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Year-to-Year Variability of Cholesterol Levels in a Pediatric Practice

Year-to-Year Variability of Cholesterol Levels in a Pediatric Practice Abstract Objectives: To study the impact of the variability of blood cholesterol levels, which are known to vary spontaneously. The impact of this variability on screening for hypercholesterolemia according to National Cholesterol Education Program (NCEP) guidelines was reviewed in a private pediatric practice. Design: Retrospective chart review. Setting: Private pediatric practice. Patients: Children (N=646) aged 3 to 19 years. Intervention: Cholesterol measurements at a mean interval of 19 months between visits. Main Outcome Measures: Year-to-year change in cholesterol levels according to NCEP guidelines, regression to the mean, age, pubertal status, body mass index, hematocrit, interval between measurements, and season of the year were assessed for their contribution to cholesterol level variability. Results: Cholesterol level varied significantly with both age (P<.001) and pubertal status (P<.01) with children aged 9 to 12 years; prepubertal children had the highest levels. Visit-to-visit consistency of NCEP classification was poorer for younger children than for older children (κ=0.21 for 3- to 6-year-olds, 0.39 for 6- to 10-year-olds, and 0.44 for those older than 10 years). Of children with initial total cholesterol levels of 5.17 mmol/L (200 mg/dL) or greater, only 40% continued to have high levels at follow-up. A child with an initial cholesterol value of 5.17 mmol/L (200 mg/dL) showed an average decline of 0.34 mmol/L (13 mg/dL) at follow-up by regression analysis. Conclusion: Year-to-year variability in total cholesterol level has a significant impact on the stability of NCEP classification.(Arch Pediatr Adolesc Med. 1995;149:292-296) References 1. National Cholesterol Education Program. Report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents . Bethesda, Md: National Institutes of Health, 1991. US Dept of Health and Human Services publication 91-2732. 2. Gidding SS. The rationale for lowering serum cholesterol levels in American children . AJDC . 1993;147:386-392. 3. Resnicow K, Berenson G, Shea S, Srinivasan S, Strong W, Wynder EL. The case against childhood cholesterol screening . JAMA . 1991;265:3003-3005.Crossref 4. Newman TB, Browner WS, Hulley SB. The case against childhood cholesterol screening . JAMA . 1990;264:3039-3043.Crossref 5. Bookstein L, Gidding SS, Donovan M, Smith FA. Day-to-day variability of serum cholesterol, triglyceride, and high-density lipoprotein cholesterol levels . Arch Intern Med . 1990;150:1653-1657.Crossref 6. Gillman MW, Cupples LA, Moore LL, Ellison RC. Impact of within-person variability on identifying children with hypercholesterolemia: Framingham Children's Study . J Pediatr . 1992;121:342-347.Crossref 7. Kafonek SD, Derby CA, Bachorik PS. Biological variability of lipoproteins and apolipoproteins in patients referred to a lipid clinic . Clin Chem . 1992;38:864-872. 8. Lauer RM, Clarke WR. Use of cholesterol measurements in childhood for the prediction of adult hypercholesterolemia: the Muscatine Study . JAMA . 1990; 264:3034-3038.Crossref 9. National Cholesterol Education Program. Current status of blood cholesterol measurement in clinical laboratories in the United States: report from the laboratory standardization panel . Clin Chem . 1988;34:193-201. 10. Benuck I, Gidding SS. Donovan M, Traisman ES, Traisman HS. Usefulness of parental total cholesterol levels in identifying children with hypercholesterolemia . Am J Cardiol . 1992;69:713-717.Crossref 11. Fleiss, TL. Statistical Methods for Rates and Proportions . New York, NY: John Wiley & Sons Inc; 1981. 12. Landis RJ, Koch GG. The measurement of interobserver agreement for categorical data . Biometrics . 1977;33:159-174.Crossref 13. Draper N, Smith H. Applied Regression Analysis . 2nd ed. New York, NY: John Wiley & Sons Inc; 1981:10-31. 14. Kwiterovich PO Jr, Fredrickson DS, Levy RI. Familial hypercholesterolemia (one form of familial type II hyperlipoproteinemia): a study of its biochemical, genetic, and clinical presentation in childhood . J Clin Invest . 1974;53:1237-1247.Crossref 15. Kallio MJT, Salmenpera L, Siimes MA, Perheentpa J, Miettinerr TA. Tracking of serum cholesterol and lipoprotein levels from the first year of life . Pediatrics . 1993;91:949-954. 16. Freedman DS, Srinivasan SR, Cresanta JL, Webber LS, Berenson GS. Serum lipids and lipoproteins . Pediatrics . 1987;80( (suppl) ):789-796. 17. Freedman DS, Byers T, Sell K, Kuester S, Newell E, Lee S. Tracking of serum cholesterol levels in a multiracial sample of preschool children . Pediatrics . 1992; 90:80-86. 18. Orchard TJ, Donahue RP, Kuller LH. Cholesterol screening in childhood: does it predict hypercholesterolemia? the Beaver County experience . J Pediatr . 1983; 103:687-691.Crossref 19. Webber LS, Srinivasan SR, Wattigney WA, Berenson GS. Tracking of serum lipids and lipoproteins from childhood to adulthood: the Bogalusa Heart Study . Am J Epidemiol . 1991;133:884-899. 20. Gao S, Beckett L, Chumlea WC, Roche AF. Serial analysis of plasma lipids and lipoproteins from 9 to 21 years . Am J Clin Nutr . 1993;58:61-67. 21. Clarke WR, Schrott HG, Leaverton PE, Connor WE, Lauer RM. Tracking of blood lipids and blood pressure in school age children: the Muscatine Study . Circulation . 1978;58:626-634.Crossref 22. Demacker PNM, Schade RWB, Jansen RTP, Van't Laar A. Intra-individual variation of serum cholesterol, triglycerides, and high density lipoprotein cholesterol in normal humans . Atherosclerosis . 1982;45:259-266.Crossref 23. Bennett MJ, Tershakovec AM, Cortner JA, Shannon BM. A quality assurance program for the measurement of capillary blood cholesterol levels in private pediatric practices: the Children's Health Project . AJDC . 1993;147:340-345. 24. Resnicow K, Morley-Kotchen J, Wynder EL. Plasma cholesterol levels of 6585 children in the United States: results of the Know Your Body screening in five states . Pediatrics . 1989;84:969-976. 25. Griffin TC, Christoffel KK, Binns HG, McGuire PA, Pediatric Practice Research Group. Family history evaluation as a predictive screen for childhood hypercholesterolemia . Pediatrics . 1989;84:365-373. 26. Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group. Relationship of atherosclerosis in young men to serum lipoprotein cholesterol concentrations and smoking . JAMA . 1990;264:3018-3024.Crossref 27. Mahoney LT, Stanford W, Thompson BH, Burns TL, Witt JD, Lauer RM. The relationship of risk factors to noninvasive assessment of coronary atherosclerosis in young men . Circulation . 1994;89:940. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Pediatrics & Adolescent Medicine American Medical Association

Year-to-Year Variability of Cholesterol Levels in a Pediatric Practice

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References (35)

Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
1072-4710
eISSN
1538-3628
DOI
10.1001/archpedi.1995.02170150072013
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Abstract

Abstract Objectives: To study the impact of the variability of blood cholesterol levels, which are known to vary spontaneously. The impact of this variability on screening for hypercholesterolemia according to National Cholesterol Education Program (NCEP) guidelines was reviewed in a private pediatric practice. Design: Retrospective chart review. Setting: Private pediatric practice. Patients: Children (N=646) aged 3 to 19 years. Intervention: Cholesterol measurements at a mean interval of 19 months between visits. Main Outcome Measures: Year-to-year change in cholesterol levels according to NCEP guidelines, regression to the mean, age, pubertal status, body mass index, hematocrit, interval between measurements, and season of the year were assessed for their contribution to cholesterol level variability. Results: Cholesterol level varied significantly with both age (P<.001) and pubertal status (P<.01) with children aged 9 to 12 years; prepubertal children had the highest levels. Visit-to-visit consistency of NCEP classification was poorer for younger children than for older children (κ=0.21 for 3- to 6-year-olds, 0.39 for 6- to 10-year-olds, and 0.44 for those older than 10 years). Of children with initial total cholesterol levels of 5.17 mmol/L (200 mg/dL) or greater, only 40% continued to have high levels at follow-up. A child with an initial cholesterol value of 5.17 mmol/L (200 mg/dL) showed an average decline of 0.34 mmol/L (13 mg/dL) at follow-up by regression analysis. Conclusion: Year-to-year variability in total cholesterol level has a significant impact on the stability of NCEP classification.(Arch Pediatr Adolesc Med. 1995;149:292-296) References 1. National Cholesterol Education Program. Report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents . Bethesda, Md: National Institutes of Health, 1991. US Dept of Health and Human Services publication 91-2732. 2. Gidding SS. The rationale for lowering serum cholesterol levels in American children . AJDC . 1993;147:386-392. 3. Resnicow K, Berenson G, Shea S, Srinivasan S, Strong W, Wynder EL. The case against childhood cholesterol screening . JAMA . 1991;265:3003-3005.Crossref 4. Newman TB, Browner WS, Hulley SB. The case against childhood cholesterol screening . JAMA . 1990;264:3039-3043.Crossref 5. Bookstein L, Gidding SS, Donovan M, Smith FA. Day-to-day variability of serum cholesterol, triglyceride, and high-density lipoprotein cholesterol levels . Arch Intern Med . 1990;150:1653-1657.Crossref 6. Gillman MW, Cupples LA, Moore LL, Ellison RC. Impact of within-person variability on identifying children with hypercholesterolemia: Framingham Children's Study . J Pediatr . 1992;121:342-347.Crossref 7. Kafonek SD, Derby CA, Bachorik PS. Biological variability of lipoproteins and apolipoproteins in patients referred to a lipid clinic . Clin Chem . 1992;38:864-872. 8. Lauer RM, Clarke WR. Use of cholesterol measurements in childhood for the prediction of adult hypercholesterolemia: the Muscatine Study . JAMA . 1990; 264:3034-3038.Crossref 9. National Cholesterol Education Program. Current status of blood cholesterol measurement in clinical laboratories in the United States: report from the laboratory standardization panel . Clin Chem . 1988;34:193-201. 10. Benuck I, Gidding SS. Donovan M, Traisman ES, Traisman HS. Usefulness of parental total cholesterol levels in identifying children with hypercholesterolemia . Am J Cardiol . 1992;69:713-717.Crossref 11. Fleiss, TL. Statistical Methods for Rates and Proportions . New York, NY: John Wiley & Sons Inc; 1981. 12. Landis RJ, Koch GG. The measurement of interobserver agreement for categorical data . Biometrics . 1977;33:159-174.Crossref 13. Draper N, Smith H. Applied Regression Analysis . 2nd ed. New York, NY: John Wiley & Sons Inc; 1981:10-31. 14. Kwiterovich PO Jr, Fredrickson DS, Levy RI. Familial hypercholesterolemia (one form of familial type II hyperlipoproteinemia): a study of its biochemical, genetic, and clinical presentation in childhood . J Clin Invest . 1974;53:1237-1247.Crossref 15. Kallio MJT, Salmenpera L, Siimes MA, Perheentpa J, Miettinerr TA. Tracking of serum cholesterol and lipoprotein levels from the first year of life . Pediatrics . 1993;91:949-954. 16. Freedman DS, Srinivasan SR, Cresanta JL, Webber LS, Berenson GS. Serum lipids and lipoproteins . Pediatrics . 1987;80( (suppl) ):789-796. 17. Freedman DS, Byers T, Sell K, Kuester S, Newell E, Lee S. Tracking of serum cholesterol levels in a multiracial sample of preschool children . Pediatrics . 1992; 90:80-86. 18. Orchard TJ, Donahue RP, Kuller LH. Cholesterol screening in childhood: does it predict hypercholesterolemia? the Beaver County experience . J Pediatr . 1983; 103:687-691.Crossref 19. Webber LS, Srinivasan SR, Wattigney WA, Berenson GS. Tracking of serum lipids and lipoproteins from childhood to adulthood: the Bogalusa Heart Study . Am J Epidemiol . 1991;133:884-899. 20. Gao S, Beckett L, Chumlea WC, Roche AF. Serial analysis of plasma lipids and lipoproteins from 9 to 21 years . Am J Clin Nutr . 1993;58:61-67. 21. Clarke WR, Schrott HG, Leaverton PE, Connor WE, Lauer RM. Tracking of blood lipids and blood pressure in school age children: the Muscatine Study . Circulation . 1978;58:626-634.Crossref 22. Demacker PNM, Schade RWB, Jansen RTP, Van't Laar A. Intra-individual variation of serum cholesterol, triglycerides, and high density lipoprotein cholesterol in normal humans . Atherosclerosis . 1982;45:259-266.Crossref 23. Bennett MJ, Tershakovec AM, Cortner JA, Shannon BM. A quality assurance program for the measurement of capillary blood cholesterol levels in private pediatric practices: the Children's Health Project . AJDC . 1993;147:340-345. 24. Resnicow K, Morley-Kotchen J, Wynder EL. Plasma cholesterol levels of 6585 children in the United States: results of the Know Your Body screening in five states . Pediatrics . 1989;84:969-976. 25. Griffin TC, Christoffel KK, Binns HG, McGuire PA, Pediatric Practice Research Group. Family history evaluation as a predictive screen for childhood hypercholesterolemia . Pediatrics . 1989;84:365-373. 26. Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group. Relationship of atherosclerosis in young men to serum lipoprotein cholesterol concentrations and smoking . JAMA . 1990;264:3018-3024.Crossref 27. Mahoney LT, Stanford W, Thompson BH, Burns TL, Witt JD, Lauer RM. The relationship of risk factors to noninvasive assessment of coronary atherosclerosis in young men . Circulation . 1994;89:940.

Journal

Archives of Pediatrics & Adolescent Medicine – American Medical Association

Published: Mar 1, 1995

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