Trends in Levels of Lipids and Apolipoprotein B in US Youths Aged 6 to 19 Years, 1999-2016

Abstract

Importance: Favorable trends occurred in the lipid levels of US youths through 2010, but these trends may be altered by ongoing changes in the food supply, obesity prevalence, and other factors.

Objective: To analyze trends in levels of lipids and apolipoprotein B in US youths during 18 years from 1999 through 2016.

Design, setting, and participants: Serial cross-sectional analysis of US population-weighted data for youths aged 6 to 19 years from the National Health and Nutrition Examination Surveys for 1999 through 2016. Linear temporal trends were analyzed using multivariable regression models with regression coefficients (β) reported as change per 1 year.

Exposures: Survey year; examined periods spanned 10 to 18 years based on data availability.

Main outcomes and measures: Age- and race/ethnicity-adjusted mean levels of high-density lipoprotein (HDL), non-HDL, and total cholesterol. Among fasting adolescents (aged 12-19 years), mean levels of low-density lipoprotein cholesterol, geometric mean levels of triglycerides, and mean levels of apolipoprotein B. Prevalence of ideal and adverse (vs borderline) levels of lipids and apolipoprotein B per pediatric lipid guidelines.

Results: In total, 26 047 youths were included (weighted mean age, 12.4 years; female, 51%). Among all youths, the adjusted mean total cholesterol level declined from 164 mg/dL (95% CI, 161 to 167 mg/dL) in 1999-2000 to 155 mg/dL (95% CI, 154 to 157 mg/dL) in 2015-2016 (β for linear trend, -0.6 mg/dL [95% CI, -0.7 to -0.4 mg/dL] per year). Adjusted mean HDL cholesterol level increased from 52.5 mg/dL (95% CI, 51.7 to 53.3 mg/dL) in 2007-2008 to 55.0 mg/dL (95% CI, 53.8 to 56.3 mg/dL) in 2015-2016 (β, 0.2 mg/dL [95% CI, 0.1 to 0.4 mg/dL] per year) and non-HDL cholesterol decreased from 108 mg/dL (95% CI, 106 to 110 mg/dL) to 100 mg/dL (95% CI, 99 to 102 mg/dL) during the same years (β, -0.9 mg/dL [95% CI, -1.2 to -0.6 mg/dL] per year). Among fasting adolescents, geometric mean levels of triglycerides declined from 78 mg/dL (95% CI, 74 to 82 mg/dL) in 1999-2000 to 63 mg/dL (95% CI, 58 to 68 mg/dL) in 2013-2014 (log-transformed β, -0.015 [95% CI, -0.020 to -0.010] per year), mean levels of low-density lipoprotein cholesterol declined from 92 mg/dL (95% CI, 89 to 95 mg/dL) to 86 mg/dL (95% CI, 83 to 90 mg/dL) during the same years (β, -0.4 mg/dL [95% CI, -0.7 to -0.2 mg/dL] per year), and mean levels of apolipoprotein B declined from 70 mg/dL (95% CI, 68 to 72 mg/dL) in 2005-2006 to 67 mg/dL (95% CI, 65 to 70 mg/dL) in 2013-2014 (β, -0.4 mg/dL [95% CI, -0.7 to -0.04 mg/dL] per year). Favorable trends were generally also observed in the prevalence of ideal and adverse levels. By the end of the study period, 51.4% (95% CI, 48.5% to 54.2%) of all youths had ideal levels for HDL, non-HDL, and total cholesterol; among adolescents, 46.8% (95% CI, 40.9% to 52.6%) had ideal levels for all lipids and apolipoprotein B, whereas 15.2% (95% CI, 13.1% to 17.3%) of children aged 6 to 11 years and 25.2% (95% CI, 22.2% to 28.2%) of adolescents aged 12 to 19 years had at least 1 adverse level.

Conclusions and relevance: Between 1999 and 2016, favorable trends were observed in levels of lipids and apolipoprotein B in US youths aged 6 to 19 years.

Figure.. Age- and Race/Ethnicity-Adjusted Trends in Mean Levels of Lipids and Apolipoprotein B in US Youths Aged 6 to 19 Years, 1999-2016

All estimates are based on population-weighted data from the National Health and Nutrition Examination Survey. The unweighted sample size ranges for each sex-age group and lipid are as follows. Among males aged 6 to 11 years, the minimum for total cholesterol in 2003-2004 was 402 and the maximum in 2013-2014 was 549; the minimum for high-density lipoprotein (HDL) and non-HDL cholesterol in 2015-2016 was 493 and the maximum in 2013-2014 was 549. Among females aged 6 to 11 years, the minimum for total cholesterol in 1999-2000 was 411 and the maximum in 2001-2002 and 2013-2014 was 500; the minimum for HDL and non-HDL cholesterol in 2009-2010 was 471 and the maximum in 2013-2014 was 500. Among males aged 12 to 19 years, the minimum for total cholesterol in 2011-2012 was 566 and the maximum in 2001-2002 was 1081; the minimum for HDL and non-HDL cholesterol in 2011-2012 was 566 and the maximum in 2009-2010 was 629; the minimum for triglycerides in 2007-2008 was 248 and the maximum in 2003-2004 was 498; the minimum for low-density lipoprotein (LDL) cholesterol in 2007-2008 was 248 and the maximum in 2003-2004 was 496; the minimum for apolipoprotein B in 2007-2008 was 248 and the maximum in 2005-2006 was 438. Among females aged 12 to 19 years, the minimum for total cholesterol in 2007-2008 was 495 and the maximum in 2001-2002 was 1056; the minimum for HDL and non-HDL cholesterol in 2007-2008 was 495 and the maximum in 2013-2014 was 615; the minimum for triglycerides in 2007-2008 was 191 and the maximum in 2001-2002 was 457; the minimum for LDL cholesterol in 2007-2008 was 191 and the maximum in 2001-2002 was 454; and the minimum for apolipoprotein B in 2007-2008 was 191 and the maximum in 2013-2014 was 276. ^aAnalysis limited to 2007 and later due to HDL cholesterol bias prior to 2007; see Methods section for details. ^bFor triglycerides, the data are expressed as geometric means and log-transformed units for the β.