Cholesterol Curves to Identify Population Norms by Age and Sex in Healthy Weight Children

Abstract

Objective. Develop clinically applicable charts of lipid values illustrating fluctuations throughout childhood and by sex among healthy weight children. Methods. The National Health and Nutrition Examination Survey (1999-2008) was used to estimate total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides by age and sex in healthy weight children age 3 to 17 years. Using LMS procedures, the authors created smoothed curves demonstrating population-based 50th percentile for age and the 75th and 95th percentiles. Results. The curves were based on 7681 children meeting inclusion criteria. Total cholesterol, HDL, and LDL demonstrated peaks at approximately 8 to 12 years for boys. Similar peaks were evident for girls at slightly younger ages, approximately 7 to 11 years. Triglycerides showed peaks for girls, but values were similar across ages for boys. Conclusions. The use of fixed lipid value cutoffs in established guidelines regardless of age or sex likely mislabels many children as abnormal. The authors’ charts may allow for a more nuanced interpretation based on population norms.