SCREENING OF CORD BLOOD LOW-DENSITY-LIPOPROTEIN CHOLESTEROL IN THE DIAGNOSIS OF FAMILIAL HYPERCHOLESTEROLAEMIA: A STUDY OF 2000 INFANTS

Abstract. A prospective follow-up study of infants selected by cord blood total cholesterol (TC) and low-density-lipoprotein cholesterol (LDL-C) levels from 2000 consecutive live births was undertaken to reassess the role of cord blood screening in the diagnosis of familial hypercholesterolaemia (FH). Mean values for serum cholesterol were (mmol/l ± S.D.): TC, 1.83 ± 0.56; LDL-C, 0.90 ± 0.49; HDL-C, 0.70 ± 0.33; TG, 0.38 ± 0.16. Seventy-three of 117 infants who had had a cord TC and/or LDL-C >95th percentile, and 373 control group children (cord TC and/or LDL-C >95th percentile) were followed up at age 3–12 months. Six of the 117 were hypercholesterolaemic (HC), and one child had an HC parent: positive detection rate ≥0.05%; false positive rate ≥3.7%. Four control-group children were HC and had an HC parent; false negative rate ≥1.1%. With the possible exception of detecting FH in a child with a known affected parent, cord blood screening appears to be unreliable for the diagnosis of FH.     

新生儿脐血血脂水平的检测

目的　了解正常足月新生儿脐血血脂水平 ,确定筛查家族性高胆固醇血症患儿的血脂上界。方法　采用全自动生化分析仪 ,分别采用酶法和一步法检测 2 42例正常足月新生儿脐血的总胆固醇 (TC)、甘油三酯 (TG)、低密度脂蛋白胆固醇 (LDL C)、高密度脂蛋白胆固醇 (HDL C)的含量。结果正常足月新生儿脐血TC、TG、LDL C和HDL C分别为 ( 1 69± 0 40 )mmol/L、( 0 2 3± 0 12 )mmol/L、( 0 81± 0 2 1)mmol/L和 ( 0 5 8± 0 16)mmol/L ,除女婴的HDL C值高于男婴外 (P <0 0 5 ) ,其余指标男女差异无显著性 (P >0 0 5 )。结论　筛查家族性高胆固醇血症患儿的脐血血脂上界值推荐为TC≥2 47mmol/L和LDL C≥ 0 89mmol/L。     

Hyperlipidemia in school children with family histories of premature coronary heart disease

Children starting their schooling were given a questionnaire asking about the occurrence of premature (before 50 years of age in men, 55 years in women) coronary heart disease (CHD) in first degree relatives. 1,920 of 2,069 questionnaires were answered, 140 of the 7-year-old children were reported to have a first degree relative with premature CHD, 84 of these 140 families agreed to participate in our study. In 79 of the 84 families both the child and the parent at 'high risk' were tested. In the initial test 19 of 84 children had total cholesterol (TC) levels above the 95th percentile (greater than 5.35 mmol/l). In the repeat test 12 of the 19 TC tests remained abnormal and all 12 also had LDL-cholesterol (LDL-C) levels above the 95th percentile (greater than 3.40 mmol/l). None had abnormal HDL-cholesterol or triglyceride levels. Among the high risk parents, 12 of 79 had abnormal initial blood lipid tests. In the repeat test 10 parents had both TC and LDL-C levels above the 95th percentile. In five families both the child and the parent had abnormal TC and LDL-C levels. In conclusion, a considerable proportion of children and parents with family histories of premature CHD have TC and LDL-C concentrations above the 95th percentile (in the present study, about 40 individuals in 140 high-risk families, if the parent and child considered at high risk all had agreed to participate). Prevention of heart disease should begin in childhood when patterns of life-style are developed. Identification by obtained family histories as in the current study may be a method of choice.     

Hyperlipidemia in School Children with Family Histories of Premature Coronary Heart Disease

ABSTRACT. Children starting their schooling were given a questionnaire asking about the occurrence of premature (before 50 years of age in men, 55 years in women) coronary heart disease (CHD) in first degree relatives. 1920 of 2069 questionnaires were answered, 140 of the 7-year-old children were reported to have a first degree relative with premature CHD. 84 of these 140 families agreed to participate in our study. In 79 of the 84 families both the child and the parent at 'high risk' were tested. In the initial test 19 of 84 children had total cholesterol (TC) levels above the 95th percentile (>5.35 mmol/l). In the repeat test 12 of the 19 TC tests remained abnormal and all 12 also had LDL-cholesterol (LDL-C) levels above the 95th percentile (>3.40 mmol/l). None had abnormal HDL-cbolesterol or triglyceride levels. Among the high risk parents, 12 of 79 had abnormal initial blood lipid tests. In the repeat test 10 parents had both TC and LDL-C levels above the 95th percentile. In five families both the child and the parent had abnormal TC and LDL-C levels. In conclusion, a considerable proportion of children and parents with family histories of premature CHD have TC and LDL-C concentrations above the 95th percentile (in the present study, about 40 individuals in 140 high-risk families, if the parent and child considered at high risk all had agreed to participate). Prevention of heart disease should begin in childhood when patterns of life-style are developed. Identification by obtained family histories as in the current study may be a method of choice.     

Hyperlipoproteinemia in newborn infants. A study of 1025 families.

As part of a screening study for the detection of hyperlipoproteinemia in 10,000 newborns, cord serum lipids and lipoproteins were measured in detail in 1025 infants. Elevated cord serum VLDL-LDL-cholesterol could easily be identified by a rapid turbidimetric estimation of cord serum VLDL-LDL. Cord serum VLDL-LDL-cholesterol was found to be significantly higher than normal in premature, asphyxiated and beta-methasone-phenobarbital-ritodrine treated infants. Other obstetric complications, however, were not associated with hyperlipoproteinemia. Furthermore all 2050 parents had their serum cholesterol determined. 3 parents had familial hypercholesterolemia (FH). One child also had FH, though her cord serum total cholesterol and VLDL-LDL-cholesterol were normal. The 2 other children of the 3 FH parents, had normal lipids and lipoproteins both at birth and follow-up.     

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.     

HYPERLIPOPROTEINEMIA IN NEWBORN INFANTS

ABSTRACT. Andersen, G. E., Lous, P. and Friis-Hansen, B. (Neonatal Department, Rigshospitalet, and the Department of Clinical Chemistry, Bispebjerg Hospital, Copenhagen, Denmark). Hyperlipoproteinemia in newborn infants. A study of 1025 families. Acta Paediatr Scand, 68: 683, 1979.—As part of a screening study for the detection of hyperlipoproteinemia in 10000 newborns, cord serum lipids and lipoproteins were measured in detail in 1025 infants. Elevated cord serum VLDL-LDL-cholesterol could easily be identified by a rapid turbidimetric estimation of cord serum VLDL-LDL. Cord serum VLDL-LDL-cholesterol was found to be significantly higher than normal in premature, asphyxiated and betamethasone-phenobarbital-ritodrine treated infants. Other obstetric complications, however, were not associated with hyperlipoproteinemia. Furthermore all 2050 parents had their serum cholesterol determined. 3 parents had familial hypercholesterolemia (FH). One child also had FH, though her cord serum total cholesterol and VLDL-LDL-cholesterol were normal. The 2 other children of the 3 FH parents, had normal lipids and lipoproteins both at birth and follow-up.     

Parental history of cardiovascular disease as an indication for screening for lipoprotein abnormalities in children

We studied the relationship between parental history of cardiovascular disease and risk for adverse lipid and lipoprotein levels in a total community study of 3313 children (ages 4 to 17 years, 63% white, 37% black). Older white children (11 to 17 years) with a parental history of heart attack or diabetes were 4.3 and 5.6 times, respectively, more likely to have high levels (greater than or equal to 95th percentile) of serum total cholesterol than those without such a history (all p less than 0.05). White children with a parental history of heart attack or diabetes were twice as likely to have an elevated (greater than or equal to 95th percentile) low-density lipoprotein cholesterol (LDL-C) level than those without such a history (both p less than 0.05). In contrast, parental history of cardiovascular disease did not predict elevated levels of total cholesterol or LDL-C in black children. However, older black children with a parental history of heart attack, hypertension, or diabetes were 4 1/2 to 5 times more likely to have low levels (less than or equal to 5th percentile) of high-density lipoprotein cholesterol than those without such a history (all p less than 0.05). Only 40% of white children and 21% of black children with elevated LDL-C levels had a parental history of vascular disease. These findings raise questions about the current practice of screening only children with a family history of cardiovascular disease to identify those with elevated total cholesterol and LDL-C levels.     

Familial history of cardiovascular disease and blood lipid pattern in newborn infants

The levels of atherogenic lipid fractions are higher in children with a family history of ischemic cardiovascular disease (CD). This study was designed to examine this relationship in neonates. A total of 1276 newborns were investigated; 400 cord blood samples were collected for measurement of triglycerides (TG), total cholesterol (TC), LDL cholesterol (LDL-C) and HDL cholesterol (HDL-C); on day 4, 1200 capillary samples were taken for TC and TG measurements. Male newborns with a positive history of CD had higher concentrations of cord blood TC (P less than 0.04) and LDL-C (P less than 0.02). On day 4 this difference in TC was no longer detectable (LDL-C not determined). A coronary heart disease (CHD) risk factor family history is sensitive (0.87) in predicting high cord blood concentrations of LDL-C, the specificity being 0.46 and the positive predicting value 0.08.     

Family history evaluation as a predictive screen for childhood hypercholesterolemia. Pediatric Practice Research Group

A study was conducted to evaluate the efficacy of family history factors as screening criteria for childhood hypercholesterolemia. When they were seen for routine care at one of eight office practices, 1005 prepubertal children underwent random serum cholesterol determinations. Parental and grandparental histories of cardiovascular risk factors and atherosclerotic complications prior to 55 years of age were also obtained. Of the initial group, 274 children had total cholesterol levels greater than or equal to 175 mg/dL, and 175 of these children returned for retesting after an overnight fast. A total of 88 children were found to have low-density lipoprotein-cholesterol (LDL-C) values greater than or equal to 90th percentile for age and sex. Maternal and paternal histories of hypercholesterolemia were significantly associated with elevated LDL-C (odds ratio = 7.3 and 2.9, respectively), but had extremely low sensitivities (0.09, 0.15) despite modest positive predictive values (0.42, 0.22). Grandparental histories of sudden death, peripheral vascular disease, and gout were associated with elevated LDL-C, but sensitivities and positive predictive values for all of these factors were less than 0.22. Family history factors most commonly recommended as criteria for cholesterol screening in children did not identify half of all the children with elevated LDL-C and did not selectively identify the most severely affected children. Adding information concerning the presence of childhood obesity did not result in appreciable improvement in LDL-C detection beyond that achieved by family history factors alone. It was concluded that if thorough identification of young children with elevated LDL-C is desired, inclusive population screening rather than a family history-based strategy would be the most effective approach.     

Influence of food intake, age, gender, HbA1c, and BMI levels on plasma cholesterol in 29 979 children and adolescents with type 1 diabetes – reference data from the German diabetes documentation and quality management system (DPV)

Objective:  We investigated influences of a 12-h fast, age, gender, body mass index (BMI), hemoglobin A1c (HbA1c) on total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) to provide reference percentiles for TC, LDL-C, and HDL-C of patients with good diabetes control (HbA1c < 7.5%) and normal weight (BMI < 90th percentile).
Method:  A cross-sectional analysis of the diabetes documentation and quality management system using the diabetes data acquisition system for prospective surveillance (DPV) software included 29 979 patients with type 1 diabetes mellitus (T1DM) aged 1–20 yr (52.4% male) from 253 diabetes centers in Germany and Austria.
Results:  Fasting had no relevant influence on TC, LDL-C, and HDL-C. Multivariate regression analysis revealed strongest dependences of cholesterol on gender and HbA1c followed by BMI and age. Reference cholesterol percentiles of well-controlled and normal weight patients showed TC ≥4.40 mmol/L (170 mg/dL) corresponding to the 50th percentile in females and the 75th percentile in males. LDL-C ≥2.59 mmol/L (100 mg/dL) corresponded to the 50th–75th percentile in females and the 75th percentile in males.
Conclusions:  (i) Fasting is no precondition for the determination of TC, LDL-C, and HDL-C; (ii) TC, LDL-C, and HDL-C are strongest associated with gender and HbA1c followed by BMI and age; (iii) Gender- and age-adjusted cholesterol percentiles of well-controlled and normal weight patients with T1DM may serve as reference values and are similar to healthy German children; and (iv) Single target values for TC, LDL-C, and HDL-C based on healthy individuals' data do not sufficiently characterize abnormal cholesterol levels in young patients with T1DM.     

Plant stanols do not restore endothelial function in pre-pubertal children with familial hypercholesterolemia despite reduction of low-density lipoprotein cholesterol levels

OBJECTIVE: To examine the effect of plant stanols on lipids and endothelial function in pre-pubertal children with familial hypercholesterolemia (FH). STUDY DESIGN: Children with FH (n=42), aged 7-12 years, were enrolled in a double-blind crossover trial, in which they consumed 500 mL of a low-fat yogurt enriched with 2.0 g of plant stanols and 500 mL of a low-fat placebo yogurt for 4 weeks, separated by a 6-week washout period. Lipid profiles and endothelial function were assessed after both consumption periods. Endothelial function was measured as flow-mediated dilation (FMD) of the brachial artery. RESULTS: This daily intake of 2.0 g of stanols significantly decreased the levels of total cholesterol (TC) by 7.5% and low-density lipoprotein cholesterol (LDL-C) by 9.2% as compared with placebo. High-density lipoprotein cholesterol and triglyceride levels remained unaltered. The reduction of LDL-C levels did not improve FMD, which was 10.5%+/-5.1% after plant stanol consumption and 10.6%+/-5.0% after placebo consumption, respectively (P=.852). CONCLUSION: This study demonstrates that plant stanols reduce LDL-C levels in children with FH without improving endothelial function.     

Resetting the detection level of cord blood thyroid stimulating hormone (TSH) for the diagnosis of congenital hypothyroidism

An appraisal of a 17-year primary thyroid stimulating hormone (TSH) screening programme for the detection of congenital hypothyroidism was carried out to establish the reference interval of cord blood TSH in unaffected infants; the mean cord blood TSH concentration of affected infants and the incidence of congenital hypothyroidism in the Najran province of Saudi Arabia. Our findings show a reference interval of cord blood TSH of 2.0-16.8 mU/l in unaffected infants; a mean cord blood TSH concentration of 399 mU/l in affected infants; a false positive rate for the diagnosis of at-risk infants of 1.02% and a congenital hypothyroidism incidence rate of 34/100 000 (1 : 2931) live births. These findings suggest that there is a need to reset the cord blood TSH concentration for the detection of at-risk infants. We suggest that the detection level of cord blood TSH for the recognition of at-risk infants can be set at 90 mU/l rather than the recommended level of 30 mU/l. This should reduce the false positive rate for detection of infants at risk of congenital hypothyroidism.     

Safety and efficacy of long-term diet and diet plus bile acid-binding resin cholesterol-lowering therapy in 73 children heterozygous for familial hypercholesterolemia

Our specific aim was to examine the efficacy and safety of long-term cholesterol-lowering diet and bile acid-binding resin therapy in 73 children heterozygous for familial hypercholesterolemia (FH). We prospectively followed accretion of height and weight in 40 FH children for 5.8 years on diet alone and in 33 FH children for 4.3 years on diet and bile acid-binding resins (8 to 20 g/d). In 67 of these 73 children, sequential data on plasma cholesterol lowering was obtained, including 32 children on diet plus bile acid-binding resins and 35 on diet alone. For all 73 children, median age, sex, and race-specific percentiles for height and weight at entry were 50 and 50, respectively, and 5.7 years later, were unchanged at 50 and 50. Initial and final percentiles for height (r = .76, P less than .001) and weight (r = .70, P less than .001) were closely correlated. Percentile distributions for height and weight at entry into the study did not differ from those at the end of follow-up (P greater than .1), in both the 40 FH children on diet alone and the 33 on diet plus bile acid-binding resins. Tracking of height and weight did not differ in the 40 children on diet alone v the 33 on diet plus bile acid-binding resins (P greater than .1). During 6 years of follow-up there were no significant differences in the percentage of serial, postbaseline measurements for height which were either less than or greater than or equal to baseline percentiles, comparing 40 FH children on diet alone, 33 FH children on diet plus resin, and 39 normal children (on ad libitum diet). FH children on diet or plus resin had a smaller percentage of weight measurements equal to or more than baseline percentiles than normals on follow-up (P less than .01), probably reflecting restriction of total fat intake to less than 35% of calories. On diet alone, 32 FH children had total plasma cholesterol of 307 +/- 8 mg/dL (mean +/- SE); bile acid-binding resins were added to diet in these children at an average age of 11.5 years, with this regimen maintained for 4.6 +/- 0.4 years, leading to a mean reduction in total plasma cholesterol of 12.5% +/- 2% beyond the effects of diet alone (P less than .01).(ABSTRACT TRUNCATED AT 400 WORDS)     

Effects of hydralazine on cardiac performance in infants receiving extracorporeal membrane oxygenation

To determine the effects of afterload reduction on cardiac performance during partial cardiopulmonary bypass, we administered hydralazine to infants who were either normotensive (n = 11) or hypertensive (n = 12) 1 hour after extracorporeal membrane oxygenation (ECMO) was begun. Load-dependent and load-independent measures of cardiac performance and indexes of cerebral blood flow were measured. Infants in both groups had similar weight, heart rate, blood pressure, and inotropic support before ECMO. Shortening fraction was normal in both groups before ECMO (47 +/- 11% vs 49 +/- 10%; p greater than or equal to 0.05), decreased during ECMO (31 +/- 18% vs 39 +/- 12%; p greater than or equal to 0.05), and did not change after administration of hydralazine (31 +/- 12% vs 37 +/- 8%; p greater than or equal to 0.05). Cardiac output was normal in both groups before ECMO (176 +/- 71 vs 157 +/- 72 ml/kg per minute; p greater than or equal to 0.05), decreased during ECMO (120 +/- 80 vs 105 +/- 64 ml/kg per minute; p greater than or equal to 0.05), and did not change after hydralazine administration. Velocity of circumferential fiber shortening, an index of contractility (circumference per second), was normal in both groups before ECMO (1.96 +/- 0.57 vs 1.90 +/- 0.43 circ/sec; p greater than or equal to 0.05), decreased during ECMO (1.18 +/- 0.83 vs 1.56 +/- 0.58 circ/sec; p greater than or equal to 0.05), and did not change after hydralazine administration. The relationship between velocity of circumferential fiber shortening and wall stress was similar in both groups before ECMO, during ECMO, and after hydralazine administration. The cerebral blood flow resistance index was similar in both groups before ECMO (0.70 +/- 0.16 vs 0.70 +/- 0.20; p greater than or equal to 0.05), decreased during ECMO (0.45 +/- 0.13 vs 0.43 +/- 0.09; p greater than or equal to 0.05), and did not change after administration of hydralazine. We conclude that hydralazine does not improve cardiac performance during ECMO.     

Iron status at 9 months of infants with low iron stores at birth

OBJECTIVE: To determine the 9-month follow-up iron status of infants born with abnormally low serum ferritin concentrations.Study design: Ten infants of >34 weeks' gestation with cord serum ferritin concentrations <5th percentile at birth (<70 microg/L) and 12 control infants with cord serum ferritin concentrations >80 microg/L had follow-up serum ferritin concentrations measured at 9 +/- 1 month of age. The mean follow-up ferritins, incidences of iron deficiency and iron-deficiency anemia, and growth rates from 0 to 12 months were compared between the two groups. RESULTS: At follow-up, the low birth ferritin group had a lower mean ferritin than the control group (30 +/- 17 vs 57 +/- 33 microg/L; P =.03), but no infant in either group had iron deficiency (serum ferritin <10 microg/L) or iron-deficiency anemia. Both groups grew equally well, but more rapid growth rates were associated with lower follow-up ferritin concentrations only in the low birth ferritin group (r = -0.52; P =.05). Both groups were predominantly breast-fed without iron supplementation before 6 months. CONCLUSIONS: Infants born with serum ferritin concentrations <5th percentile continue to have significantly lower ferritin concentrations at 9 months of age compared with infants born with normal iron status, potentially conferring a greater risk of later onset iron deficiency in the second postnatal year.     

Membrane fluid properties of cord blood mononuclear leucocytes: association with increased insulin receptors

Insulin receptors are present on fetal and newborn tissues in significantly greater numbers than on adult tissues. Recent studies have suggested that membrane fluidity, which is dependent upon lipid constituents, is important in regulating the appearance and behavior of insulin receptors. We have compared the lipid composition and fluidity as well as insulin receptor binding to monocytes from normal adults and full term normal infants. Newborn infants had significantly higher insulin levels than did fasting adults (17.4 +/- 2.4 versus 9.8 +/- 0.6 microU/ml; P less than 0.001); despite this, cord blood monocytes showed significantly higher 125I-insulin tracer binding than did those of adults (9.5 +/- 0.51 versus 7.6 +/- 0.45%/10(7) cells; P less than 0.02). From Scatchard analysis, it was evident that cord monocytes had greater numbers of both high (2.94 versus 1.25 X 10(-10) M-1) and low affinity (13.1 versus 8.57 X 10(-10) M-1) receptors than adult monocytes. Cord mononuclear cells had significantly lower phospholipid concentrations than adult cells (0.085 +/- 0.012 versus 129 +/- 0.012 mg/mg of protein; P less than 0.025) and significant elevations of cholesterol/phospholipid ratios (0.520 +/- 0.045 versus 0.354 +/- 0.009; P less than 0.005). Microviscosity determinations were performed using the fluorescent probe 1,6-diphenyl-1,3,5-hexatriene. Cord cells had significantly greater microviscosity values (fluorescence polarization) (0.339 +/- 0.030 versus 0.186 +/- 0.019; P less than 0.005), compared to adult cells. For all subjects, a highly significant correlation was noted between cell microviscosity measurements (fluorescence polarization) and 125I-insulin tracer binding to mononuclear cells (r = 0.72, n = 15, P less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)     

Apolipoprotein A-I and B levels in adolescents; a trial to define subjects at risk for coronary heart disease

The normal levels of apolipoprotein A-I and B (apo A-I, apo B) were determined in 220 male and 340 female 16-19-year-old adolescents. In addition to these apolipoproteins, total and high density lipoprotein cholesterol (total-C HDL-C) were analysed in an attempt to define subjects at high risk for coronary heart disease (CHD). The normal levels were for boys: apo A-I 0.96 +/- 0.13 g/l, apo B 0.64 +/- 0.14 g/l; for girls: apo A-I 1.04 +/- 0.18 g/l, apo B 0.65 +/- 0.14 g/l; for girls taking combined oral contraceptives: apo A-I 1.14 +/- 0.22 g/l, apo B 0.72 +/- 0.16 g/l. Subjects with the following high-risk profiles were selected for further follow-up: 1. Total-C and apo B greater than or equal to 95th percentile; 2. Total-C or apo B greater than or equal to 95th and HDL-C or apo A-I less than or equal to 5th percentile. Seven adolescents had the combination of high total-C and apo B. None had any of the other combinations. One girl had lipid, apolipoprotein levels and a family history indicating familial hypercholesterolemia (f.h.). Another two adolescents were suspected of having f.h. while one girl might have abnormal levels secondary to oral combined contraceptives. The study suggests that the analyses of apolipoproteins, especially apo B, are of value to trace adolescents at risk for future CHD.     

Is Family History of Premature Cardiovascular Diseases Appropriate for Detection of Dyslipidemic Children in Population-Based Preventive Medicine Programs? CASPIAN Study

The objectives of this study were to determine the prevalence of dyslipidemia and the usefulness of self-report family history (FH) of premature cardiovascular disease (CVD) for identifying children with lipid disorders. This study was conducted on a representative, population-based sample of 4811 Iranian children and adolescents (2248 boys and 2563 girls) aged 6–18 years. We compared the obtained serum lipid profile with that of the Lipid Research Clinic (LRC) and calculated the predictive value of FH for detecting those children with dyslipidemia. Overall, for both genders and for age groups, the mean serum triglycerides (TG) and its percentiles were significantly higher, and the mean and percentiles of total, low-density, and high-density cholesterol (TC, LDL-C, and HDL-C respectively) were significantly lower than the LRC values. In total, 45.7% of participants had dyslipidemia; the most frequent ones were low HDL-C (24.8%) and hypertriglyceridemia (24.5%), followed by hypercholesterolemia (6.4%) and high LDL-C (6.3%), respectively. The mean serum lipid levels and the anthropometric measures were not significantly different among those with or without positive FH. The sensitivity, and specificity, positive and negative predictive values for FH in detecting those children with dyslipidemia were 28.4, 70.3. 44.7, and 53.8%, respectively. The usefulness of FH in identifying dyslipidemic children was relatively low. The common lipid disorders in our community were the components of the metabolic syndrome. We suggest that the current guidelines for screening lipid disorders in youths, which are based on cholesterol, should consider such ethnic differences.     

The effect of intrauterine malnutrition on the term infant. A 14-year progressive study

The developmental outcome of 33 newborn infants with clinical intrauterine malnutrition at birth and 13 clinically well nourished infants from a middle to high socio-economic population have been followed from birth to 12-14 years of age. Psychometric studies revealed a lowering of the IQ score in malnourished infants compared to well nourished infants (104 +/- 15 compared to 121 +/- 13, p less than 0.05) and a need for special education (p less than 0.03). Forty-five percent of the malnourished infants' birth weights were above the 10th percentile on the Colorado Intrauterine Growth Grid. The Full Scale IQ of malnourished infants with BW greater and less than 10th percentile on the Colorado Intrauterine Growth Grid were comparable. Malnourished infants with birth weights greater than 10th percentile had lower IQ scores than well nourished infants (101 +/- 13 compared to 121 +/- 13, p less than 0.006). Thirty-nine percent of the infants with handicaps would have been missed if only infants with birth weights less than 10th percentile were considered high risk.