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Original Investigation
May 21, 2019

Trends in Levels of Lipids and Apolipoprotein B in US Youths Aged 6 to 19 Years, 1999-2016

Author Affiliations
  • 1Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 2Division of Cardiology, Department of Pediatrics, Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 3National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
  • 4Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
  • 5Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
JAMA. 2019;321(19):1895-1905. doi:10.1001/jama.2019.4984
Key Points

Question  What are the recent trends in serum levels of lipids and apolipoprotein B in US youths aged 6 to 19 years?

Findings  In this serial cross-sectional analysis of nationally representative data from 26 047 youths during the period 1999-2000 to 2015-2016, decreasing linear trends were observed in mean levels of total cholesterol (from 164 mg/dL to 155 mg/dL), non–high-density lipoprotein cholesterol (from 108 mg/dL to 100 mg/dL), low-density lipoprotein cholesterol (from 92 mg/dL to 86 mg/dL), triglycerides (from 78 mg/dL to 63 mg/dL), and apolipoprotein B (from 70 mg/dL to 67 mg/dL), and increasing linear trends were observed in mean levels of high-density lipoprotein cholesterol (from 52.5 mg/dL to 55.0 mg/dL).

Meaning  Lipids and apolipoprotein B changed favorably in US youths during recent years.

Abstract

Importance  Favorable trends occurred in the lipid levels of US youths through 2010, but these trends may be altered by ongoing changes in the food supply, obesity prevalence, and other factors.

Objective  To analyze trends in levels of lipids and apolipoprotein B in US youths during 18 years from 1999 through 2016.

Design, Setting, and Participants  Serial cross-sectional analysis of US population–weighted data for youths aged 6 to 19 years from the National Health and Nutrition Examination Surveys for 1999 through 2016. Linear temporal trends were analyzed using multivariable regression models with regression coefficients (β) reported as change per 1 year.

Exposures  Survey year; examined periods spanned 10 to 18 years based on data availability.

Main Outcomes and Measures  Age- and race/ethnicity-adjusted mean levels of high-density lipoprotein (HDL), non-HDL, and total cholesterol. Among fasting adolescents (aged 12-19 years), mean levels of low-density lipoprotein cholesterol, geometric mean levels of triglycerides, and mean levels of apolipoprotein B. Prevalence of ideal and adverse (vs borderline) levels of lipids and apolipoprotein B per pediatric lipid guidelines.

Results  In total, 26 047 youths were included (weighted mean age, 12.4 years; female, 51%). Among all youths, the adjusted mean total cholesterol level declined from 164 mg/dL (95% CI, 161 to 167 mg/dL) in 1999-2000 to 155 mg/dL (95% CI, 154 to 157 mg/dL) in 2015-2016 (β for linear trend, −0.6 mg/dL [95% CI, −0.7 to −0.4 mg/dL] per year). Adjusted mean HDL cholesterol level increased from 52.5 mg/dL (95% CI, 51.7 to 53.3 mg/dL) in 2007-2008 to 55.0 mg/dL (95% CI, 53.8 to 56.3 mg/dL) in 2015-2016 (β, 0.2 mg/dL [95% CI, 0.1 to 0.4 mg/dL] per year) and non-HDL cholesterol decreased from 108 mg/dL (95% CI, 106 to 110 mg/dL) to 100 mg/dL (95% CI, 99 to 102 mg/dL) during the same years (β, −0.9 mg/dL [95% CI, −1.2 to −0.6 mg/dL] per year). Among fasting adolescents, geometric mean levels of triglycerides declined from 78 mg/dL (95% CI, 74 to 82 mg/dL) in 1999-2000 to 63 mg/dL (95% CI, 58 to 68 mg/dL) in 2013-2014 (log-transformed β, −0.015 [95% CI, −0.020 to −0.010] per year), mean levels of low-density lipoprotein cholesterol declined from 92 mg/dL (95% CI, 89 to 95 mg/dL) to 86 mg/dL (95% CI, 83 to 90 mg/dL) during the same years (β, −0.4 mg/dL [95% CI, −0.7 to −0.2 mg/dL] per year), and mean levels of apolipoprotein B declined from 70 mg/dL (95% CI, 68 to 72 mg/dL) in 2005-2006 to 67 mg/dL (95% CI, 65 to 70 mg/dL) in 2013-2014 (β, −0.4 mg/dL [95% CI, −0.7 to −0.04 mg/dL] per year). Favorable trends were generally also observed in the prevalence of ideal and adverse levels. By the end of the study period, 51.4% (95% CI, 48.5% to 54.2%) of all youths had ideal levels for HDL, non-HDL, and total cholesterol; among adolescents, 46.8% (95% CI, 40.9% to 52.6%) had ideal levels for all lipids and apolipoprotein B, whereas 15.2% (95% CI, 13.1% to 17.3%) of children aged 6 to 11 years and 25.2% (95% CI, 22.2% to 28.2%) of adolescents aged 12 to 19 years had at least 1 adverse level.

Conclusions and Relevance  Between 1999 and 2016, favorable trends were observed in levels of lipids and apolipoprotein B in US youths aged 6 to 19 years.

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