PEDIATRICS Vol. 120 No. 1 July 2007, pp. e215-e219 (doi:10.1542/peds.2006-1812)
SPECIAL ARTICLE |
Screening for Lipid Disorders in Children: US Preventive Services Task Force Recommendation Statement
Abbreviations: USPSTF—US Preventive Services Task Force • TC—total cholesterol • LDL-C—low-density lipoprotein cholesterol • HDL-C—high-density lipoprotein cholesterol • CHD—coronary heart disease • NCEP—National Cholesterol Education Program • RCT—randomized, controlled trial
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SUMMARY OF RECOMMENDATION |
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The US Preventive Services Task Force (USPSTF) concludes that the evidence is insufficient to recommend for or against routine screening for lipid disorders in infants, children, adolescents, or young adults (up to age 20) (I recommendation).
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RATIONALE |
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Importance
There is good evidence that children with lipid disorders (dyslipidemia) are at risk for becoming adults with lipid disorders.
Detection
For children with familial dyslipidemia, the group most likely to benefit from screening, use of family history in screening may be inaccurate because of variability of definitions and unreliability of information. Serum lipid levels are accurate screening tests for childhood dyslipidemia, although many children with multifactorial types of dyslipidemia would have normal lipid levels in adulthood. Fifty percent of children and adolescents with dyslipidemia will have dyslipidemia as adults.
Benefits of Detection and Early Treatment*
Trials of statin drugs in children with monogenic dyslipidemia (defined below in "Clinical Considerations") indicate improved total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) measures. For children with multifactorial types of dyslipidemia, there is no evidence that diet or exercise interventions in childhood lead to improved lipid profiles or better health outcomes in adulthood.
Harms of Detection and Early Treatment
Potential harms of screening may include labeling of children whose dyslipidemia would not persist into adulthood or cause health problems, although evidence is lacking. Adverse effects from lipid-lowering medications and low-fat diets, including potential long-term harms, have been inadequately evaluated in children.
USPSTF Assessment
The USPSTF was unable to determine the balance between potential benefits and harms for routinely screening children and adolescents for dyslipidemia.
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CLINICAL CONSIDERATIONS |
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- Dyslipidemias are abnormalities of lipoprotein metabolism and include elevations in TC, LDL-C, or triglyceride levels or deficiencies of HDL-C. These disorders can be acquired or familial; monogenic dyslipidemias are related to genetic conditions such as familial hypercholesterolemia in some individuals. Multifactorial dyslipidemias are caused by risk factors including environmental factors (obesity, diet) or currently unidentified
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