Printer Friendly

Serum lipid profiles including non-high density lipoprotein cholesterol levels in Turkish school-children / Turk okul cocuklarinda serum lipid profili ve non-HDL kolesterol duzeyleri.

ABSTRACT

Objective: Early detection of dyslipidemia and long-term prevention of atherosclerosis by controlling risk factors should begin in childhood. The purpose of this study was to evaluate the prevalence of dyslipidemia according to non-high density lipoprotein cholesterol (non-HDL-C) levels in children and also evaluate serum non-HDL-C levels according to age groups, gender difference and living areas.

Methods: Overall, 2896 children (1467 girls, 1429 boys) aged between 7-18 years, residing in urban and rural parts of Eskisehir, Turkey, were enrolled in this randomized cross-sectional study. Serum non-HDL-C, total cholesterol (TC) and triglyceride (TG) levels were assessed in all participants of the study. Statistical analysis was performed Student's independent-samples T test for comparison of lipid parameters and relations between lipid parameters and age, anthropometric measurements, body fat percentage were evaluated by Pearson correlation test.

Results: Serum non-HDL-C levels were significantly higher in girls (115.5 [+ or -] 31.5mg/dl) than boys (106.7 [+ or -] 30.2 mg/Dl) (p<0.001). For girls, serum non-HDL-C levels were higher in 7-10 year age group than in 11-14-year and 15-18-year age groups (p<0.01 and p<0.05, respectively). For boys serum non-HDL-C levels of 7-10 year age group were significantly higher than in 11-14-year and 15-18-year age groups (p<0.001 for both). Serum non-HDL-C, total cholesterol and triglyceride levels were higher in girls than in boys especially in the 7-10-year-old age group. Serum TC, LDL-C, and HDL-C levels were higher in urban area residents, while serum TG levels were higher in rural area residents (p<0.001). Serum non-HDL-C levels were similar in residents of different living areas (p>0.05). In both sexes, non-HDL-C levels positively correlated with age and lipid parameters except HDL-C levels and also negatively correlated with HDL-C levels. In boys, non-HDL-C levels also correlated with total body fat percentage, weight, height. The prevalence of dyslipidemia according to non-HDL-C levels was higher (13.2%) in girls than boys (8.9%) (p<0.001). The prevalence of elevated non-HDL-C levels was higher in urban area residents than in rural area residents (p<0.05). The dyslipidemia prevalence according to non-HDL-C levels was similar with dyslipidemia prevalence according to serum LDL-C levels.

Conclusion: Our results are indicative of the prevalence of dyslipidemia in children is considerably common in our population. Serum non-HDL-C levels could be used as an appropriate tool for detecting dyslipidemia in childhood. (Anadolu Kardiyol Derg 2007; 7: 415-20)

Key words: Children, lipid, lipoprotein, non-HDL, Turkey

OZET

Amac: Dislipidemin erken donemde saptanmasi ve uzun sureli korumada ateroskleroz icin tanimlanmis risk faktorlerinin erken donemde kontrolunun cocukluk yas grubunda baslanmasi onerilmektedir. Bu calismada cocuklarda serum yuksek dansiteli lipoprotein disi kolesterol (non-HDL-K) duzeylerine gore dislipidemi prevalansinin belirlenmesi ve serum non-HDL-K duzeylerinin yas gruplari, cinsiyet ve yasam alanina gore degerlendirilmesi planlandi.

Yontemler: Eskisehir kent ve kirsal bolgesinde yasayan 7-18 yaslari arasinda 2896 cocuk (1467 kiz, 1429 erkek) bu randomize kros-seksiyonel calismaya alindi. Tum cocuklarda serum non-HDL-K, total kolesterol (TK) and trigliserid (TG) duzeyleri olculdu. Istatistiksel analizde lipid parametrelerin karsilastirmasi Student bagimsiz orneklem T testi ile yapildi. Lipid parametrelerin yas, antropometrik olcumleri, total vucut yag yuzdesi ile iliskileri Pearson korelasyon testi ile incelendi.

Bulgular: Serum non HDL-K duzeyleri kiz cocuklarinda (115.5 [+ or -] 31.5 mg/dl) erkek cocuklarina (106.7 [+ or -] 30.2mg/dl) gore yuksek olarak saptandi (p<0.001). Yedi-10 yas grubundaki kiz cocuklarinda serum non-HDL-K duzeyleri 11-14 yas ve 15-18 yas grubundaki kiz cocuklarindan yuksek olarak saptandi (sirasiyla p<0.01, p<0.05). Yedi-10 yas grubundaki erkek cocuklarinda serum non-HDL-K duzeyleri, 11-14 yas ve 15-18 yas grubundaki erkek cocuklarindan yuksek olarak saptandi (her iki grup icin de p<0.001). Serum non-HDL-K, total kolesterol ve trigliserid duzeyleri 7-10 yas grubunda, kiz cocuklarinda erkek cocuklarindan yuksek olarak saptandi. Serum total kolesterol, LDL-K ve HDL-K duzeyleri kentlerde yasayan cocuklarda yuksek olarak saptanirken, serum trigliserid duzeyleri kirsal alanda yasayan cocuklarda yuksek olarak saptandi (p<0.001). Serum non-HDL-K duzeyleri icin kentsel ve kirsal alanda yasayan cocuklarda fark saptanmadi (p>0.05). Her iki cinsiyette de serum non-HDL-K duzeyleri yas ve HDL-K disindaki diger lipid parametreleri ile pozitif, serum HDL-K duzeyleri ile negatif korelasyon saptandi. Erkek cocuklarinda, serum non-HDL-K duzeyleri ayni zamanda total vucut yag yuzdesi, vucut agirligi ve boy ile korelasyon saptandi. Serum non-HDL-K duzeylerine gore dislipidemi prevalansi kiz cocuklarinda (%13.2) erkek cocuklarina (%8.9) gore yuksek olarak saptandi (p<0.001). Serum non-HDL-K duzeylerine gore dislipidemi prevalansi kentte yasayan cocuklarda kirsal alanda yasayan cocuklara gore yuksek olarak saptandi (p<0.05). Cocuklarda serum non-HDL-K duzeylerine gore dislipidemi prevalansi serum LDL-K duzeylerine gore dislipidemi prevalansi ile benzerdi.

Sonuc: Calismamizin sonunda cocuklarda dislipidemi prevalansi beklenenden yuksek olarak saptandi. Ayrica cocukluk caginda dislipideminin saptanmasinda serum non-HDL-K duzeylerinin kullanilabilecegi sonucuna varildi. (Anadolu Kardiyol Derg 2007; 7: 415-20)

Anahtar kelimeler: Cocuk, lipid, lipoprotein, non-HDL, Turkiye

Introduction

Coronary heart disease (CHD) is a leading cause of death in worldwide. Because of the atherosclerotic process begins in childhood before clinical symptoms, it seems prudent to minimize adult coronary risk factors in younger as well as in adults (1-4). For this reason, some authors recommended that routine screening program for blood lipid levels to be performed in all children and have provided guidelines to identify and treat children who are at risk for the development of accelerated atherosclerosis in early adult life (4-5). While serum low-density lipoprotein cholesterol (LDL-C) levels were considered as the gold standard for determination of coronary risk factors and dyslipidemia, limitations of the use were recently reported (6-7). Srinivasan et al. (7) reported that non-high density lipoprotein cholesterol (non-HDL-C) levels could be useful for determination of lipoprotein related risk assessment. Measurement of non-HDL has been proposed for screening program because of non-HDL-C includes both cholesterol-rich and triglyceride rich atherogenic apolipoprotein-B containing lipoproteins and the measurement do not require overnight fasting (7).

This cross-sectional study was designed to measure plasma lipids and lipoprotein levels, to evaluate the prevalence of dyslipidemia according to non-HDL-C levels and evaluate serum non-HDL-C levels according to age groups, gender difference and living areas in school-children aged between 7 to 18 years in Eskisehir, Turkey.

Methods

As a part of our previously published study (8), 2896 schoolchildren (1467 girls, 1429 boys) aged between 7 to 18 years, who were randomly selected from the students attending 11 schools located in the different regions of Eskisehir city center (urban area) and Cifteler county (rural area) in Turkey, were included in this randomized cross-sectional study.

Eskisehir, which is one of the big cities of Turkey with population of 500.000 is an industrial and commercial center and has two universities. Cifteler county is located 64 km from Eskisehir city center and has population of 11.000, who maintain their living mainly by agriculture.

The selected schools were socio-economically representative of the region. The eligible population included all school age children living in the study area after written parental content. Study group was divided into three different subgroups for both sexes consisting of age 7-10, 11-14, and 15-18 years age groups.

Permission for the study was requested from schools, parents and children themselves. The study protocol was approved by the Local Ethical Committee of Eskisehir Osmangazi University. Before the study day, the students were informed about the aim and the design of the study and a written message was sent to their families for instructing at least 12 hours fasting before blood sampling.

A study team consisting of pediatricians, research assistants and interns of pediatrics who were previously trained regarding the study, visited the schools during morning hours. The questionnaire forms included the demographic data, smoking status and self-reported daily physical activity degree.

The children were classified into 3 physical activity groups according to-their self-reporting information: 1) children who make only activities that do not require physical effort such as reading, watching TV, etc. and go to school by motor-vehicles without walking; 2) children who go to school by walking and make some mild physical activities such as walking, riding bicycle or etc.; 3) children who make some heavy physical activities such as joining competitive sports, making severe training regularly or doing heavy garden works. Those children in the lowest of the three physical activity groups were considered to be at risk as sedentary life-style (9).

Height and weight of children was measured with wearing minimum indoor clothing, without shoes, using scales calibrated several times during the day. Body mass index (BMI) was estimated by the formula of weight (kg) / height ([m.sup.2]). Skinfold thickness was obtained from four sites (over triceps, biceps, subscapular and suprailiac regions) by skinfold caliper for estimation of total body fat percentage according to the method of Durnin and Rahaman (10). Blood pressure (BP) was measured twice from the right arm by sphygmomanometer using a cuff of appropriate size, while the subject sitting quietly for at least 5 minutes. The mean of the two measurements was recorded (11).

Approximately 5 ml venous blood samples were obtained from the antecubital veins and centrifuged within 1.5-2 hours. Serum total cholesterol (TC) and triglyceride (TG) concentrations were analyzed in a BM-Hitachi-747 auto analyzer (Boehringer Mannheim GmbH, Mannheim, Germany) by enzymaticcolorimetric methods using original kits. Serum high-density lipoprotein cholesterol (HDL-C) levels were analyzed by enzymatic method after precipitating serum reagents with phosphotungstic acid and magnesium. Serum LDL-C and very low low-density lipoprotein cholesterol (VLDL-C) values were estimated by the formula of Friedewald et al (12). Non-HDL levels were calculated by the formula of "total cholesterol minus HDL-C" (7).

For determining dyslipidemia, serum TC level of >200 mg/dl, LDL-C of >130 mg/dl, and TG level of >140 mg/dl, which were determined as the 95th percentile values and serum HDL-C level of <35 mg/dl, determined as the 10th percentile value for children and adolescents, were accepted as the risk thresholds (13). Unfavorable lipid profile according to non-HDL-C levels were described as above 150 mg/dl (4).

Statistical analysis

The sample size was calculated according with the results of our previous study (8) with power of the study of 80% and significance level of 5%.

All statistical analysis was conducted using SPSS version 10.0 (Statistical Package for Social Sciences, Chicago, IL, USA). Lipid parameters values are expressed as mean [+ or -] SD for nonskewed distributed data, the comparison of the data was performed using Student's independent-samples T test and categorical variables were analyzed by Chi-square test. Relations between lipid parameters and age, anthropometric measurements, body fat percentage were evaluated by Pearson correlation test was used for correlations. P values of <0.05 were considered significant.

Results

Mean serum lipid and lipoprotein levels and percentile values of our study population (Tables 1, 2) and their levels according to sex and living areas are shown in Table 3. Serum non-HDL-C levels were significantly higher in girls (115.5 [+ or -] 31.5 mg/dl) than in boys (106.7 [+ or -] 30.2 mg/dl) (p<0.001) and they were higher in girls than in boys for each age group (p<0.01, p<0.01 and p<0.0001 respectively). For girls, serum non-HDL-C levels were higher in 7-10-year age group than 11-14-year age group and 15-18-year age group (p<0.01 and p<0.05, respectively). For boys serum non-HDL-C levels of 7-10- year age group were significantly higher than in 11-14-year age group and 15-18-year age group (p<0.001 for both).

Serum TC and HDL levels were higher in children living in urban area than those of children living in rural area (p<0.001). Serum TG levels were higher in children living in rural area than in those of children living in urban area (p<0.001). Serum LDL-C levels were higher in children living in urban area than in those residing in rural without statistically significant difference (p>0.05). Serum non-HDL-C levels were similar in residents of different living areas (p>0.05).

Serum non-HDL-C levels correlated with serum TC, TG, HDL, LDL and VLDL levels in both sexes especially significantly with serum LDL-C levels (r=0.970, p<0.001 for girls and r=0.959, p<0.001 for boys). While in boys, serum non-HDL-C levels positively correlated with age, weight, height (p<0.001, p<0.001, p0.001 consecutively), in girls, serum non-HDL-C levels positively correlated with age (p<0.05) and did not correlate with height and weight. Serum non-HDL-C levels positively correlated total body fat percentage in boys (r=0.139, p<0.001) unlike girls. Serum non-HDL-C levels were not correlated with BMI and physical activity status for both sexes.

Prevalence of dyslipidemia for both sexes are shown in Table 4. The proportion of the children with hypercholesterolemia, with LDL-C levels and non-HDL-C levels above the 95th percentile values in girls were higher than in boys (p<0.001 for both). The prevalence of dyslipidemia according to non-HDL-C levels was 13.2% in girls and 8.9% in boys (p<0.0001). The prevalence of dyslipidemia in girls was significantly higher than in boys in 15-18 years age group (p<0.001). In 7-10 years age group, the proportion of the girls who had serum non-HDL-C levels above the 95th percentile value was higher than in those of 11-14 years age group (p<0.05).

For boys, hypercholesterolemia, elevated LDL-C and non-HDL-C levels were common in 7-10 years age group than in other age groups (p<0.001). The proportion of the boys with decreased HDL-C levels in 7-10 years and 15-18 years age groups were significantly higher than in those of 11-14 years age group (Table 4).

The prevalence of dyslipidemia for living areas is shown in Table 4. In spite of hypercholesterolemia was common in urban area (p<0.001), hypertriglyceridemia was commonly observed in rural area (p<0.05). The prevalence of elevated LDL-C levels and decreased HDL-C levels were not different in urban and rural areas (p>0.05). The prevalence of elevated non-HDL-C levels were higher in urban area than in rural area (p<0.05).

Discussion

In our study the prevalence of dyslipidemia according to LDL-C and non-HDL-C levels were similar for both sexes. These findings may support opinion that non-HDL-C levels may be used for determining dyslipidemia in children. Non HDL-C has been proposed as a better screening tool for coronary artery disease risk assessment and treatment with the rationale being that non-HDL-C includes both cholesterol-rich and TG-rich atherogenic apolipoprotein -B containing lipoproteins (VLDL, IDL, LDL, lipoprotein-a) and the measurement does not require overnight fasting (7). In adult's elevated non-HDL-C concentration are associated with advanced atherosclerotic lesions and increased risk of clinically manifested atherosclerotic disease (14-15). In a recent study carried out in young persons, fatty streaks and raised lesions in the right coronary artery and in the abdominal aorta were associated with increased non-HDL-C concentration, hypertension, impaired glucose tolerance, obesity and low HDL-C (4). Interestingly the 95th percentile values of our children were higher than in those of Bogalusa Heart Study's population (7). In our study serum non-HDL-C levels were positively correlated with other lipid parameters for both sexes and also were correlated with weight and total body fat percentage in boys unlike girls. Dyslipidemia prevalence for non-HDL-C levels was higher in girls than in boys and similar with the dyslipidemia prevalence according to serum LDL-C levels.

In our study, serum non-HDL-C levels were higher before puberty and significantly decreased after 10 years age up to 16 years age. This decline may be explained with decrease of TC levels and increased HDL-C levels during puberty in girls. In boys, this decline was not statistically significant.

Mean serum TC levels tended to be steady during prepubertal years, dropped during puberty in both sexes being more pronounced in boys, and then rise again during adolescence after maturation is completed (16). In our study, serum TC levels showed a more pronounced decline starting from 9 years of age until 15 years of age, and then started to rise at 17 years of age. Recent studies reported different prevalence of dyslipidemia according to TC levels among the countries (3, 5, 13, 16-17). The prevalence of hypercholesterolemia of our study population was 11.8% and mean TC levels of our study was 169 mg/dl in girls and 159 mg/dl in boys, being similar with some reports from different countries (3, 13, 16-17). Mean TC values of Muscatine study (5) and Boreham et al.'s (18) study were higher, 181 mg/dl and 178 mg/dl respectively, than our study values. Yavuz and Bayraktaroglu (19) reported that mean TC of their study population were 131 mg/dl and prevalence of hypercholesterolemia was 2.5% in their region, in Turkey. These differences may be explained with study design, genetic and nutritional factors such as low intake of animal foods or high fiber and carbohydrate consumption (19-20). Serum LDL-C levels showed a similar trend to that of TC levels by age in our population, as reported in the literature (21-22).

Navarra and Muscatine studies (5, 21) reported that serum TG levels increased with age in children and serum TG levels were lower in girls than in boys after 13 years age. In our study, in girls, serum TG levels were stable except a slight increase during puberty (11-13 years) and after 17 years age. In boys, younger than 15 years age, serum TG levels were higher than in girls of the same age, but after 15 years, serum TG levels were slightly higher in girls than in boys.

Reports from Turkey demonstrated that serum HDL-C levels were typically 10-15 mg/dl lower in Turkish adults than in European and North Americans and lower level of HDL-C appears to be largely of genetic origin (23-25). In our study, mean HDL-C levels for each age in both sexes, were above 45 mg/dl. Mean serum HDL-C level was 57.1 mg/dl at 10 years of age, but it decreased to 45 mg/dl at 18 years of age. Mahley et al. (24) reported a greater decrease in HDL-C levels of Turkish children after puberty, which was significantly pronounced in boys than in girls, like our study. High levels of hepatic lipase activity and protein mass are characteristics of Turkish people and may explain their low HDL-C levels (26). However, recent large cohort performed in adults for the determination of the prevalence of metabolic syndrome in our Turkey showed that 47.64% of the women had HDL-C levels above the 50 mg/dl and 58.42% of the man had serum HDL-C levels above the 40 mg/dl. Overall, 44.1% of the total study population had lower serum HDL-C levels (27). The difference of frequency between the studies may be explained with the laboratory technique as precipitation or direct method.

Conclusion

In conclusion, age, sex and living areas, such as urban or rural area are important factors for serum lipid and lipoprotein levels in Turkish children. The prevalence of dyslipidemia in children is considerably common in our region. Non-HDL-C level may be an appropriate tool for detecting dyslipidemia in childhood. Early detection of dyslipidemia and long-term prevention of atherosclerosis by controlling the risk factors including elevated non-HDL-C level should begin in childhood.

Acknowledgement

We thank to research assistants and interns of pediatrics for their assistance in the survey and the research assistants and technicians of biochemistry for their assistance in lipid analyses. We also thank the head teachers, teachers, and children of the schools who participated in the study for their help and cooperation. This study was supported by grants from TUBITAK (The Scientific and Technical Research Council of Turkey; SBAG-1438) and Osmangazi University Research Fund (95/20).

References

(1.) American Academy of Pediatrics, Committee on Nutrition. Cholesterol in childhood. Pediatrics 1998; 101: 141-7.

(2.) NCEP Expert panel on blood cholesterol levels in children and adolescents. National Cholesterol Education Program (NCEP): high lights of the report of the expert panel on blood cholesterol levels in children and adolescents. Pediatrics 1992; 89: 495-501.

(3.) Frereichs RR, Srinivasan SR, Webber LS, Berenson GR. Serum cholesterol and triglyceride levels in 3446 children from a biracial community: the Bogalusa Heart Study. Circulation 1976; 54: 302-9.

(4.) McGill HC Jr, McMahan CA, Herderick EE, Malcolm GT, Tracy RE, Strong JP. Origin of atherosclerosis in childhood and adolescence. Am J Clin Nutr 2000; 72: 1307-15.

(5.) Lauer RM, Connor WE, Leaverton PE, Reiter MA, Clarke WR. Coronary heart disease risk factor in schoolchildren; the Muscatine study. J Pediatr 1975; 86: 697-706.

(6.) Frost PH, Havel RJ. Rational use of non-high-density lipoprotein cholesterol screening and assessment of risk and therapy. Am J Cardiol 1998; 81 (Suppl 4A): 26B-31B.

(7.) Srinivasan SR, Myers L, Berenson GS. Distribution and correlates of non-high-density lipoprotein cholesterol in children: The Bogalusa Heart Study. Pediatrics 2002; 110: e29.

(8.) Ucar B, Kilic Z, Colak O, Oner S, Kalyoncu C. Coronary risk factors in Turkish school-children: randomized cross-sectional study. Pediatr Int 2000; 42: 259-67.

(9.) Lochen ML, Rasmussen K. The Tromso Study: Physical fitness, self-reported physical activity and their relationship to other coronary risk factors. J Epidemiol Community Health 1992; 26: 103-7.

(10.) Durnin JVGA, Rahaman MM. The assessment of the amount of fat in the human body from measurements of skinfold thickness. Br J Nutr 1967; 21: 681-9.

(11.) National Institutes of Health. Report of the Second Task Force on Blood Pressure Control in Children. Pediatrics 1987; 79: 1-25.

(12.) Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972; 18: 499-502.

(13.) Rifkind BM, Segal P. Lipid Research Clinics Programme reference values for hyperlipidemia and hypolipidemia. JAMA 1983; 250: 1869-72.

(14.) Winkleby MA, Robinson TN, Sundquist J, Kraemer HC. Ethnic variation in cardiovascular disease risk factors among children and young adults: finding from the Third National Health and Nutrition Examination Survey, 1988-1994. JAMA 1999; 281: 1006-13.

(15.) Ballantyne CM, Andrews TS, Hsia JA, Kramer JH, Shear C for the ACCESS Study group. Correlations of non-high density lipoprotein cholesterol with apolipoprotein B: effect of 5 hydroxymethyl glutamyl coenzyme A reductase inhibitors of non-high density lipoprotein cholesterol levels. Am J Cardiol 2001; 88: 265-69.

(16.) Goff DC Jr, Donker GA, Rgan JD Jr, Adkins AT, Killinger RP, Caudill JW Jr, et al. Cholesterol screening in pediatric practice. Pediatrics 1991; 88: 250-8.

(17.) Resnicow K, Marley-Kotchen J, Wynder E. Plasma cholesterol levels of 6585 children in the United States; results of the know your body screening in five states. Pediatrics 1989; 84: 969-76.

(18.) Boreham C, Savage JM, Primrose D, Gran G, Strain J. Coronary risk factors in schoolchildren. Arch Dis Child 1993; 68: 182-6.

(19.) Coskun Y, Bayraktaroglu Z. Coronary risk factors in Turkish schoolchildren-report of a pilot study. Acta Paediatr 1997; 86: 187-91.

(20.) Knuiman JT, West CE, Katan MB, Hautvast JG. Total cholesterol and high density lipoprotein cholesterol levels in populations differing in fat and carbohydrate intake. Arteriosclerosis 1987; 6: 612-9.

(21.) Elcarte Lopez R, Villa Elizaga I, Sada Goni J, Gasco Eguiluz M, Oyarzabal Irigoyen M, Sola Mateos A, et al. The Navarra Study. Prevalence of arterial hypertension, hyperlipidemia and obesity in the infant-child population of Navarra. Association of risk factors. An Esp Pediatr 1993; 38: 428-36.

(22.) Webber LS, Harsha DW, Philipps GT, Srinivasan SR, Simpson JW, Berenson GS. Cardiovascular risk factors in Hispanic, white and black children: The Brooks County and Bogalusa Heart studies. Am J Epidemiol 1991; 133: 704-14.

(23.) Mahley RW, Palaoglu KE, Atak Z, Dawson-Pepin J, Langlois AM, Cheung V, et al. Turkish Heart Study: lipids, lipoproteins, and apolipoproteins. J Lipid Res 1995; 36: 839-59.

(24.) Mahley RW, Arslan P, Pekcan G, Pepin GM, Agacdiken A, Karaagaoglu N, et al. Plasma lipids in Turkish school-children: impact of puberty, socioeconomic status, and nutrition on plasma cholesterol and HDL. J Lipid Res 2001; 42: 1996-2006.

(25.) Bersot TP, Vega GL, Grundy SM, Palaoglu KE, Atagunduz P, Ozbayrakci S, et al. Elevated hepatic lipase activity and low levels of high density lipoprotein in a normotriglyceridemic, nonobese Turkish population. J Lipid Res 1999; 40: 432-8.

(26.) Hergenc G, Schulte H, Assman G, von Eckardstein A. Association of obesity markers, insulin, and sex hormones with HDL-cholesterol levels in Turkish and German individuals. Atherosclerosis 1999; 145: 147-56.

(27.) Kozan O, Oguz A, Abaci A, Erol C, Ongen Z, Temizhan A, et al. Prevalence of the metabolic syndrome among Turkish adults. Eur J Clin Nutr 2007; 61: 548-53.

Birsen Ucar, Zubeyir Kilic, Ener Cagri Dinleyici *, Omer Colak**, Erdogan Gunes *

Department of Pediatric Cardiology, Pediatrics *, and Biochemistry **, Eskisehir Osmangazi University, Faculty of Medicine, Eskisehir, Turkey

Address for Correspondence/Yazisma Adresi: Ener Cagri Dinleyici, MD, Department of Pediatrics Eskisehir Osmangazi University, Faculty of Medicine TR-26480 Eskisehir, Turkey Phone: +90 222 229 00 64 E-mail: timboothtr@yahoo.com
Table 1. Mean and percentile (5th, 50th and 95th) values of serum lipid
and lipoprotein levels in girls

Age, TC, mg/dl
years Mean [+ or -] SD 5 50 95

7 171.7 [+ or -] 31.3 122 168 225
8 171.4 [+ or -] 29.4 121 175 213
9 173.1 [+ or -] 37.3 121 167 234
10 165.5 [+ or -] 29.7 115 166 215
11 168.3 [+ or -] 28.0 120 168 220
12 168.4 [+ or -] 26.0 132 168 213
13 167.8 [+ or -] 27.7 126 166 215
14 163.5 [+ or -] 30.0 119 159 221
15 167.5 [+ or -] 29.4 121 164 219
16 167.9 [+ or -] 32.5 121 168 219
17 177.7 [+ or -] 34.6 126 178 249
18 176.5 [+ or -] 37.9 103 181 244
TOTAL 169.1 [+ or -] 30.8 122 167 222

Age, TO, mg/dl
years Mean [+ or -] SD 5 50 95

7 83.6 [+ or -] 34.4 30 79 158
8 85.2 [+ or -] 39.5 29 82 163
9 88.5 [+ or -] 36.4 34 84 159
10 90.7 [+ or -] 37.5 42 83 166
11 104.4 [+ or -] 40.2 50 97 199
12 103.4 [+ or -] 41.5 52 97 175
13 102.7 [+ or -] 35.5 53 97 177
14 90.0 [+ or -] 38.6 46 82 155
15 88.4 [+ or -] 42.5 44 80 158
16 78.2 [+ or -] 29.5 41 75 135
17 83.8 [+ or -] 26.0 28 72 127
18 88.2 [+ or -] 23.6 20 70 144
TOTAL 89.6 [+ or -] 28.5 41 83 161

Age, LDL-C, mg/dl
years Mean [+ or -] SD 5 50 95

7 105.3 [+ or -] 31.2 60 103 160
8 105.2 [+ or -] 32.5 53 106 150
9 101.8 [+ or -] 39.1 42 97 168
10 89.6 [+ or -] 25.6 43 92 136
11 94.4 [+ or -] 27.8 51 96 140
12 92.0 [+ or -] 26.6 46 93 139
13 94.0 [+ or -] 27.1 56 93 143
14 92.9 [+ or -] 29.9 45 92 145
15 97.2 [+ or -] 27.8 51 98 148
16 97.8 [+ or -] 29.5 56 96 150
17 103.6 [+ or -] 33.4 52 104 155
18 106.2 [+ or -] 36.4 57 108 160
TOTAL 97.6 [+ or -] 30.4 51 96 149

Age, HDL-C, mg/dl
years Mean [+ or -] SD 5 50 95

7 48.9 [+ or -] 14.2 32 47 80
8 48.7 [+ or -] 13.3 30 46 78
9 52.7 [+ or -] 13.2 34 52 77
10 53.4 [+ or -] 13.8 35 51 85
11 54.0 [+ or -] 15.1 35 51 90
12 55.2 [+ or -] 15.4 35 53 87
13 52.9 [+ or -] 13.3 33 53 78
14 52.5 [+ or -] 13.7 34 50 81
15 52.7 [+ or -] 12.8 35 51 77
16 54.9 [+ or -] 15.2 36 53 79
17 60.3 [+ or -] 24.0 37 55 99
18 54.7 [+ or -] 15.8 32 56 92
TOTAL 53.3 [+ or -] 15.1 34 51 81

Age, Non-HDL-C, mg/dl
years Mean [+ or -] SD 5 50 95

7 121.7 [+ or -] 32.3 75 118 184
8 122.3 [+ or -] 33.1 61 120 171
9 119.5 [+ or -] 39.7 59 114 191
10 106.9 [+ or -] 26.9 64 106 152
11 115.0 [+ or -] 28.9 67 113 160
12 112.7 [+ or -] 27.4 66 111 159
13 114.6 [+ or -] 27.9 72 112 165
14 110.9 [+ or -] 32.1 61 109 169
15 115.1 [+ or -] 29.2 72 115 167
16 113.3 [+ or -] 31.1 69 110 168
17 118.3 [+ or -] 34.8 65 117 176
18 122.6 [+ or -] 38.7 37 121 189
TOTAL 115.5 [+ or -] 31.5 67 113 169

Data presented are Mean [+ or -] standard deviation for continuous
variables. HDL-C- high density lipoprotein cholesterol, LDL-C- low
density lipoprotein cholesterol, non-HDL-C- non high density
lipoprotein cholesterol, TC-total cholesterol, TG- triglyceride

Table 2. Mean and percentile (5th, 50th and 95th) values of serum lipid
and lipoprotein levels in boys

Age, TC, mg/dl
years Mean [+ or -] SD 5 50 95

7 163.6 [+ or -] 26.0 124 159 222
8 163.0 [+ or -] 29.0 125 161 215
9 172.9 [+ or -] 36.3 125 168 241
10 170.3 [+ or -] 33.2 122 163 236
11 166.4 [+ or -] 31.2 123 161 224
12 166.7 [+ or -] 30.1 118 165 216
13 160.0 [+ or -] 28.5 114 159 208
14 153.9 [+ or -] 26.5 109 151 206
15 149.7 [+ or -] 25.1 114 147 196
16 151.5 [+ or -] 32.2 103 148 224
17 149.7 [+ or -] 27.8 104 148 207
18 153.6 [+ or -] 30.6 113 149 258
TOTAL 159.2 [+ or -] 30.5 115 155 214

Age, TG, mg/dl
years Mean [+ or -] SD 5 5D 95

7 75.7 [+ or -] 32.1 32 68 161
8 78.8 [+ or -] 38.8 30 75 156
9 85.2 [+ or -] 33.5 37 82 150
10 85.8 [+ or -] 36.3 39 77 152
11 90.2 [+ or -] 42.2 43 81 184
12 93.2 [+ or -] 41.0 45 85 182
13 86.3 [+ or -] 41.7 39 81 180
14 85.9 [+ or -] 35.2 44 79 154
15 87.7 [+ or -] 38.5 45 79 169
16 84.2 [+ or -] 43.7 38 73 147
17 87.3 [+ or -] 36.5 41 83 171
18 99.0 [+ or -] 43.5 39 97 179
TOTAL 86.7 [+ or -] 38.9 41 80 163

Age, LDL-C, mg/dl
years Mean [+ or -] SD 5 50 95

7 96.9 [+ or -] 29.8 49 92 147
8 95.9 [+ or -] 28.9 54 92 144
9 103.1 [+ or -] 34.1 51 101 164
10 85.7 [+ or -] 28.0 42 82 139
11 96.2 [+ or -] 30.3 55 93 150
12 94.9 [+ or -] 27.6 52 94 144
13 90.4 [+ or -] 27.7 49 90 145
14 83.5 [+ or -] 24.0 45 82 128
15 83.1 [+ or -] 25.2 49 79 130
16 86.3 [+ or -] 31.6 45 81 148
17 83.8 [+ or -] 26.0 37 82 131
18 88.2 [+ or -] 23.6 47 85 161
TOTAL 89.6 [+ or -] 285 49 86 141

Age, HDL-C, mg/dl
years Mean [+ or -] SD 5 50 95

7 51.9 [+ or -] 14.9 32 49 77
8 50.7 [+ or -] 15.5 32 49 83
9 52.2 [+ or -] 14.3 34 51 83
10 57.1 [+ or -] 13.2 37 56 83
11 52.2 [+ or -] 11.1 35 52 74
12 53.2 [+ or -] 13.9 35 50 81
13 52.1 [+ or -] 12.2 32 51 74
14 52.8 [+ or -] 13.0 35 52 76
15 49.1 [+ or -] 12.4 29 48 71
16 48.2 [+ or -] 13.6 30 46 78
17 48.2 [+ or -] 14.5 32 45 80
18 45.0 [+ or -] 12.5 30 43 83
TOTAL 51.1 [+ or -] 13.5 32 49 76

Age, Non-HDL-C, mg/dl
years Mean [+ or -] SD 5 5D 95

7 111.2 [+ or -] 29.7 67 107 173
8 111.2 [+ or -] 29.6 68 106 161
9 120.1 [+ or -] 37.0 66 117 191
10 101.0 [+ or -] 28.7 58 96 152
11 114.1 [+ or -] 33.7 68 108 183
12 113.5 [+ or -] 29.5 67 113 159
13 107.6 [+ or -] 30.2 65 106 159
14 100.6 [+ or -] 25.2 60 98 146
15 100.7 [+ or -] 25.9 65 96 150
16 103.3 [+ or -] 33.4 56 99 170
17 101.0 [+ or -] 27.5 57 101 152
18 107.1 [+ or -] 26.5 68 105 186
TOTAL 106.7 [+ or -] 30.2 65 103 159

HDL-C- high density lipoprotein cholesterol, LDL-C- low density
lipoprotein cholesterol, non-HDL-C- non high density lipoprotein
cholesterol, TC- total cholesterol, ~ TG- triglyceride

Table 3. Serum lipid and lipoprotein levels according to sex and
living areas *

 TC, mg/dl

Girls (n=1467) 169.1 [+ or -] 30.8
 7-10 years (n=420) 170.7 [+ or -] 32.3 (a)
 11-14 years (n=538) 166.8 [+ or -] 28.0 (f)
 15-18 years (n=509) 170.1 [+ or -] 32.1

Boys (n=1429) 159.2 [+ or -] 30.5
 7-10 years (n=349) 168.5 [+ or -] 32.6 (h,j)
 11-14 years (n=591) 160.8 [+ or -] 29.2 (e)
 15-18 years (n=489) 150.5 [+ or -] 28.3

p1 <0.001

Urban area (n=2230) 165.3 [+ or -] 31.6

Rural area (n=666) 160.5 [+ or -] 28.8

p2 <0.001

 TG, mg/dl

Girls (n=1467) 89.7 [+ or -] 38.5
 7-10 years (n=420) 86.8 [+ or -] 36.9 (b,c)
 11-14 years (n=538) 99.5 [+ or -] 39.5 (g)
 15-18 years (n=509) 81.9 [+ or -] 36.6

Boys (n=1429) 86.7 [+ or -] 38.9
 7-10 years (n=349) 82.6 [+ or -] 35.5 (j)
 11-14 years (n=591) 88.4 [+ or -] 39.8
 15-18 years (n=489) 87.6 [+ or -] 39.8

p1 <0.05

Urban area (n=2230) 87.2 [+ or -] 37.3

Rural area (n=666) 91.7 [+ or -] 43.0

p2 <0.001

 LDL-C, mg/dl

Girls (n=1467) 97.6 [+ or -] 30.4
 7-10 years (n=420) 102.0 [+ or -] 33.5 (b)
 11-14 years (n=538) 93.2 [+ or -] 27.9 (f)
 15-18 years (n=509) 99.0 [+ or -] 30.0

Boys (n=1429) 89.6 [+ or -] 28.5
 7-10 years (n=349) 96.5 [+ or -] 31.4 (i,k)
 11-14 years (n=591) 90.3 [+ or -] 27.4 (l)
 15-18 years (n=489) 84.5 [+ or -] 27.0

p1 <0.001

Urban area (n=2230) 94.3 [+ or -] 30.2

Rural area (n=666) 91.8 [+ or -] 28.3

p2 ns

 HDL-C, mg/dl

Girls (n=1467) 53.3 [+ or -] 15.1
 7-10 years (n=420) 50.6 [+ or -] 13.7 (d,e)
 11-14 years (n=538) 53.6 [+ or -] 14.3
 15-18 years (n=509) 55.0 [+ or -] 16.7

Boys (n=1429) 51.1 [+ or -] 13.5
 7-10 years (n=349) 52.9 [+ or -] 14.6 (i)
 11-14 years (n=591) 52.6 [+ or -] 12.7 (1)
 15-18 years (n=489) 48.3 [+ or -] 13.3

p1 <0.001

Urban area (n=2230) 52.8 [+ or -] 15.1

Rural area (n=666) 50.3 [+ or -] 11.6

p2 <0.001

 Non-HDL-C, mg/dl

Girls (n=1467) 115.5 [+ or -] 31.5
 7-10 years (n=420) 119.1 [+ or -] 34.3 (c,d)
 11-14 years (n=538) 113.0 [+ or -] 29.3
 15-18 years (n=509) 115.4 [+ or -] 31.4

Boys (n=1429) 106.7 [+ or -] 30.2
 7-10 years (n=349) 112.2 [+ or -] 32.9 (h,j)
 11-14 years (n=591) 107.9 [+ or -] 29.7 (1)
 15-18 years (n=489) 101.9 [+ or -] 28.3

p1 p<0.0001

Urban area (n=2230) 111.5 [+ or -] 31.7

Rural area (n=666) 110.2 [+ or -] 29.4

p2 ns

Data presented are Mean [+ or -] standard deviation for continuous
variables.

p1- unpaired Student t test comparisons between girls and boys

p2- unpaired Student t test comparisons between urban and rural area

Age groups comparisons- unpaired Student t test For girls;

(a) 7-10 years group and 11-14 years group, (p<0.05)

(b) 7-10 years group and11-14 years group, (p<0.001)

(c) 7-10 years group and 15-18 years group, (p<0.05)

(d) 7-10 years group and11-14 years group, (p<0.01)

(e) 7-10 years group and15-18 years group, (p<0.001)

(f) 11-14 years group and 15-18 years group, (p<0.01)

(g) 11-14 years group and15-18 years group, (p<0.001)

For boys

(h) 7-10 years group and11-14 years group, (p<0.001)

(i) 7-10 years group and15-18 years group, (p<0.001)

(j) 7-10 years group and 11-14 years group, (p<0.05)

(k) 7-10 years group and 11-14 years group, (p<0.01)

(l) 11-14 years group and 15-18 years group and (p<0.001)

HDL-C-high density lipoprotein cholesterol, LDL-C-low density
lipoprotein cholesterol, non-HDL-C-non high density lipoprotein
cholesterol, ns-not significant, TC-total cholesterol,
TG-triglyceride

Table 4. Prevalence of dyslipidemia according to age groups in both
sexes and living areas

 Hypercholesterolemia
 n %

Girls (n=1467) 207 14.1
7-10 years (n=420) 73 17.4 (a)
11-14 years (n=538) 53 9.91
15-18 years (n=509) 81 15.9

Boys (n=1429) 136 9.5
7-10 years (n=349) 56 16.0 (a,b)
11-14 years (n=591) 52 8.8
15-18 years (n=489) 28 5.7
Total (n=2896) 343 11.8
p1 <0.001
Urban Area (n=2230) 293 13.1
Rural Area (n=666) 50 7.5
Total (n=2896) 343 11.8
p2 <0.001

 Hyperhiglyceridemia
 n %

Girls (n=1467) 130 8.9
7-10 years (n=420) 40 9.5 (b)
11-14 years (n=538) 66 12.3 (g)
15-18 years (n=509) 24 4.7

Boys (n=1429) 116 8.1
7-10 years (n=349) 23 6.6
11-14 years (n=591) 48 8.1
15-18 years (n=489) 45 9.2
Total (n=2896) 246 7.5
p1 ns
Urban Area (n=2230) 177 7.9
Rural Area (n=666) 69 10.4
Total (n=2896) 246 7.5
p2 <0.05

 Elevated LDL-C
 n %

Girls (n=1467) 202 14.5
7-10 years (n=420) 78 21.1 (b,c)
11-14 years (n=538) 53 10.2
15-18 years (n=509) 71 14.2

Boys (n=1429) 123 9.1
7-10 years (n=349) 47 16.2 (b,c)
11-14 years (n=591) 46 8.0
15-18 years (n=489) 30 6.2
Total (n=2896) 325 11.9
p1 <0.001
Urban Area (n=2230) 257 12.4
Rural Area (n=666) 68 10.2
Total (n=2896) 325 11.9
p2 ns

 Decreased HDL-C
 n %

Girls (n=1467) 77 5.5
7-10 years (n=420) 31 8.4 (d)
11-14 years (n=538) 27 5.2
15-18 years (n=509) 19 3.8

Boys (n=1429) 104 7.7
7-10 years (n=349) 27 9.3 (a)
11-14 years (n=591) 25 4.3 (d)
15-18 years (n=489) 52 10.8
Total (n=2896) 181 6.6
p1 <0.05
Urban Area (n=2230) 143 6.9
Rural Area (n=666) 38 5.7
Total (n=2896) 181 6.6
p2 ns

 Elevated non-HDL-C
 n %

Girls (n=1467) 183 13.2
7-10 years (n=420) 66 15.7d (a,e)
11-14 years (n=538) 60 11.1
15-18 years (n=509) 57 11.1

Boys (n=1429) 119 8.9
7-10 years (n=349) 40 11.4 (c)
11-14 years (n=591) 51 8.6 (d)
15-18 years (n=489) 28 5.2
Total (n=2896) 302 10.4
p1 <0.0001
Urban Area (n=2230) 243 10.9
Rural Area (n=666) 59 8.9
Total (n=2896) 302 10.4
p2 <0.05

Data presented are the number and % of patients for
categorical variables.

* p1-Chi-square test for comparison between girls and total boys
p2- Chi-square test for comparisons between rural and urban areas Age
groups comparisons- Chi-square test

For girls

(a) 7-10 years group and 11-14 years group, (p<0.011

(b) 7-10 years group and 15-18 years group, (p<0.011

(c) 7-10 years group and11-14 years group, (p<0.001)

(d) 7-10 years group and 15-18 years group (p<0.01

(e) 7-10 years group and 11-14 years group (p<0.05)

(f) 11-14 years group and 15-18 years group (p<0.01)

(g) 11-14 years group and 15-18 years group (p<0.001)

For boys

(a) 7-10 years group and 11-14 years group, (p<0.011

(b) 7-10 years group and15-18 years group, (p<0.001)

(c) 7-10 years group and11-14 years group, (p<0.001)

(d) 11-14 years group and 15-18 years group, (p<0.001)

HDL-C- high density lipoprotein cholesterol, LDL-C- low density
lipoprotein cholesterol, non-HDL-C- non high density lipoprotein
cholesterol, ns-not significant, TC-total cholesterol, TG-triglyceride
COPYRIGHT 2007 Galenos Yayincilik
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2007 Gale, Cengage Learning. All rights reserved.

 Reader Opinion

Title:

Comment:



 

Article Details
Printer friendly Cite/link Email Feedback
Title Annotation:Original Investigation / Orijinal Arastirma
Author:Ucar, Birsen; Kilic, Zubeyir; Dinleyici, Ener Cagri; Colak, Omer; Gunes, Erdogan
Publication:The Anatolian Journal of Cardiology (Anadolu Kardiyoloji Dergisi)
Article Type:Clinical report
Geographic Code:7TURK
Date:Dec 1, 2007
Words:6832
Previous Article:Does cardiopulmonary bypass change serum neuron-specific enolase levels? / Kardiyopulmoner baypas serum noron spesifik enolaz duzeyini degistiriyor...
Next Article:Dyslipidemia in school-children / Okul cocuklarinda dislipidemi.
Topics:


Related Articles
Effect of black tea on the fasting concentrations of chylomicrons and chylomicron remnants in humans. (Original Research).
Preliminary results of HDL levels in the Duzce region (Turkey): normal rather than low/Duzce (Turkiye) bolgesinde HDL duzeylerinin on calisma...
Koroner risk katsayisi ile koroner anjiyografik olarak damar tutulumu ve risk faktorleri arasindaki iliski/Relationship between coronary risk...
Serum apolipoprotein B is superior to LDL-cholesterol level in predicting incident coronary disease among Turks/Turk halkinda yeni gelisen koroner...
Total variation of LDL-cholesterol and apolipoprotein B/ Serum apolipoprotein B is superior to LDL-cholesterol level in predicting incident coronary...
Effects of exercise training on blood lipids and lipoproteins in children and adolescents.
Dyslipidemia in school-children / Okul cocuklarinda dislipidemi.
Association of microalbuminuria and fasting insulin levels with presence and severity of coronary artery disease in non-diabetic cases/Diyabetik...
Preanalytical factors for non-HDL cholesterol measurements/ Serum lipid profiles including non-high density lipoprotein cholesterol levels in Turkish...
Can a city population represent a whole country? Essentials of study design for epidemiologic studies/Serum lipid profiles including non-high density...

Terms of use | Copyright © 2014 Farlex, Inc. | Feedback | For webmasters