NCEP）切点，但未考虑年龄、性别和种族差异。本研究旨在为中国儿童血脂异常筛查制定性别和年龄特异性的血脂切点，并比较新切点和 NCEP 儿科切点预测肥胖和不良血压（BP）水平的能力。
本研究数据来自一项全国多中心横断面研究：中国儿童青少年心血管健康研究，共纳入 12875 名 6-18 岁的中国儿童。我们使用广义加性模型（General Additive Model for Location Scale and Shape），计算出与中国成人异常血脂阈值相关的总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）和甘油三酯（TG）异常水平的切点。
为了对中国儿童的异常血脂进行分类，我们制定了边界高和高切点（TC、LDL-C 和 TG）以及低切点（HDL-C）。与 NCEP 儿科切点相比，新提出的切点在预测肥胖、血压升高和高血压方面具有更好的表现（肥胖的 AUC：0.612 比 0.597，p=0.017；血压升高的 AUC：0.529 比 0.521，p=0.017；高血压的 AUC：0.536 比 0.527，p=0.016）。
性别和年龄特异性切点应该能够提高中国血脂异常筛查的准确性，并且在实践中更加合理。
