Usefulness of Non-High-Density Lipoprotein Cholesterol for Screening Dyslipidemia in Children and Adolescents with Overweight or Obesity: A Single-Center Retrospective Study

TL;DR

Non-fasting non-HDL cholesterol is a reliable and convenient screening tool for detecting dyslipidemia in overweight or obese children and adolescents.

Contribution

Demonstrates that non-fasting non-HDL cholesterol is non-inferior to fasting measures and highly sensitive for detecting elevated LDL cholesterol in children.

Findings

Non-HDL cholesterol had 100% sensitivity in boys and 97.8% in girls for detecting elevated LDL cholesterol.

Random non-HDL cholesterol showed significantly higher sensitivity in boys compared to fasting values.

Non-HDL cholesterol detected dyslipidemia in 94% of boys and 85.4% of girls with high non-HDL levels.

Abstract

What are the main findings?
Non–high-density-lipoprotein cholesterol (non-HDL cholesterol) showed high diagnostic performance for detecting elevated LDL-cholesterol, with a sensitivity of 100% in boys and 97.8% in girls.Random non-HDL cholesterol was non-inferior to fasting values and demonstrated significantly higher sensitivity in boys.

Non–high-density-lipoprotein cholesterol (non-HDL cholesterol) showed high diagnostic performance for detecting elevated LDL-cholesterol, with a sensitivity of 100% in boys and 97.8% in girls.

Random non-HDL cholesterol was non-inferior to fasting values and demonstrated significantly higher sensitivity in boys.

What is the implication of the main finding?
Non-fasting non-HDL cholesterol is a practical first-line screening tool for dyslipidemia in overweight or obese children.More convenient screening may help identify more children at risk, allowing earlier lifestyle interventions to reduce future cardiovascular risk.

Non-fasting non-HDL cholesterol is a practical first-line screening tool for dyslipidemia in overweight or obese children.

More convenient screening may help identify more children at risk, allowing earlier lifestyle interventions to reduce future cardiovascular risk.

Background/Objectives: Non-high-density lipoprotein (non-HDL) cholesterol provides a practical alternative for assessing dyslipidemia, with the advantage of not requiring fasting. The aim of this study was to evaluate the utility of non-HDL cholesterol measured in random (non-fasting) samples for screening dyslipidemia in children and adolescents with overweight or obesity. Methods: We retrospectively analyzed 751 children and adolescents (268 boys and 483 girls) aged 2 to 19 years with overweight or obesity. They underwent lipid profile evaluation without fasting. Dyslipidemia was defined as the presence of one or more of the following: total cholesterol ≥ 200 mg/dL, triglycerides ≥ 100 mg/dL (ages 0–9) or ≥130 mg/dL (ages 10–19), low-density lipoprotein (LDL) cholesterol ≥ 130 mg/dL, and HDL cholesterol < 40 mg/dL. A cutoff value of ≥145 mg/dL was used for non-HDL cholesterol. The sensitivity and specificity of non-HDL cholesterol were compared with those of fasting-state data from the Korean National Health and Nutrition Examination Survey. Results: Dyslipidemia was identified in 52.6% of children and adolescents with overweight or obesity. Non-HDL cholesterol ≥ 145 mg/dL was observed in 18.7% of boys and 17.0% of girls, and dyslipidemia was observed in 94.0% and 85.4% of boys and girls with high non-HDL cholesterol, respectively. Non-HDL cholesterol demonstrated excellent performance in detecting elevated measured LDL cholesterol, with a sensitivity and specificity of 100% and 92.0%, respectively, for boys and 97.8% and 91.3%, respectively, for girls. When stratified by age, non-HDL cholesterol showed sensitivity comparable to or higher than that of total cholesterol for both boys and girls. The sensitivity of non-HDL cholesterol in random samples was significantly higher than that of non-HDL cholesterol in fasting-state samples from boys (100% vs. 94.3%, p = 0.010), with a similar trend shown by girls (92.9% vs. 92.3%, p = 0.510). Conclusions: Non-HDL cholesterol measurement may be a reliable and practical tool for dyslipidemia screening in children and adolescents with overweight or obesity. Its applicability in non-fasting conditions makes it a convenient tool for routine clinical use.

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