Truthmann Julia, Schienkiewitz Anja, Kneuer Antje, Du Yong, Scheidt-Nave Christa
Department of Epidemiology and Health Monitoring, Robert Koch-Institute Berlin, Berlin, Germany.
Department of General Practice, Institute for Community Medicine, University Medical Centre Greifswald, Greifswald, Germany.
Lipids Health Dis. 2024 Dec 26;23(1):421. doi: 10.1186/s12944-024-02409-1.
Universal lipid screening in childhood for early detection and treatment of familial hypercholesterolemia is under discussion, but will also detect children with multifactorial dyslipidemia. Results from population-based studies can support the design of public health strategies. As few previous studies considered pubertal changes in serum lipid levels, we examined tracking of serum lipids from prepuberty to young adulthood in a population-based cohort.
This longitudinal study includes 692 children from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS; baseline: 2003-2006, follow-up: 2014-2017) who were 6-8 years old at baseline, at least 18 years old at follow-up, and had measurements of serum total cholesterol (TC), high-density and non-high-density lipoprotein cholesterol (HDL-C; non-HDL-C) at both time points. We calculated proportions of participants by life stage-specific risk categories applying cut points for young children and young adults. We used correlation coefficients to estimate serum lipid tracking from childhood to young adulthood. The association between follow-up and baseline lipid levels was examined in sex-specific multivariable linear regression models including body mass index (BMI), health-related behaviors and medication use as covariables.
The correlation coefficient between baseline and follow-up was 0.60 for non-HDL-C, 0.56 for TC, and 0.43 for HDL-C and was higher in males than in females. 67% of participants had acceptable and 9% had borderline/elevated non-HDL-C levels at both time points. Of participants with borderline/elevated non-HDL-C levels at baseline 32% remained in this category and 68% improved. Non-HDL-C levels at baseline explained 53% of the variance in levels at follow-up in males and 28% in females. After adjustment for covariables, the explained variance increased to 62% in males and 45% in females. An increase in BMI z-scores from childhood to young adulthood in all sexes and oral contraceptive use in females was positively associated with higher levels at follow-up.
Non-HDL-C levels in prepuberty are moderate predictors of levels in young adulthood, along with increasing BMI from childhood to young adulthood, and oral contraceptive use among women. Comprehensive strategies including public health interventions targeting elevated lipid levels and obesity in combination, are essential to prevent premature cardiovascular events.
儿童期进行普遍血脂筛查以早期发现和治疗家族性高胆固醇血症正在讨论中，但也会检测出患有多因素血脂异常的儿童。基于人群的研究结果可为公共卫生策略的设计提供支持。由于之前很少有研究考虑青春期血清脂质水平的变化，我们在一个基于人群的队列中研究了从青春期前到青年期血清脂质的追踪情况。
这项纵向研究纳入了来自德国儿童和青少年健康访谈与检查调查（KiGGS；基线：2003 - 2006年，随访：2014 - 2017年）的692名儿童，他们在基线时6 - 8岁，随访时至少18岁，且在两个时间点均测量了血清总胆固醇（TC）、高密度和非高密度脂蛋白胆固醇（HDL - C；非HDL - C）。我们根据针对幼儿和青年的切点，按特定生命阶段的风险类别计算参与者的比例。我们使用相关系数来估计从儿童期到青年期的血清脂质追踪情况。在性别特异性多变量线性回归模型中，以体重指数（BMI）、健康相关行为和药物使用作为协变量，研究随访与基线脂质水平之间的关联。
非HDL - C的基线与随访之间的相关系数为0.60，TC为0.56，HDL - C为0.43，男性高于女性。67%的参与者在两个时间点的非HDL - C水平均可接受，9%的参与者处于临界/升高水平。在基线时非HDL - C水平处于临界/升高的参与者中，32%仍处于该类别，68%有所改善。基线时的非HDL - C水平解释了男性随访时水平变异的53%，女性为28%。在调整协变量后，男性的解释变异增加到62%，女性为45%。从儿童期到青年期，所有性别的BMI z评分增加以及女性使用口服避孕药与随访时较高的水平呈正相关。
青春期前的非HDL - C水平是青年期水平的中度预测指标，同时还包括从儿童期到青年期BMI的增加以及女性使用口服避孕药。包括针对血脂升高和肥胖的公共卫生干预措施相结合的综合策略对于预防过早的心血管事件至关重要。
