Official reprint from UpToDate®
www.uptodate.com ©2018 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Dyslipidemia in children: Definition, screening, and diagnosis

Sarah D de Ferranti, MD, MPH
Jane W Newburger, MD, MPH
Section Editor
David R Fulton, MD
Deputy Editor
Carrie Armsby, MD, MPH


Dyslipidemias are disorders of lipoprotein metabolism that result in the following abnormalities:

High total cholesterol (TC)

High low-density lipoprotein cholesterol (LDL-C)

High non-high-density lipoprotein cholesterol (non-HDL-C)

High triglycerides (TG)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Dec 2017. | This topic last updated: Aug 01, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2018 UpToDate, Inc.
  1. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents, National Heart, Lung, and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics 2011; 128 Suppl 5:S213.
  2. Dai S, Yang Q, Yuan K, et al. Non-high-density lipoprotein cholesterol: distribution and prevalence of high serum levels in children and adolescents: United States National Health and Nutrition Examination Surveys, 2005-2010. J Pediatr 2014; 164:247.
  3. Lipid Research Clinics Program. The Lipid Research Clinics Population Studies Data Book - Vol 1. Governement Printing Office; DHHS publication NO. (NIH) 80-1527, Washington, DC 1980.
  4. Morrison JA, Sprecher DL, Biro FM, et al. Serum testosterone associates with lower high-density lipoprotein cholesterol in black and white males, 10 to 15 years of age, through lowered apolipoprotein AI and AII concentrations. Metabolism 2002; 51:432.
  5. Morrison JA, Barton BA, Biro FM, Sprecher DL. Sex hormones and the changes in adolescent male lipids: longitudinal studies in a biracial cohort. J Pediatr 2003; 142:637.
  6. Berenson GS, Srinivasan SR, Cresanta JL, et al. Dynamic changes of serum lipoproteins in children during adolescence and sexual maturation. Am J Epidemiol 1981; 113:157.
  7. Jolliffe CJ, Janssen I. Distribution of lipoproteins by age and gender in adolescents. Circulation 2006; 114:1056.
  8. Innis SM, Hamilton JJ. Effects of developmental changes and early nutrition on cholesterol metabolism in infancy: a review. J Am Coll Nutr 1992; 11 Suppl:63S.
  9. Daniels SR, Greer FR, Committee on Nutrition. Lipid screening and cardiovascular health in childhood. Pediatrics 2008; 122:198.
  10. Gidding SS. New cholesterol guidelines for children? Circulation 2006; 114:989.
  11. Kit BK, Carroll MD, Lacher DA, et al. Trends in serum lipids among US youths aged 6 to 19 years, 1988-2010. JAMA 2012; 308:591.
  12. Kit BK, Kuklina E, Carroll MD, et al. Prevalence of and trends in dyslipidemia and blood pressure among US children and adolescents, 1999-2012. JAMA Pediatr 2015; 169:272.
  13. Centers for Disease Control and Prevention (CDC). Prevalence of abnormal lipid levels among youths --- United States, 1999-2006. MMWR Morb Mortal Wkly Rep 2010; 59:29.
  14. Rizk NM, Yousef M. Association of lipid profile and waist circumference as cardiovascular risk factors for overweight and obesity among school children in Qatar. Diabetes Metab Syndr Obes 2012; 5:425.
  15. Riaño-Galán I, Fernández-Somoano A, Rodríguez-Dehli C, et al. Proatherogenic Lipid Profile in Early Childhood: Association with Weight Status at 4 Years and Parental Obesity. J Pediatr 2017; 187:153.
  16. de Ferranti SD. Declining cholesterol levels in US youths: a reason for optimism. JAMA 2012; 308:621.
  17. McCrindle BW, Urbina EM, Dennison BA, et al. Drug therapy of high-risk lipid abnormalities in children and adolescents: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee, Council of Cardiovascular Disease in the Young, with the Council on Cardiovascular Nursing. Circulation 2007; 115:1948.
  18. Haney EM, Huffman LH, Bougatsos C, et al. Screening and treatment for lipid disorders in children and adolescents: systematic evidence review for the US Preventive Services Task Force. Pediatrics 2007; 120:e189.
  19. Berenson GS, Srinivasan SR, Bao W, et al. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med 1998; 338:1650.
  20. McGill HC Jr, McMahan CA, Zieske AW, et al. Associations of coronary heart disease risk factors with the intermediate lesion of atherosclerosis in youth. The Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group. Arterioscler Thromb Vasc Biol 2000; 20:1998.
  21. Juonala M, Viikari JS, Rönnemaa T, et al. Associations of dyslipidemias from childhood to adulthood with carotid intima-media thickness, elasticity, and brachial flow-mediated dilatation in adulthood: the Cardiovascular Risk in Young Finns Study. Arterioscler Thromb Vasc Biol 2008; 28:1012.
  22. Mahoney LT, Burns TL, Stanford W, et al. Coronary risk factors measured in childhood and young adult life are associated with coronary artery calcification in young adults: the Muscatine Study. J Am Coll Cardiol 1996; 27:277.
  23. Li S, Chen W, Srinivasan SR, et al. Childhood cardiovascular risk factors and carotid vascular changes in adulthood: the Bogalusa Heart Study. JAMA 2003; 290:2271.
  24. Raitakari OT, Juonala M, Kähönen M, et al. Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study. JAMA 2003; 290:2277.
  25. Frontini MG, Srinivasan SR, Xu J, et al. Usefulness of childhood non-high density lipoprotein cholesterol levels versus other lipoprotein measures in predicting adult subclinical atherosclerosis: the Bogalusa Heart Study. Pediatrics 2008; 121:924.
  26. Webber LS, Srinivasan SR, Wattigney WA, Berenson GS. Tracking of serum lipids and lipoproteins from childhood to adulthood. The Bogalusa Heart Study. Am J Epidemiol 1991; 133:884.
  27. Bao W, Srinivasan SR, Wattigney WA, et al. Usefulness of childhood low-density lipoprotein cholesterol level in predicting adult dyslipidemia and other cardiovascular risks. The Bogalusa Heart Study. Arch Intern Med 1996; 156:1315.
  28. Schrott HG, Bucher KA, Clarke WR, Lauer RM. The Muscatine hyperlipidemia family study program. Prog Clin Biol Res 1979; 32:619.
  29. National Cholesterol Education Program (NCEP): highlights of the report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents. Pediatrics 1992; 89:495.
  30. McGill HC Jr, McMahan CA, Herderick EE, et al. Effects of coronary heart disease risk factors on atherosclerosis of selected regions of the aorta and right coronary artery. PDAY Research Group. Pathobiological Determinants of Atherosclerosis in Youth. Arterioscler Thromb Vasc Biol 2000; 20:836.
  31. US Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, et al. Screening for Lipid Disorders in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. JAMA 2016; 316:625.
  32. Klančar G, Grošelj U, Kovač J, et al. Universal Screening for Familial Hypercholesterolemia in Children. J Am Coll Cardiol 2015; 66:1250.
  33. Ritchie SK, Murphy EC, Ice C, et al. Universal versus targeted blood cholesterol screening among youth: The CARDIAC project. Pediatrics 2010; 126:260.
  34. Psaty BM, Rivara FP. Universal screening and drug treatment of dyslipidemia in children and adolescents. JAMA 2012; 307:257.
  35. Newman TB, Pletcher MJ, Hulley SB. Overly aggressive new guidelines for lipid screening in children: evidence of a broken process. Pediatrics 2012; 130:349.
  36. Belamarich PF. Counterpoint: The evidence does not support universal screening and treatment in children. J Clin Lipidol 2015; 9:S101.
  37. Newman TB, Schroeder AR, Pletcher MJ. Lipid Screening in Children: Low-Value Care. JAMA Intern Med 2016; 176:1437.
  38. Gillman MW, Daniels SR. Is universal pediatric lipid screening justified? JAMA 2012; 307:259.
  39. Ford ES, Li C, Zhao G, Mokdad AH. Concentrations of low-density lipoprotein cholesterol and total cholesterol among children and adolescents in the United States. Circulation 2009; 119:1108.
  40. McCrindle BW, Tyrrell PN, Kavey RE. Will obesity increase the proportion of children and adolescents recommended for a statin? Circulation 2013; 128:2162.
  41. Gooding HC, Rodday AM, Wong JB, et al. Application of Pediatric and Adult Guidelines for Treatment of Lipid Levels Among US Adolescents Transitioning to Young Adulthood. JAMA Pediatr 2015; 169:569.
  42. Yu HH, Markowitz R, De Ferranti SD, et al. Direct measurement of LDL-C in children: performance of two surfactant-based methods in a general pediatric population. Clin Biochem 2000; 33:89.
  43. Frontini MG, Srinivasan SR, Xu JH, et al. Utility of non-high-density lipoprotein cholesterol versus other lipoprotein measures in detecting subclinical atherosclerosis in young adults (The Bogalusa Heart Study). Am J Cardiol 2007; 100:64.
  44. Srinivasan SR, Frontini MG, Xu J, Berenson GS. Utility of childhood non-high-density lipoprotein cholesterol levels in predicting adult dyslipidemia and other cardiovascular risks: the Bogalusa Heart Study. Pediatrics 2006; 118:201.
  45. Rainwater DL, McMahan CA, Malcom GT, et al. Lipid and apolipoprotein predictors of atherosclerosis in youth: apolipoprotein concentrations do not materially improve prediction of arterial lesions in PDAY subjects. The PDAY Research Group. Arterioscler Thromb Vasc Biol 1999; 19:753.
  46. Freedman DS, Wang YC, Dietz WH, et al. Changes and variability in high levels of low-density lipoprotein cholesterol among children. Pediatrics 2010; 126:266.
  47. NICE clinical guideline: Identification and management of familial hypercholesterolaemia. Available at: https://www.nice.org.uk/guidance/cg71/resources/guidance-identification-and-management-of-familial-hypercholesterolaemia-pdf (Accessed on August 18, 2015).
  48. Wiegman A, Gidding SS, Watts GF, et al. Familial hypercholesterolaemia in children and adolescents: gaining decades of life by optimizing detection and treatment. Eur Heart J 2015; 36:2425.
  49. Nordestgaard BG, Chapman MJ, Humphries SE, et al. Familial hypercholesterolaemia is underdiagnosed and undertreated in the general population: guidance for clinicians to prevent coronary heart disease: consensus statement of the European Atherosclerosis Society. Eur Heart J 2013; 34:3478.
  50. Wierzbicki AS, Humphries SE, Minhas R, Guideline Development Group. Familial hypercholesterolaemia: summary of NICE guidance. BMJ 2008; 337:a1095.
  51. Cuchel M, Bruckert E, Ginsberg HN, et al. Homozygous familial hypercholesterolaemia: new insights and guidance for clinicians to improve detection and clinical management. A position paper from the Consensus Panel on Familial Hypercholesterolaemia of the European Atherosclerosis Society. Eur Heart J 2014; 35:2146.
  52. Gregg RE, Connor WE, Lin DS, Brewer HB Jr. Abnormal metabolism of shellfish sterols in a patient with sitosterolemia and xanthomatosis. J Clin Invest 1986; 77:1864.