Coronary risk factors in Turkish school children—report of a pilot study

In 432 school children aged 7–15 years we investigated the following parameters: body mass index, blood pressure, total cholesterol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol. Only 2.8% of children were considered to be obese. Of the children, 3.5% had systolic, 4.9% had diastolic and 3.9% had both blood pressures higher than the acceptable age- and sex-stratified values. The mean total cholesterol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol levels were 3.37, 1.93 and 1.33 mmol1^-1 respectively. In 31 (7.1%) of the children, total cholesterol levels were found to be above the risk cut-off level of 4.4 mmol l^-1; in 39 (9%) of the children, low-density lipoprotein cholesterol levels were elevated above an acceptable upper limit of 2.84 mmol1^-1. Significantly reduced high-density lipoprotein cholesterol values were observed in 8.8%. Mean total cholesterol and low-density lipoprotein cholesterol values were elevated significantly in hypertensive cases, while high-density lipoprotein cholesterol levels showed no difference. Sensitivity and the positive predictive value for selected total cholesterol cut-off points for determining elevated low-density lipoprotein cholesterol were 67% and 54%, respectively. These levels of risk are considerably lower than those found in studies in Western countries.     

Further definition of lipid-lipoprotein abnormalities in children with various degrees of chronic renal insufficiency

We characterized the lipid-lipoprotein abnormalities encountered in a series of 45 nonnephrotic uremic children with various degrees of chronic renal insufficiency. A mild hypertriglyceridemia associated with decreased serum high-density lipoprotein cholesterol levels was confirmed. The correlation between high-density lipoprotein cholesterol and creatinine clearance showed a power behavior with a marked decrease in high-density lipoprotein cholesterol below a creatinine clearance value of 40 ml/min/1.73 m2. A number of uremic children accumulate an abnormal population of very low-density lipoprotein particles in their plasma. On agarose gel electrophoresis these particles migrate as a slow moving pre-beta band and are clearly distinguished from the regular fast moving pre-beta very low-density lipoprotein band. This electrophoretic phenomenon has been called double pre-beta lipoproteinemia. The prevalence of double pre-beta lipoproteinemia increased significantly with the degree of impairment of renal function, reaching highest figures in patients on hemodialysis. Accordingly, the very low-density lipoprotein cholesterol/triglyceride ratio also was significantly increased. The double pre-beta lipoproteinemia phenomenon was not detected in any of the control, nonuremic subjects. The clinical importance of double pre-beta lipoproteinemia in uremic plasma is related to its possible atherogenic role.     

High density lipoprotein cholesterol and total cholesterol in children with asthma and allergic rhinitis

Serum high density lipoprotein cholesterol and total cholesterol were studied in 15 children with allergic rhinitis, 45 asymptomatic asthmatic children and 16 children with acute asthmatic attacks. The latter were also studied in their asymptomatic phase. Two control groups of children with minor anatomical defects and those with acute pneumonia with respiratory distress were also studied. The serum concentrations of high density lipoprotein cholesterol were significantly higher (p less than 0.001) and those of total cholesterol lower (p less than 0.001) in children with respiratory allergy when compared to controls. The concentration of high density lipoprotein cholesterol increased and that of total cholesterol decreased during acute asthma.     

Body composition, atherogenic risk factors and apolipoproteins following growth hormone treatment

We studied the change in atherogenic risk factors in 27 children, 21 boys and 6 girls, 6 to 14 years of age. with growth hormone deficiency during 12 months of growth hormone replacement therapy. Changes in body composition and lipid profile during growth hormone treatment were evaluated. The atherogenic index was calculated using the equation [(total cholesterol - high-density lipoprotein cholesterol)(apolipoprotein B)] / [(apolipoprotein A₁)(high-density lipoprotein cholesterol)]. Body fat decreased (p < 0.01), associated with an increase in lean body mass (p < 0.01). Total cholesterol and high-density lipoprotein cholesterol showed no significant changes. The atherogenic index significantly decreased from 1.44 ± 0.60 to 1.09 ± 0.52 (p < 0.01) after 12 months. Apolipoproteins C_u and C_m increased throughout the study period (p < 0.01). Lipoprotein(a) and apolipoproteins A₁, B and B/A₁ ratio did not change significantly. In conclusion, growth hormone treatment improved body composition and reduced atherogenic risk factors in children with growth hormone deficiency.     

Lipoprotein alterations in children with bacterial meningitis

Abnormalities in serum lipids, including hypertriglycerideinia, are common during infectious disorders. However, the lipoprotein pattern during infections, particularly in children, has been investigated to only a limited extent. We have monitored alterations in serum lipoproteins in eight children with a severe baclcrial infcction (meningitis) by a quantitating method measuring cholesterol and triglyccrides in each major class. The levels of triglyccrides in serum and in low-density lipoproteins were markedly elevated during the infection, whereas the amount of cholesterol in high-density lipoprotcins was decreased. The cholesterol to triglyceride ratio was decreased in low-, as well as in high-density lipoproteins. These lipoprotein abnormalities may, at least in part, be explained by a depressed lipolytic activity of lipoprotein lipasc, the key enzyme for removal of triglycerides in man. Serum triglycerides and the levels of cholesterol in high-density lipoproteins, as well as the ratio between these parameters, may be used as indicators of inflammatory activity.     

Lipoprotein alterations in children with bacterial meningitis

Abnormalities in serum lipids, including hypertriglycerideinia, are common during infectious disorders. However, the lipoprotein pattern during infections, particularly in children, has been investigated to only a limited extent. We have monitored alterations in serum lipoproteins in eight children with a severe baclcrial infcction (meningitis) by a quantitating method measuring cholesterol and triglyccrides in each major class. The levels of triglyccrides in serum and in low-density lipoproteins were markedly elevated during the infection, whereas the amount of cholesterol in high-density lipoprotcins was decreased. The cholesterol to triglyceride ratio was decreased in low-, as well as in high-density lipoproteins. These lipoprotein abnormalities may, at least in part, be explained by a depressed lipolytic activity of lipoprotein lipasc, the key enzyme for removal of triglycerides in man. Serum triglycerides and the levels of cholesterol in high-density lipoproteins, as well as the ratio between these parameters, may be used as indicators of inflammatory activity.     

Lipoprotein profiles in hypercholesterolemic children

Atherosclerosis is a process that begins in early life. Coronary heart disease is the result of complex interactions among a variety of risk factors of which hypercholesterolemia is but one. During routine screening, 500 children were identified with total cholesterol levels above the 95th percentile of 5.2 mmol/L (200 mg/dL). Lipoprotein profiles were then performed to confirm and delineate their lipid abnormalities. A definable lipid disorder was present in 85% of such children. Abnormal lipoprotein patterns included 292 children with type IIa, 99 with type IIb, and 25 with type IV phenotypes. An abnormally low high-density lipoprotein cholesterol level of less than 0.9 mmol/L (35 mg/dL) was observed in 20 children. Only 5% of patients were identified as being hypercholesterolemic because they had high-density lipoprotein cholesterol levels above the 95th percentile of 1.8 mmol/L (70 mg/dL). Thirty-two percent of children with total cholesterol levels above 5.2 mmol/L had a family member (sibling, parent, uncle, aunt, or grandparent) with a myocardial infarction prior to 55 years of age. Data from this study support universal cholesterol testing after 3 years of age and lipoprotein profiles for those with levels above 5.2 mmol/L.     

Should children with infection be tested for lipid,lipoprotein and apolipoprotein?

The lipid profile is known to alter in patients with infection, but there has not been a study of the apolipoprotein levels in serum of otherwise healthy children during infection. Lipids, lipoproteins, apolipoproteins A-l and B and lipoprotein (a) were evaluated prospectively in 31 consecutive children, aged4–15 years, who were admitted to the hospital with bacterial pharyngitis. The degree of dyslipidemia associated with bacterial pharyngitis was assessed using each child as his/her own control and by comparison with 79 healthy children who had not had an infection during the past 3 months. Serum total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, apolipoprotein A-l and apolipoprotein B levels were significantly decreased during the symptomatic phase of the disease, whereas the serum triglyceride level was slightly elevated. Serum lipoprotein (a) concentration did not change significantly. In conclusion, it is suggested that serum lipids, lipoproteins and apolipoproteins should not be assessed during infection because of the possible transient changes of these parameters during infection or inflammation.     

Dietary fibre, exercise and serum lipids and lipoprotein cholesterols in 12 to 15 year olds

Serum lipid and lipoprotein cholesterol levels track from childhood and are associated with risk of coronary heart disease. There is some evidence that these are influenced by dietary intake and exercise. Serum lipid and lipoprotein cholesterols were measured in a cohort of 119 British children aged 12–15 y who completed a dietary assessment and exercise questionnaire. The ratio of total- to high-density lipoprotein cholesterol fell with increasing fibre intake, but after adjustment for age, body mass index, sex and other dietary factors, this was not statistically significant. Children exercising at least once a day had significantly lower serum total cholesterol and low density lipoprotein cholesterol levels than those exercising less frequently, even after adjustment for the above factors and dietary fibre intake. No dietary factor was significantly associated with any lipid measure after adjustment for the above factors. The challenge is how to optimize exercise level in adolescent children.     

The effect of weight control on lipid changes in obese children

The effects of weight change on serum lipid changes were assessed in a sample of 56 obese children randomly assigned to family-based behavioral obesity treatment vs controls given no treatment. Fasting serum lipid levels, height, weight, and fitness were measured at program entry and after 6 months of treatment. Children assigned to treatment showed significantly greater relative weight and weight changes than children in the control group, and the weight changes were significantly related to reductions in fasting serum triglyceride and total serum cholesterol levels and increases in high-density lipoprotein serum cholesterol. Results after 5 years of follow-up available for a small sample of treated children showed that a change in relative weight and fitness from 6 months to 5 years was also associated with changes in the high-density lipoprotein level. These results suggest that weight control in obese preadolescent children may be associated with improvement in lipoprotein profiles.     

Effect of Growth Hormone on Lipoprotein Metabolism in Male Pituitary Dwarfs: Changes in Lipoprotein Lipase Activity and Cholesterol Level in HDL Subfractions

To determine the effect of a chronic therapeutic dose (0.24 IU/kg/week) of growth hormone on the cholesterol concentration in serum lipoproteins and postheparin plasma lipase activities in previously untreated children with idiopathic growth hormone deficiency, seven male patients under 10 years of age were studied before and three months after the initiation of growth hormone therapy. Lipase activity was measured by an immunochemical method. The cholesterol concentration in high-density lipoprotein subfractions was determined, using a micromethod for ultracentrifugation. Serum total cholesterol and triglyceride levels did not change significantly during treatment, while the high-density lipoprotein cholesterol level decreased significantly after treatment to 79% of the baseline level, with an equal decrease of cholesterol concentration in both high-density lipoprotein₂ and ₃. Lipoprotein lipase, but not hepatic triglyceride lipase, activity decreased significantly after treatment. These were not associated with changes in either thyroid status as determined by serum triiodothyronine levels or insulin responsiveness after oral glucose challenge, suggesting that these changes may be induced by a direct action of growth hormone.     

Measurement of apolipoprotein B as a screening test for identifying children with elevated levels of low-density lipoprotein cholesterol

We compared the efficacy of two screening tests, measurement of apolipoprotein B (apo B) levels and measurement of serum total cholesterol levels, in detecting elevated low-density lipoprotein cholesterol (LDL-C) values in children. We studied 2850 children, aged 5 to 17 years, who had fasting lipid, lipoprotein, and apolipoprotein levels measured as part of the Bogalusa Heart Study. The test characteristics of apo B were superior to those of serum total cholesterol in screening children to detect elevated levels of LDL-C (greater than or equal to 95th percentile) and moderately elevated LDL-C levels (greater than or equal to 80th percentile). Unusually high or low values of high-density lipoprotein cholesterol are responsible for most of the misclassification that occurs when measurement of total cholesterol is used as a screening test for identifying children with elevated levels of LDL-C. This confounding effect of high-density lipoprotein cholesterol was eliminated when measurement of apo B levels was used as a screening test. Because the apo B test is more specific at a given sensitivity than the total cholesterol test, the apo B test can cost more and still be less expensive as a screening strategy. As the methods for determining apolipoprotein levels become standardized and readily available, the measurement of apolipoproteins could be developed into superior screening tests for the identification of patients with dyslipidemias.     

Effect of High-Carbohydrate Diet on Lipid Metabolism in Young Type I Diabetics: Transient Changes in High-Density Lipoprotein2 and Lipoprotein Lipase

The short-term effect of a high-carbohydrate, low-fat diet on lipoprotein metabolism was evaluated in eight young patients with type I diabetes mellitus. An isocaloric exchange diet containing 60% carbohydrate and 20% fat was administered for four weeks and serum lipid, high-density lipoprotein and subfraction cholesterol, and the activity of the lipolytic enzymes in postheparin plasma were monitored. The assay methods for lipase activity and cholesterol concentration in high-density lipoprotein subfractions were described previously. There were no appreciable changes in diabetic control, serum triglyceride and total cholesterol levels. The high-density lipoprotein₂ cholesterol level decreased significantly after two weeks on the diet and returned toward baseline levels thereafter. There was a significant correlation between high-density lipoprotein₂ cholesterol level and lipoprotein lipase activity. The high carbohydrate diet did not affect the glycemic control but induced a transient decrease in high-density lipoprotein₂ cholesterol mediated by the decrease in lipoprotein lipase activity.     

Lipoproteins in the progeny of young men with coronary artery disease: children with increased risk

The authors studied 173 progeny from 63 families in which the father had angiographically diagnosed coronary artery disease by 50 years of age. To assess the nature of the coronary risk factors in these families, we measured their height and weight to calculate Quetelet index (wt/ht2), BP, fasting plasma cholesterol, triglyceride, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were measured in the affected fathers, their wives, and their progeny. These values were compared with age- and sex-specific values from the Lipid Research Clinic data. Sixty-five percent of the affected fathers and 51% of the progeny had elevated triglyceride, elevated low-density lipoprotein cholesterol, diminished high-density lipoprotein cholesterol, or combinations thereof. The distribution of the lipids and lipoproteins in the children bore a close resemblance to those observed in the affected fathers. A significant number of the mothers had diminished high-density lipoprotein cholesterol, which was attributed to their obesity. Screening the progeny of young coronary artery disease patients is therefore highly productive in identifying young people at excessive risk for future coronary artery disease. Early identification of this young high-risk population offers an opportunity for early initiation of preventive measures.     

Cholesterol and carotid artery wall in children and adolescents with familial hypercholesterolaemia: a controlled study by ultrasound

The carotid artery wall was studied with ultrasound in 23 children and adolescents with familial hypercholesterolaemia and in 23 age-matched healthy controls. The study revealed changes in the carotid artery wall related both to familial hypercholesterolaemia and to age. In the control subjects, the carotid artery wall became stiffer with age. In the patients with hypercholesterolaemia, no clear age-dependence was found, but wall stiffness correlated with total and low-density lipoprotein cholesterol. The intimal-medial wall thickness was associated with serum total cholesterol, low-density lipoprotein and triglyceride concentrations, and correlated inversely with the ratio of high-density lipoprotein to total cholesterol. Carotid artery wall properties seem to be associated with the degree of hypercholesterolaemia and the high-density lipoprotein-to-total cholesterol ratio even in children. In childhood and adolescence it is already possible, with ultrasound, to detect changes in the arterial wall related both to familial hypercholesterolaemia and to age.     

儿童初发IgA肾病肾病综合征型的临床特点

目的 研究儿童初发IgA肾病肾病综合征型的临床特点,探讨其与原发性肾病综合征的异同,为这两种疾病的临床鉴别诊断提供理论依据。方法 选择50例初发IgA肾病且表现为肾病综合征的患儿为观察对象,以72例初发原发性肾病综合征患儿为对照组,比较两组患儿的临床及实验室检查特点。结果 IgA肾病组患儿肉眼血尿、镜下血尿、高血压、急性肾损伤、贫血、低高密度脂蛋白胆固醇血症、低补体C4血症、激素耐药、肾炎型肾病综合征发生率均显著高于对照组,血IgE升高发生率低于对照组(P< 0.05)。两组血肌酐、血尿酸、血总胆固醇、高密度脂蛋白胆固醇、血IgE、血C4、血红蛋白水平比较差异有统计学意义(P< 0.05)。血IgE< 131.2 IU/mL、高密度脂蛋白胆固醇< 1.35 mmol/L作为临界值对鉴别IgA肾病肾病综合征型及原发性肾病综合征显示了一定的价值(Youden 指数分别为0.535、0.564)。结论 IgA肾病肾病综合征型患儿临床多表现为肾炎型肾病综合征及激素耐药型肾病综合征;临床表现联合高密度脂蛋白胆固醇、血IgE水平有助于鉴别IgA肾病肾病综合征型及原发性肾病综合征 。     

Hypercholesterolemia and hyper-alpha-lipoproteinemia in schoolchildren.

Elevated levels of high-density lipoprotein cholesterol (C-HDL) can explain apparent hypercholesterolemia in some children, and high C-HDL levels may aggregate in families. In this study, 17 kindreds were identified by virture of hypercholesterolemic proband children whose hypercholesterolemia was accounted for the elevated C-HDL levels Family lipod and lipoprotein sampling revealed three-generation vertical appearance of elevated C-HDL level in two kindreds, and two-generation vertical appearance in eight additional kindreds. Since CHDL level is inversely associated with coronary heart disease in adults, it is important to quantitate C-HDL and low-density lipoprotein cholesterol (C-LDL) in hypercholesterolemic children and to identify those with putatively reduced risk (elevated C-HDL level) or increased risk (elevated C-LDL level).     

Early increases in concentrations of total, LDL, and HDL cholesterol in HIV-infected children following new exposure to antiretroviral therapy

Antiretroviral therapy (ART) is associated with dyslipidemia and cardiovascular disease in adults infected with HIV. For children perinatally infected with HIV, ART exposure is lifelong and early-onset dyslipidemia could have significant long-term effects. We examined cholesterol levels in children during the first year after exposure to a new ART regimen (initiation or switch). In 52 children, total cholesterol increased by 30.5 and 43 mg/dL at 6 and 12 months, respectively (P < 0.001). Low-density lipoprotein cholesterol made the largest contribution, but high-density lipoprotein cholesterol also increased within months of therapy alteration. Early identification of these children and intervention could mediate potential increased risk for future cardiovascular disease.     

Plant stanol ester margarine lowers serum total and low-density lipoprotein cholesterol concentrations of healthy children: the STRIP project. Special Turku Coronary Risk Factors Intervention Project

OBJECTIVE: To investigate cholesterol-lowering efficacy and safety of plant stanol ester margarine in healthy 6-year-old children already consuming a low-saturated-fat, low-cholesterol diet.Study design: Eighty-one intervention children from the STRIP project, a randomized prospective trial aimed at reducing exposure of young children to the known environmental atherosclerosis risk factors, were recruited to this double-blind crossover study at 6 years of age. In randomized order the families were advised to replace daily 20 g of the child's dietary fat intake with plant stanol ester margarine or control margarine for 3 months. The washout period lasted 6 weeks. Statistical analysis was performed according to intention-to-treat principle with analysis of variance for crossover design. RESULTS: The mean daily plant stanol ester margarine consumption was 18.2 g (1.5 g plant stanol). The well-tolerated plant stanol ester margarine reduced serum total and low-density lipoprotein cholesterol concentrations by 5.4% and 7.5%, respectively (P =.0001 for both). The serum high-density lipoprotein cholesterol and triglyceride concentrations and alpha-tocopherol to low-density lipoprotein cholesterol ratio remained unchanged. The serum beta-carotene to low-density lipoprotein cholesterol ratio decreased by 19% (P =.003). CONCLUSION: Plant stanol ester margarine significantly diminishes serum total and low-density lipoprotein cholesterol concentration without adverse clinical effects in healthy children who already consume a low-saturated-fat, low-cholesterol diet but decreases the serum beta-carotene to low-density lipoprotein cholesterol ratio.