Persistent High Non-High-Density Lipoprotein Cholesterol in Early Childhood: A Latent Class Growth Model Analysis

Jordan M Albaum; Sarah Carsley; Yang Chen; David W H Dai; Gerald Lebovic; Brian W McCrindle; Jonathon L Maguire; Patricia C Parkin; Catherine S Birken; TARGet Kids! Collaboration

doi:10.1016/j.jpeds.2017.08.079

Persistent High Non-High-Density Lipoprotein Cholesterol in Early Childhood: A Latent Class Growth Model Analysis

J Pediatr. 2017 Dec:191:152-157. doi: 10.1016/j.jpeds.2017.08.079.

Authors

Jordan M Albaum¹, Sarah Carsley², Yang Chen³, David W H Dai³, Gerald Lebovic⁴, Brian W McCrindle⁵, Jonathon L Maguire⁶, Patricia C Parkin⁷, Catherine S Birken⁸; TARGet Kids! Collaboration

Affiliations

¹ Pediatrics Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario; Faculty of Medicine, University of Toronto, Toronto, Ontario; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario.
² Pediatrics Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario.
³ The Applied Health Research Centre of the Li Ka Shing Knowledge Institute, Toronto, Ontario.
⁴ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario; The Applied Health Research Centre of the Li Ka Shing Knowledge Institute, Toronto, Ontario.
⁵ Faculty of Medicine, University of Toronto, Toronto, Ontario; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario.
⁶ Faculty of Medicine, University of Toronto, Toronto, Ontario; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario; The Applied Health Research Centre of the Li Ka Shing Knowledge Institute, Toronto, Ontario.
⁷ Faculty of Medicine, University of Toronto, Toronto, Ontario; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario; Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario.
⁸ Pediatrics Outcomes Research Team (PORT), The Hospital for Sick Children, Toronto, Ontario; Faculty of Medicine, University of Toronto, Toronto, Ontario; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario; Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario. Electronic address: catherine.birken@sickkids.ca.

PMID: 29173300
DOI: 10.1016/j.jpeds.2017.08.079

Abstract

Objectives: To examine patterns of non-high-density lipoprotein (HDL) cholesterol in early childhood and identify factors associated with persistent high non-HDL cholesterol in healthy urban children.

Study design: We identified all children enrolled in a primary care practice-based research network called TARGet Kids! (The Applied Research Group for Kids) with ≥3 laboratory measurements of non-HDL cholesterol. Latent class growth model analysis was performed to identify distinct trajectory groups for non-HDL cholesterol. Trajectory groups were then categorized into "normal" vs "persistent-high" non-HDL cholesterol based on guideline cut-off values and logistic regression was completed to examine the association between trajectory group and the presence of anthropometric and cardiometabolic risk factors.

Results: A total of 608 children met inclusion criteria for the trajectory analysis (median age at enrolment = 18.3, IQR = 27.9 months). Four trajectory groups were identified with 2 groups (n = 451) categorized as normal non-HDL cholesterol and 2 groups (n = 157) as persistent high non-HDL cholesterol. Family history of high cholesterol (OR 2.04, 95% CI 1.27-3.28) was associated significantly with persistent high non-HDL cholesterol, whereas East/Southeast Asian vs European ethnicity (OR 0.33, 95% CI 0.14-0.78), longer breastfeeding duration (OR 0.96, 95% CI 0.93-1.00), and greater birth weight (OR 0.69, 95% CI 0.48-1.00) were associated with lower odds of persistent high non-HDL cholesterol.

Conclusions: Patterns of non-HDL cholesterol are identified during early childhood, and family history of high cholesterol was associated most strongly with persistent high non-HDL cholesterol. Future research should inform the development of a clinical prediction tool for lipids in early childhood to identify children who may benefit from interventions to promote cardiovascular health.

Keywords: cardiovascular; lipids; trajectory; trends.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Biomarkers / blood
Cardiovascular Diseases / etiology
Child
Child, Preschool
Cholesterol, LDL / blood*
Female
Humans
Hypercholesterolemia / blood
Hypercholesterolemia / diagnosis
Hypercholesterolemia / epidemiology*
Hypercholesterolemia / etiology
Hyperlipoproteinemias / blood
Hyperlipoproteinemias / diagnosis
Hyperlipoproteinemias / epidemiology*
Hyperlipoproteinemias / etiology
Infant
Infant, Newborn
Logistic Models
Longitudinal Studies
Male
Multivariate Analysis
Ontario / epidemiology
Primary Health Care
Risk Factors

Substances

Biomarkers
Cholesterol, LDL

Grants and funding

133585/CIHR/Canada