A longitudinal evaluation of the NCEP-Peds guidelines for elevated total and LDL cholesterol in adolescent girls and boys

Abstract

The National Cholesterol Education Program-Peds (NCEP-Peds) guidelines established single sets of cutoffs for evaluating borderline and elevated total (TC) and low density lipoprotein (LDL-C) cholesterol in children up to age 19 years, corresponding roughly to the 75th and 95th percentiles, respectively, of these distributions in the Lipid Research Clinics Prevalence Study (1972–1976). These cutoffs do not take into account the effects of puberty on these lipids. The purpose of this review is to describe adolescent changes and to demonstrate the effects of these changes on the prevalence of elevated TC and LDL-C. Thus, we present data on changes in growth velocity, obesity, fat patterning and pubertal maturation and apply the NCEP-Peds cutoffs to biracial adolescent cohorts by single year of age to show the variability in the percentage of children identified for follow-up. The net effect of these adolescent changes is a fall in the percentage of children identified for follow up of almost 50% from age 10 to mid-adolescence, followed by a rise in the percentages. Using multivariable analyses, we show that increasing obesity (body mass index, kg/m 2) increases the prevalence of dyslipidemias and advancing puberty decreases it. Thus, how a child is diagnosed may be a function of age and pubertal status at the time of the tests. These results suggest a need to modify the NCEP-Peds classification cutoffs to account for pubertal status.