Non-fasting lipid profile determination in presumably healthy children: Impact on the assessment of lipid abnormalities

Abstract

ObjectiveDespite the common use of non-fasting measurements for lipid profile in children it remains unclear as to the extent non-fasting conditions have on laboratory results of lipids measurements. We aimed to assess the impact of non-fasting lipid profile on the occurrence of dyslipidemia in children.Materials and methodsBasic lipid profile including: total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG), as well as small, dense-LDL-C (sd-LDL-C), apolipoprotein AI (ApoAI), apolipoprotein B (ApoB) and lipoprotein(a) [Lp(a)], were measured in 289 presumably healthy children aged 9–11 in both fasting and non-fasting condition. The clinical impact of non-fasting lipid profile was evaluated individually for each child with estimation of false positive (FP) and false negative (FN) results.ResultsThe highest percentage of FP results in non-fasting condition was observed for TG (42.3%) being significantly higher when compared to FN results (p = 0.003). In contrast, the highest percentage of FN results in a non-fasting state were shown for LDL-C (14.3%), but the difference was statistically insignificant when compared to FP results. When comparing fasting and non-fasting lipid profile a number of significant differences was shown for: TG (p<0.001), HDL-C (p = 0.002) LDL-C (p<0.001) and ApoAI (p<0.001), respectively. The occurrence of dyslipidemia, recognized on the basis of non-fasting lipids was significantly higher (p = 0.010) when compared to fasting lipid profile.ConclusionsA higher occurrence of dyslipidemia, based on the measurement of non-fasting lipids in children, is suggestive of possible disorders in lipid metabolism. However, accurate identification of dyslipidemia by assessment of non-fasting lipids requires the establishment of appropriate cut-off values for children.

The cut-off values for non-fasting routine lipid parameters in presumably healthy 9–11-year-old children

“…The results of the study revealed that the cut-off values among children in a non-fasting state, for the total cholesterol, are higher by about 30 mg/dL (upper cut-off value in fasting state was 200 mg/dl), while the TG concentration is 2.5-fold higher (upper cut-off value in fasting state for age 0-9 years was 100 mg/dl and for 10-19 years was 130 mg/dl) in comparison to determinations performed in a fasting state for similar age range groups [8]. What is more, the higher cut-off value was also different for the LDL-C concentration in comparison to that measured in a non-fasting state in the adult population.…”

Overview of Dyslipidemia in Childhood and Adolescence: Why Does It Matter and What Do We Do About It?

“…3 Triglycerides tend to have the largest variance between the two types of tests. 2 In children who are overweight and obese, there were no statistically significant differences between the fasting and nonfasting test results. 2 For nonfasting screens, the highest falsepositive rate is in triglycerides and the highest false-negative rate is in LDL-C. 2 If cholesterol levels are elevated with a nonfasting lipid panel, further evaluation should be completed with two separate fasting lipid panels at least 2 weeks apart.…”

“…3,7,16 In 2011, the AAP endorsed the recommendation of the National Heart, Lung, and Blood Institute (NHLBI) that universal screening of children at age 9 to 11 years and again at age 17 to 21 years was warranted for early identification of dyslipidemia. 2,3,12,14,15,17 The timing of these laboratory tests is important as lipid levels are fairly stable from about Healthy Baby/Healthy Child age 2 years until a child reaches adolescence, but during puberty the levels of TC and LDL-C tend to decrease, and then begin rising again in the later teen years. 3 Screening in the mid-teen years may miss potentially affected children.…”

“…Although a fasting lipid panel provides the most accurate look at a patient's lipid profile, the differences between fasting and nonfasting laboratory results are often not significant. 2,3 It is easier to screen with a nonfasting lipid panel because patients can complete the test while they are in the office and compliance with returning for a fasting laboratory test is low. Nonfasting HDL-C seems to be a sensitive screening tool for dyslipidemia in children and adolescents.…”

“…Dyslipidemia is the term used for any abnormality in the lipid profile, which consists of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides; 2 non-HDL-C is also sometimes included. 2 Non-HDL-C comprises all of the cholesterol that is present in lipoprotein particles that are considered atherogenic, which includes LDL-C, liproprotein(a), intermediatedensity lipoprotein, and very lowdensity lipoproteins. 1,3 Dyslipidemia occurs when there is an elevation in TC, LDL-C, non-HDL-C, or triglycerides, or when there is low HDL-C. 4,5 High TC is defined as >200 mg/dL, high non-HDL-C is >145 mg/dL, and low HDL is <40 mg/dL 6 (Table 1).…”