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.     

Vitamin E status in hypercholesterolemic children

The prime role of oxidized low-density lipoprotein in the pathogenesis of atherosclerosis is almost universally accepted. Fat soluble antioxidant vitamin E associated with lipoproteins, appears to have antiatheroma properties. In the presented studies concentration of vitamin E and the relationship between tocopherol and lipids were studied in blood of hypercholesterolemic children. Level of vitamin E was determined by high-performance liquid chromatography (HPLC) method. Compared with normocholesterolemic children, hypercholesterolemic patients had a significantly lower red blood cell vitamin E content (2.55 +/- 0.19 micromol/l vs 3.15+/- 0.33 micromol/l; p<0.005) in spite of their higher plasma vitamin E concentration (27.9 +/- 8.3 micromol/l vs 21.01 +/- 3.6 micromol/l; pl;0.001). In the group of patient tocopherol-to-total cholesterol and tocopherol-to-lipids ratio was statistically lower compared to those in the control group. In hypecholesterolemic children vitamin E positively correlated with total cholesterol (r=0.43; p<0.02), LDL-C (low-density lipoprotein cholesterol) (r=0.42; p<0.02) and lipids (triglycerides + total cholesterol) (r=0.45; p<0.02). This study demonstrates that total plasma vitamin E concentration is not a suitable predictor of cell vitamin E status. Our results suggested that the tocopherol of erythrocytes and vitamin E to lipids ratio in plasma, could be more meaningful indicators to evaluate the vitamin E status in hypercholesterolemic children.     

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??Objective To investigate the relationship between the presence of dyslipidemia in pregnant females and the risk of congenital heart defects??CHD??. Methods A total of 54 pregnant females at 24 to 28 weeks??w?? of gestation admitted between March 2013 and June 2014 in Department of Pediatric Cardiology??First Affiliated Hospital of SUN Yat-sen University were enrolled in the study . The case group included 18 females who had a fetus with cardiac defects??and each case was matched with 2 controls with no pregnancy complications. The mean ages were 29.06??SD=3.11?? years and 29.03??SD=3.9?? years in the case and control groups??respectively. The main outcome measurements were total cholesterol??TC????triglycerides??TG????low-density lipoprotein cholesterol??LDL-c????high-density lipoprotein cholesterol??HDL-c????apolipoprotein and homocysteine. Results Patients in the case group had a significantly higher mean LDL-c??4.15 mmol/L vs. 3.45 mmol/L?? and apolipoprotein B ??2.23 g/L vs. 1.78 g/L????all P??0.05?? than those in the control group. Correlation analysis indicated that LDL-C??r=0.32??P=0.017????apolipoprotein B??r=0.33??P=0.016?? and homocysteine??r=0.34??P=0.011?? were associated with fetal congenital heart disease.Conclusion Serum LDL-cholesterol and apolipoprotein B levels in the case group are significantly higher than those in the control group. Pregnancy dyslipidemia may be associated with a higher incidence rate of CHD.     

妊娠期血脂紊乱与胎儿先天性心脏病发病关系探讨

目的 探讨妊娠期血脂水平与胎儿先天性心脏病之间的关系。方法 收集2013年3月至2014年6月于中山大学附属第一医院产检的孕周为24～28周的孕母54例, 其中18例存在胎儿先天性心脏病, 为病例组, 余36例为正常对照组。病例组与对照组孕母的年龄分别为（29.06±3.11）岁、（29.03±3.90）岁,主要检测指标包括总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、载脂蛋白以及同型半胱氨酸。结果 病例组孕母低密度脂蛋白胆固醇（4.15 mmol/L vs. 3.45 mmol/L,P＜0.05）及载脂蛋白B（2.23 g/L vs. 1.78 g/L,P＜0.05）水平较对照组明显升高。相关分析提示低密度脂蛋白胆固醇（r＝0.32,P＝0.017）、载脂蛋白B（r＝0.33,P＝0.016）及同型半胱氨酸（r＝0.34,P＝0.011）与胎儿患先天性心脏病相关。结论 病例组血清低密度脂蛋白胆固醇和载脂蛋白B水平较对照组明显升高。妊娠期血脂代谢异常可能会导致胎儿先天性心脏病的风险增加。     

Homocysteine, fibrinogen and lipid profile in children of young adults with coronary artery disease

Plasma homocysteine (9.05 ± 4.78 vs 5.93 ± 1.46 umol/L, P<0.01), plasma fibrinogen (313.76 ± 80.02 vs 275.47 ± 53.77 mg/dL, P<0.01), serum total cholesterol (171.64 ± 35.48 vs 152.62 ± 25.40 mg/dL, P<0.01), serum LDL cholesterol (109.51 ± 36.93 vs 87.6 ± 21.6 mg/dL, P<0.01) and fasting blood sugar (99.89 ± 7.46 vs 90.29 ± 9.85 mg/dL, ;were significantly higher in children (n=45) of young adults (<45 y) with coronary artery disease as compared to control group (n=45). No significant correlation was found for plasma homocysteine level of children with that of their parents in either group, whereas significant correlation was found for plasma fibrinogen of children with their parents in both the groups.     

Treatment of type IIa hyperlipidemia in childhood by a simplified American Heart Association diet and fiber supplementation

Thirty-six children identified as having primary type IIa hypercholesterolemia were treated with a diet restricting the intake of saturated fat to 10% of total energy and supplemented with soluble fiber for 8.1 +/- 2.4 (mean +/- SEM) months. In 14 of 36 patients first treated with the American Heart Association "Step-One" diet for 8.0 +/- 1.1 months, total cholesterol level dropped from 257.9 +/- 15.8 mg/dL to 240.6 +/- 10.9 mg/dL; the low-density lipoprotein cholesterol level dropped from 191.8 +/- 17.4 mg/dL to 175.0 +/- 11.7 mg/dL; the high-density lipoprotein cholesterol level dropped from 42.8 +/- 1.94 mg/dL to 41.6 +/- 1.68 mg/dL; and triglyceride concentration rose from 115.9 +/- 13.7 mg/dL to 128.1 +/- 14.1 mg/dL. The 36 patients treated with saturated fat-restrictive diets and supplemental soluble fiber diets had a reduction of total cholesterol levels from 249.2 +/- 7.66 mg/dL to 207.1 +/- 6.31 mg/dL and a low-density lipoprotein cholesterol level reduction from 184.7 +/- 7.55 mg/dL to 142.6 +/- 6.7 mg/dL, a reduction of 18% and 23%, respectively. There was no significant change in high-density lipoprotein cholesterol levels (46.4 +/- 1.9 mg/dL vs 44.3 +/- 2.1 mg/dL) or in triglyceride concentrations (94.2 +/- 7.43 mg/dL vs 102.2 +/- 8.45 mg/dL). In addition, the reduction in serum lipoprotein concentrations resulting from this program was significantly greater than the concentrations resulting from the American Heart Association diet alone. The different responses to these regimens suggest that a simplified diet and soluble fiber supplementation is well tolerated and reduces total and low-density lipoprotein cholesterol levels more effectively than the standard American Heart Association diet in children.     

The levels of asymmetric dimethylarginine, homocysteine and carotid intima-media thickness in hypercholesterolemic children

The aim of this study was to examine the intima-media thickness (IMT) of carotid arteries and endothelial function parameters such as plasma asymmetric dimethylarginine (ADMA) and homocysteine levels in hypercholesterolemic children and to investigate the relations of these parameters with hypercholesterolemia. Fifty-seven hypercholesterolemic and 37 healthy children were included in the study. Hypercholesterolemia was defined as 155 mg/dl and above for low-density lipoprotein (LDL)-cholesterol. Plasma concentrations of ADMA and homocysteine were measured and the measurement of carotid IMT was determined. Both carotid IMT and plasma ADMA levels were significantly higher in hypercholesterolemic children than healthy children (p<0.01). No significant difference was determined in homocysteine concentration between hypercholesterolemic children and the control group (p>0.05). No significant correlation was observed between lipid profiles and the levels of ADMA and homocysteine. However, a significant positive correlation was found between carotid IMT and total and LDL-cholesterol levels and between the levels of ADMA and LDL-cholesterol. In conclusion, the progressive increase in ADMA levels and carotid IMT and the positive relationship between carotid IMT and serum cholesterol levels support that plasma ADMA levels and carotid IMT can be indicators of early atherosclerosis in hypercholesterolemic children.     

Plasma homocysteine levels and folate status in children with sickle cell anemia.

PURPOSE: A sensitive inverse relationship between plasma homocysteine concentration and folate status has been demonstrated. Although children with sickle cell anemia (SCA) are at potential risk for folate deficiency, plasma homocysteine levels have not been reported in such patients. Therefore, a study was designed to assess plasma homocysteine levels as a marker of folate status. DESIGN: Plasma homocysteine concentrations were measured in 120 children with SCA (102 in steady state and 18 during an acute complication) who had never received supplemental folic acid. Folate status was directly assessed in 34 of these patients. RESULTS: Plasma homocysteine levels in the patients with SCA and control subjects were similar. The mean value +/- 1 SD was 5.8+/-2.5 micromol/L (range, 1.6 to 14.1 micromol/L) in the patients with SCA and 6.1+/-2.7 micromol/L (range, 1.7 to 15.3 micromol/L) in 73 pediatric control subjects. In a subpopulation of the study group (34 children), simultaneous serum folate, red cell folate, and total homocysteine concentrations were also measured. Their serum folate and red cell folate concentrations were normal: 12.4+/-10.0 nmol/L (range, 1 to 42 nmol/L) and 604+/-374.7 nmol/L (range, 205 to 1741 nmol/L), respectively. There was no correlation of plasma homocysteine concentration with various clinical or laboratory measures or with red cell folate concentration. CONCLUSION: Folate stores in children with SCA not receiving folic acid supplements are adequate despite an underlying hemolytic anemia.     

Effects of gender,apolipoprotein E phenotype and cholesterol-lowering by plant stanol esters in children: the STRIP study. Special Turku Coronary Risk Factor Intervention Project

AIM: To evaluate the effects of gender, apolipoprotein E phenotype and cholesterol absorption and synthesis (estimated as serum plant sterol and cholesterol precursor sterol concentrations) on the cholesterol-lowering effect of plant stanol esters in children. METHODS: Eighty-one healthy, normocholesterolaemic 6-y-old children (45 boys) were recruited from the Special Turku Coronary Risk Factor Intervention Project (STRIP), a randomized prospective trial aiming at atherosclerosis prevention in childhood. This placebo-controlled, double-blind, cross-over study comprised two 3-mo study periods and a 6-wk wash-out period. During the study periods, 20 g of the children's daily dietary fat intake was replaced with plant stanol ester margarine or control margarine. RESULTS: In boys, plant stanol esters reduced serum total and low-density lipoprotein cholesterol concentrations by 6% (0.09 to 0.42 mmol/L) and 9% (0.09 to 0.36 mmol/L), respectively (p < 0.01 for both). In girls, the decreases in concentrations were 4% (0.03 to 0.38 mmol/L) and 6% (0.02 to 0.32 mmol/l) (p < 0.05 for both). The response rate did not differ between the genders. Serum total and low-density lipoprotein cholesterol concentrations decreased by 6% and 8% (p < 0.01 for both), respectively, in both children with the apolipoprotein E 3/4 or 4/4 (apoE4+) phenotype and the apolipoprotein E 2/3 or 3/3 (apoE4-) phenotype. Cholesterol absorption decreased both in the apoE4+ children and in the apoE4- children, but cholesterol synthesis consistently increased in the apoE4+ children only. CONCLUSION: Plant stanol esters reduce serum cholesterol concentration in healthy children irrespective of their gender or apoE4 phenotype.     

Plasma homocysteine and lipoprotein (a) levels as risk factors for atherosclerotic vascular disease in epileptic children taking anticonvulsants

AIM: To assess the effect of anticonvulsant treatment on plasma homocysteine level and lipoprotein (a) in epileptic children. METHODS: Plasma total homocysteine, folate, vitamin B12 and lipoprotein (a) concentrations were measured in 111 epilectic children taking anticonvulsant drugs for longer than 12 mo. Forty-six healthy, sex- and age-matched children served as controls. RESULTS: Patients and controls differed significantly in concentrations of homocysteine (p < 0.05) and lipoprotein (a) (p < 0.001). The number of patients with homocysteine concentrations of >9 microM was significantly higher in the patient group than in the control group. A significant inverse relationship was found between vitamin B12 folate levels and plasma homocysteine levels in the patient group; 28.8% of the patient group had lipoprotein (a) concentrations above the cut-off value (30 mg/dl) for increased risk of early atherosclerosis, whereas none of the control patients had concentrations above this value. CONCLUSION: These data indicate that prolonged anticonvulsant treatment could increase plasma homocysteine and lipoprotein (a) concentrations and that it may be useful to measure the levels routinely in order to prevent atherosclerosis in epileptic children taking anticonvulsant drugs.     

Lack of cholesterol-lowering effect of graded doses of cholestyramine in children with Alagille syndrome: a pilot study

BACKGROUND: There is controversy about the potential risk of sustained high concentrations of cholesterol and triglyceride in patients with cholestatic chronic liver disease. However, it is currently accepted that cholesterol-lowering therapy may reduce morbidity and mortality rates in hypercholesterolemic patients without preexisting coronary heart disease, as well as in those with coronary heart disease. The objective of this study was to evaluate the effect of cholestyramine on the serum lipid profile of a group of children with Alagille syndrome and hypercholesterolemia. METHODS: Five children with Alagille syndrome and basal serum cholesterol concentrations greater than 230 mg/dL were included. Total serum cholesterol, triglyceride, low-density, and high-density lipoprotein cholesterol concentrations were measured on days 0, 10, 20, and 30 after the administration of oral cholestyramine 100, 250, and 500 mg(kg.d), respectively. Lipid fractions were reported as mean +/- 1 SD. Statistical analysis was performed with Friedman analysis of variance. RESULTS: The basal values and those of the three 10-day subsequent 100-, 250-, and 500-mg(kg.d) cholestyramine periods were as follows: total cholesterol: 327.6 +/- 77.1, 305.4 +/- 52.1, 290.6 +/- 24.1, and 320.6 +/- 32.3, respectively (P = 0.668); triglyceride: 136.4 +/- 14.6, 144.8 +/- 41.3, 161 +/- 30.9, and 165.4 +/- 40.7, respectively (P = 0.356); low-density lipoprotein cholesterol: 245.4 +/- 57.8, 239.8 +/- 48.6, 242.2 +/- 68.6, and 246.4 +/- 49.5, respectively (P = 0.782); and high-density lipoprotein cholesterol: 44.4 +/- 11.2, 41.8 +/- 12.8, 44.6.2 +/- 13.2, and 47 +/- 8.5, respectively (P = 0.431). CONCLUSION: Under the conditions of the current study, no significant effect of variable doses of cholestyramine could be demonstrated on the serum lipid profile of a series of children with Alagille syndrome. While the controversy on the potential atherogenic risk of low-density lipoprotein hypercholesterolemia in patients with chronic liver disease persists, new, prospective pharmacologic or nutritional trials are required.     

Plasma homocysteine levels in children and adolescents with type 1 diabetes

OBJECTIVE: Hyperhomocysteinemia has been established as a risk factor for cardiovascular disease. The objective was to investigate total plasma homocysteine concentrations in children and adolescents with type 1 diabetes and a control group. METHOD: Twenty-seven children with type 1 diabetes and 27 subjects of an age- and sex-matched control group were recruited. Fasting samples were collected for plasma total homocysteine, serum vitamin B12, folate, and creatinine. RESULTS: Fasting total homocysteine concentrations showed no difference between patients and controls (5.6 +/- 2.9 micromol/L vs 5.7 +/- 2.2 micromol/L; p greater than 0.05). The diabetic patients had significantly higher serum folate than the healthy controls (11.4 +/- 3.3 ng/mL vs 9.4 +/- 4.1 ng/mL; P = 0.02 and higher serum B12 than the control group (282.8 +/- 119 pg/mL vs 228.5 +/- 50.9 pg/mL; P = 0.03). Total plasma homocysteine concentration correlated with age (r = 0.44, P = 0.02), weight (r = 0.56, P = 0.002), body mass index (r = 0.57, P = 0.002), folate (r = -0.48, P = 0.01), and creatinine (r = 0.41, P = 0.03) in diabetic patients. In stepwise multivariate regression model for diabetics, the independent correlates for total plasma homocysteine concentration was folate (P = 0.002). CONCLUSION: We concluded that fasting plasma total homocysteine concentrations were within normal limits in children and adolescents with type 1 diabetes who were without any clinical evidence of microvascular and macrovascular complications.     

单纯性肥胖儿童外周血单核细胞载脂蛋白E基因的表达

目的　探讨单纯性肥胖儿童外周血单核细胞载脂蛋白E基因表达及其与血脂、脂蛋白、载脂蛋白的相关关系。方法　采用竞争性逆转录 聚合酶链式反应方法分析 3 2例单纯性肥胖儿童和 3 2例正常健康儿童外周血单核细胞的载脂蛋白E基因表达。结果　载脂蛋白E基因能在儿童外周血单核细胞表达 ,与健康儿童比较 ,单纯性肥胖儿童外周血单核细胞载脂蛋白E基因表达水平显著下调 (P <0 0 1) ,重度肥胖儿童尤其明显 ,载脂蛋白E基因表达水平与肥胖度呈负相关 (P <0 0 5)。肥胖儿童存在明显的血脂代谢紊乱 ,载脂蛋白E基因表达水平与低密度脂蛋白 胆固醇呈负相关 ,与血载脂蛋白E浓度呈正相关 (P <0 0 5) ,与血总胆固醇、甘油三酯、高密度脂蛋白 胆固醇、脂蛋白 (a)、载脂蛋白AⅠ水平无明显相关 (P >0 0 5)。结论　单纯性肥胖儿童外周血单核细胞载脂蛋白E基因表达水平明显下调 ,并与肥胖程度及血脂代谢异常相关联 ,提示载脂蛋白E基因表达变化可能与肥胖的发生发展及肥胖的心血管病变相关联     

Cord Blood Lipid Profile in a Population of Iranian Term Newborns

Premature coronary artery disease (CAD) and its risk factors are highly prevalent in Iran. It is well documented that atherosclerosis starts in childhood and there is evidence that this association with adult levels may originate at birth, so assessment of serum lipid levels in neonates might be of importance. In this study we aimed to measure serum lipoprotein and apolipoprotein levels in a representative sample of Iranian newborns. Cord blood lipid profile, apolipoprotein A, apolipoprotein B, and lipoprotein a (LPa) were analyzed in 378 full-term, Iranian newborns. The mean values of total cholesterol (TC), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), apolipoprotein A, apolipoprotein B, and Lpa in girls were 81.4 ± 28.3, 35.9 ± 22.4, 31.1 ± 9.9, 87.9 ± 20.2, 34.2 ± 18.2, and 21.0 ± 2.8 mg/dL, respectively; these values in boys were 75.2 ± 21.1, 32.1 ± 16.3, 28.8 ± 8.7, 84.3 ± 16.0, 32.6 ± 14.2, and 19.5 ± 2.7 mg/dL, respectively. Median values of triglycerides (TGs) in boys and girls were 61 and 62 mg/dL, respectively. Female neonates had significantly higher concentrations of TC and HDL-C than males (81.4 ± 28.3 vs. 75.2 ± 21.1, p = 0.02, and 31.18 ± 9.97 vs. 28.8 ± 8.7, p = 0.02, respectively). Other biochemical factors were not significantly different between genders. The mean and median concentrations of LPa were 20.3 and 18.7 mg/dL, respectively, which are almost five times higher than those reported in some other studies. The TG concentration was 1.5–2 times higher than those previously reported. Our findings indicate that serum concentrations of LPa and TG in Iranian neonates are higher than those in previous studies; this disorder, which is likely placing Iranians at increased risk for future CADs, needs to be assessed in longitudinal studies.     

One-Month Therapy with Simvastatin Restores Endothelial Function in Hypercholesterolemic Children and Adolescents

Simvastatin has been shown to restore endothelial function in children with familial hypercolesterolemia after 28 weeks of treatment. The aim of this study was to evaluate 1-month simvastatin treatment effect on endothelial function in hypercholesterolemic children and adolescents. Eighteen hypercholesterolemic patients (HC group) and 18 healthy controls, aged 6–18 years, were studied with medical history, physical examination, full lipid profile, serum apolipoprotein B (apo B), fibrinogen, hepatic transaminases, and creatine kinase concentrations. Flow-mediated dilatation (FMD) was performed by high-resolution ultrasound of the brachial artery. The HC group received simvastatin 10 mg/day for 1 month. Arterial diameter was measured by two experienced sonographers who were unaware of subjects’ conditions. At baseline, FMD was impaired in the HC group (mean, 5.27 ± 4.67%) compared to controls (mean, 15.05 ± 5.97%) (p < 0.001). After treatment, we observed a significant reduction in total cholesterol (TC) (29%), low-density lipoprotein cholesterol (LDL-C); (37%), apo B concentrations (36%) and FMD restoration (mean, 12.94 ± 7.66%), with an absolute increase of 7.66 ± 8.58 (p = 0.001). These results show that children and adolescents with hypercholesterolemia present endothelial dysfunction, and simvastatin, in addition to significantly reducing TC, LDL-C, and apo B concentrations, restores endothelial function with 1-month treatment.     

Effect of phenytoin and valproic acid therapy on serum lipid levels and liver function tests

We conducted a case control study to evaluate the effect of phenytoin and valproic acid on serum lipids and liver function tests in epileptic children. Seventy-nine children receiving at least 6 months of antiepileptic monotherapy were categorized into two groups, depending on whether they were receiving phenytoin or valproic acid. Age matched healthy controls were also included. The mean total cholesterol (TC) in children on phenytoin therapy was significantly higher than the control group (P=0.03). Serum triglycerides, low density lipoprotein cholesterol, very low density lipoprotein cholesterol, and high density lipoprotein cholesterol, were not significantly different in the three groups. The proportion of children with TC > 200mg/dL was significantly higher in the phenytoin group. We recommend monitoring of serum lipids of epileptic children receiving phenytoin.     

窒息新生儿血清同型半胱氨酸与叶酸的变化

目的：探讨血清中高同型半胱氨酸（Hcy）血症及低叶酸水平与新生儿窒息的发生是否具有相关性,并对性别、胎龄等因素对血清中同型半胱氨酸及叶酸水平是否有一定影响进行分析。方法：应用酶联免疫吸附实验方法检测血清中Hcy水平,应用放射免疫法测定血中叶酸浓度。结果：①与无窒息对照组相比, 新生儿窒息患儿血清Hcy水平显著升高,而叶酸水平显著降低;②窒息组男婴血清Hcy、叶酸水平分别为15.82 ±2.51 μmol/L; 2.49 ±0.19 ng/mL,女婴为10.50±2.19 μmol/L; 2.38±0.40 ng/mL,男、女婴之间比较差异无显著性;③窒息组足月儿血清Hcy、叶酸水平为12.34 ±2. 01 μmol/L,2.58 ±0.19 ng/mL;早产儿为21.25±5.01 μmol/L; 2.14±0.34 ng/mL。早产儿Hcy水平显著高于足月儿（P<0.05）。结论：①新生儿窒息与血清Hcy及叶酸水平具有显著相关性。②血清Hcy及叶酸水平在性别上无显著差异。③缺氧窒息合并早产者血清Hcy水平升高最为显著。     

Serum lipids and glucose control: the SEARCH for Diabetes in Youth study

OBJECTIVE: To assess the relationship of serum lipid concentrations with glucose control in youth with diabetes mellitus. DESIGN: Cross-sectional analyses of data from the SEARCH for Diabetes in Youth study. SETTING: Multicenter study of youth with diabetes onset at younger than 20 years. PATIENTS/ PARTICIPANTS: Nineteen hundred seventy-three SEARCH participants aged 10 years or older with hemoglobin A(1c) and fasting total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride measured at the SEARCH study examination. MAIN EXPOSURE: Hemoglobin A(1c). OUTCOME MEASURE: Lipid concentrations. RESULTS: There were significant trends of higher levels of TC, LDL-C, triglyceride, and non-HDL-C (but not HDL-C) with higher hemoglobin A(1c) concentrations for both diabetes types. The slopes of TC increase were 7.8 mg/dL (0.20 mmol/L) per unit increase in hemoglobin A(1c) for type 1 and 8.1 mg/dL (0.21 mmol/L) for type 2. Levels of TC, LDL-C, triglyceride, and non-HDL-C were all significantly higher (all P values <.001) in type 2 than in type 1 diabetes (mean differences in milligrams per deciliter [millimoles per liter], +13.6 [+0.35] for TC; +8.3 [+0.22] for LDL-C; +66.3 [+0.75] for triglyceride; +25.5 [+0.66] for non-HDL-C). Levels of HDL-C were lower in youth with type 2 diabetes (mean difference, -11.9 mg/dL [-0.31 mmol/L]). Among those with type 1 diabetes in poor glycemic control, 35%, 27%, and 12% had high concentrations of TC (>or=200 mg/dL [5.17 mmol/L]), LDL-C (>or=130 mg/dL [3.36 mmol/L]), and triglyceride (>or=200 mg/dL [2.26 mmol/L]), respectively. In youth with type 2 diabetes in poor glycemic control, percentages with high levels of TC, LDL-C, and triglycerides were 65%, 43%, and 40%, respectively. CONCLUSIONS: Glycemic control and lipid levels are independently associated in youth with both type 1 and type 2 diabetes.     

Circulating lipids and glycaemic control in insulin dependent diabetic children

The prevalence of dyslipidaemia in children with insulin dependent diabetes mellitus (IDDM) and its relation to glycaemic control was studied in a group of 51 diabetic children and a control population of 132 schoolchildren. The prevalence of dyslipidaemia in the fasting state was increased in the diabetic group (39%) compared with control subjects (17%). Serum cholesterol concentration alone was raised in 25% of diabetic subjects while serum cholesterol and triglycerides were raised in 14%, compared with 16% and 0.7% respectively in control subjects. Serum total cholesterol (5.1 v 4.5 mmol/l), low density lipoprotein cholesterol (3.2 v 2.6 mmol/l), non-esterified fatty acids (0.91 v 0.50 mmol/l), and triglycerides (0.94 v 0.76 mmol/l) were higher in diabetic children. Serum total cholesterol, triglycerides, and apolipoprotein (apo)B concentrations increased with worsening control, while serum high density lipoprotein cholesterol and apoA-I concentrations were unaltered. There were also positive correlations between glycated haemoglobin and total cholesterol, triglycerides, and apoB in diabetic children. Thus, abnormalities in circulating lipids are common in young subjects with IDDM but largely disappear if blood glucose concentrations are reasonably controlled.     

Circulating lipids and glycaemic control in insulin dependent diabetic children.

The prevalence of dyslipidaemia in children with insulin dependent diabetes mellitus (IDDM) and its relation to glycaemic control was studied in a group of 51 diabetic children and a control population of 132 schoolchildren. The prevalence of dyslipidaemia in the fasting state was increased in the diabetic group (39%) compared with control subjects (17%). Serum cholesterol concentration alone was raised in 25% of diabetic subjects while serum cholesterol and triglycerides were raised in 14%, compared with 16% and 0.7% respectively in control subjects. Serum total cholesterol (5.1 v 4.5 mmol/l), low density lipoprotein cholesterol (3.2 v 2.6 mmol/l), non-esterified fatty acids (0.91 v 0.50 mmol/l), and triglycerides (0.94 v 0.76 mmol/l) were higher in diabetic children. Serum total cholesterol, triglycerides, and apolipoprotein (apo)B concentrations increased with worsening control, while serum high density lipoprotein cholesterol and apoA-I concentrations were unaltered. There were also positive correlations between glycated haemoglobin and total cholesterol, triglycerides, and apoB in diabetic children. Thus, abnormalities in circulating lipids are common in young subjects with IDDM but largely disappear if blood glucose concentrations are reasonably controlled.