Serum lipids in Brazilian children and adolescents: determining their reference intervals

BMC Public Health

Adagmar Andriolo¹  Glaucia V Novak³  Cor JF Fontes²  Raymundo S Azevedo³  Cristina MA Jacob³  Natasha Slhessarenko² 

[1]Department of Medicine, Universidade Federal de São Paulo, São Paulo, Brazil

[2]Julio Müller School Hospital, Universidade Federal de Mato Grosso, Cuiabá, MT, Brazil

[3]School of Medicine, Universidade de São Paulo, São Paulo, Brazil

关键词: Adolescent;    Child;    Reference intervals;    Serum lipids;   

Others  :  1090637
DOI  :  10.1186/s12889-015-1359-4

 received in 2014-08-13, accepted in 2015-01-06,  发布年份 2015

【 摘 要 】

Background

Demographic, geographic, environmental and genetic factors influence lipids. In many countries, the normal lipid ranges for laboratory tests are based on references from American children and adolescents. In this work, we determined the reference intervals (RIs) for total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), non-high-density lipoprotein cholesterol (nHDL-c), low-density lipoprotein cholesterol (LDL-c) and triglycerides (TG) in Brazilian healthy children and adolescents.

Methods

A cross-sectional study was conducted of 1,866 randomly sampled healthy children and adolescents from kindergartens and schools. Blood samples were collected after a variable period of fasting based on the age of the participant. The upper cut-off points were the 75^th and 95^th percentiles for TC, nHDL-c, LDL-c and TG. The 10^th percentile (low) was used as the bottom level for HDL-c. Non-parametric tests were used for statistical analyses.

Results

The following RI and 75^th and 95^th percentiles were observed for each age interval. The 95^th percentile values obtained for TC were: 1 to 2 years, 189 mg/dL, 3 to 8 years, 199 mg/dL; 9 to 12 years, 205 mg/dL. For the nHDL c, the only age group 1 to 12 years, this percentile value was 150 mg/dL. For the LDL-cholesterol, the values corresponding to the percentiles above, aged 1 to 8 years and 9 to 12 years, were 132 mg/dL 139 mg/dL, respectively. For the triglycerides, the values corresponding to 95^th percentile were: 1 year, 189 mg/dL; 2 to 5 years, 139 mg/dL; 6 to 12 years, 139 mg/dL . The 10^th percentiles for HDL-c were 24 mg/dL, 28 mg/dL, 32 mg/dL and 36 mg/dL for children 1, 2, 3 and 4-12 years old, respectively.

Conclusions

The lipid reference intervals defined in the studied Brazilian children and adolescents differ from those recommended by the international literature and should be used for clinical decisions contributing to improve the diagnosis in this particular group in our country.

【 授权许可】

   
2015 Slhessarenko et al.; licensee BioMed Central.

【 图 表 】

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【 参考文献 】

• [1]American Academy of Pediatrics: National cholesterol education program report of the expert panel on blood cholesterol levels in children and adolescents Pediatrics 1992, 89:525-84.
• [2]National Cholesterol Education Program (NCEP): Highlights of the report of the expert panel on blood cholesterol levels in children and adolescents Pediatrics 1992, 89:S495-501.
• [3]Kwiterovich PO Jr: Prevention of coronary disease starting in childhood: what risk factors should be identified and treated? Coron Artery Dis 1993, 4:611-30.
• [4]American Academy of Pediatrics. Committee on Nutrition: American academy of pediatrics. Committee on nutrition. Cholesterol in childhood Pediatrics 1998, 101:141-7.
• [5]National Heart, Lung, and Blood Institute (NHLBI). Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. [http://www.nhlbi.nih.gov/guidelines/cvd_ped/peds_guidelines_sum.pdf].
• [6]Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents; National Heart, Lung and Blood Institute: Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report Pediatrics 2011, 128(5):S213-56.
• [7]Kavei RE, Daniels SR, Lauer RM, Atkins DL, Hayman LL, Taubert K: American Heart Association guidelines for primary prevention of atherosclerosclerotic cardiovascular disease beginning in childhood. Circulation 2003, 107:1562-6. doi:10.1161/01.CIR.0000061521.15730.6E
• [8]Kwiterovich PO Jr: Recognition and management of dyslipidemia in children and adolescents. J Clin Endocrinol Metab 2008, 93:4200-9. doi: 10.1210/jc.2008-1270
• [9]Daniels SR, Greer FR: Lipid screening and cardiovascular health in childhood. Pediatrics 2008, 122:198-208. doi: 10.1542/peds.2008-1349
• [10]Clinical and Laboratory Standards Institute (CLSI): Defining, Establishing, and Verifying Reference Intervals in the Clinical Laboratory-Approved Guideline. 3rd edition. CLSI document C28-A3, Wayne, PA; 2008.
• [11]Ceriotti F: Establishing pediatric reference intervals: a challenging task. Clin Chem 2012, 58:1-3. doi: 10.1373/clinchem.2012.183483
• [12]Adeli K: Closing the gap in pediatric reference intervals: the CALIPER initiative. Clin Biochem 2011, 44:480-2. doi:10.1016/j.clinbiochem.2011.02.017
• [13]Ferreira CES, Andriolo A: Intervalos de referência no laboratório clínico (Reference ranges in clinical laboratory). J Bras Patol Med Lab 2008, 44:1-8. Portuguese
• [14]Friedberg RC, Souers R, Wagar EA, Stankovic AK, Valenstein PN: The origin of reference intervals. A college of American pathologists Q-probes study of “normal ranges” used in 163 clinical laboratories. Arch Pathol Lab Med 2007, 131:348-57.
• [15]ARUP Laboratories. Pediatric reference intervals. Children aren’t small adults! [http://www.aruplab.com/pediatrics/about/pediatric-reference-intervals].
• [16]Caliper project – Canadian laboratories initiative on pediatric reference intervals. [http://www.sickkids.ca/caliperproject].
• [17]KIGGS – German health interview and examination survey for children and adolescents. [http://www.kiggs-studie.de/english/survey.html].
• [18]The national children’s study (NCS). [http://www.nationalchildrensstudy.gov/Pages/default.aspx].
• [19]Giuliano ICB, Caramelli B, Pellanda L, Duncan B, Mattos S, Fonseca FH: I diretriz de prevenção da aterosclerose na infância e na adolescência da sociedade brasileira de cardiologia (1st guideline for preventing atherosclerosis in childhood and adolescence). Arq Bras Cardiol 2005, 85(IV):1-36. doi: 10.1590/S0066-782X2005002500001 [Portuguese]
• [20]Xavier HT, Izar MC, Faria Neto JR, Assad MH, Rocha VZ, Sposito AC, et al.: V Diretriz Brasileira de dislipidemias e prevenção da aterosclerose. Arq Bras Cardiol 2013, 101:1-22. doi: 10.5935/abc.2013S010 [Portuguese]
• [21]Santos RD, Gagliardi ACM, Xavier HT: Sociedade brasileira de cardiologia: I diretriz brasileira de hipercolesterolemia familiar. Arq Bras Cardiol 2012, 99:1-28. doi: 10.5935/abc.20120202. [Portuguese]
• [22]Liao Y, Mi J, Wang Y, Chen S, Liu Y, Tang C, et al.: Study on the reference values of serum lipids in children aged 3-18 years old in Beijing, China. Pediatr Int 2009, 52:472-9.
• [23]Du JB: Epidemiological status of dyslipidemia in children. J Appl Clin Pediatr 2006, 21:801-2.
• [24]Guiliano ICB, Coutinho MSSA, Freitas SFT, Pires MMS, Zunino JN, Ribeiro RQC: Lípides séricos em crianças e adolescentes de Florianópolis, SC – Estudo Floripa Saudável 2040. Arq Bras Cardiol 2005, 85:85-91.
• [25]Moura EC, Castro CM, Mellin AS, Figueiredo DB: Perfil lipídico em escolares de Campinas, SP, Brasil. Rev Saúde Púb 2000, 34:499-505.
• [26]Pereira PB, Arruda IKG, Cavalcanti AMTS, Diniz AS: Perfil lipídico em escolares de Recife –PE. Arq Bras Cardiol 2010, 95:606-13.
• [27]Ribas AS, Silva LCS: Dislipidemia em escolares na rede privada de Belém. Arq Bras Cardiol 2009, 92:446-51.
• [28]Seki M, Niyama FP, Seki MO, Pereira Júnior PG, Seki MO, Bonametti AM, et al.: Perfil lipídico: intervalos de referência em escolares de 2 a 9 anos de idade da cidade de Maracaí (SP). J Bras Patol Med Lab 2003, 39:131-7.
• [29]Seki M, Seki MO, Niyama FP, Pereira Júnior PG, Seki MO, Matsuo T, et al.: Perfil lipídico: intervalos de referência em escolares de 10 a 19 anos de idade da cidade de Maracaí (SP). J Bras Patol Med Lab 2003, 39:309-16.
• [30]Colantonio DA, Kyriakopoulou L, Chan MK, Daly CH, Brinc D, Venner AA, et al.: Closing the gap in pediatric laboratory reference intervals: a CALIPER Database of 40 biochemical markers in a healthy and multiethnic population of children. Clin Chem 2012, 58:1-15.
• [31]Srinivasan SR, Myers L, Berenson GS: Distribuition and correlates of non-HDL-density lipoprotein cholesterol in children: the Bogalusa heart study. Pediatrics 2002, 110:e29.