Obesity, Overweight, and Dyslipidemia in Children and Adolescents

Table of Contents

1. OBESITY, OVERWEIGHT, AND DYSLIPIDEMIA IN CHILDREN AND ADOLESCENTS
2. DEFINITIONS
3. BODY MASS INDEX (BMI)
4. EPIDEMIOLOGY
5. ETIOLOGY
6. ASSESSMENT
7. CO-MORBIDITIES
8. HYPERLIPIDEMIA
   1. Primary Disorders of Cholesterol Metabolism
   2. Secondary Causes of Hypercholesterolemia
   3. Cholesterol Metabolism
   4. Cholesterol Screening
9. DIET AND EXERCISE RECOMMENDATIONS
10. PHARMACOLOGIC INTERVENTIONS
11. REFERRING TO SUBSPECIALISTS
12. TAKE HOME POINTS
13. RESOURCES & REFERENCES
14. ABOUT THE MODULE

Cholesterol Screening

Current AAP guidelines recommend that children be screened with a fasting lipid profile after 2 years of age but not later than 10 years of age for the following populations (Daniels, 2008):

• All children and adolescents with a positive family history of dyslipidemia or premature cardiovascular disease (CVD) (<55 years of age for men and < 65 years of age for women)

• All patients with unknown family history

• All patients with other CVD risk factors, such as personal history of overweight, obesity, hypertension, cigarette smoking, or diabetes mellitus

Normal screen

Patients who continue to meet any of the above criteria should be retested every 3-5 years

Abnormal screen

First step: diet and exercise plan initiated as outlined below

Follow up in 3-6 months with a repeat fasting lipid panel

Second step: AAP guidelines recommend initiating treatment for the following groups of patients:

• LDL concentration persistently > 190 mg/dL despite diet therapy in a patient with no other CVD risk factors
• LDL concentration persistently > 160 mg/dL despite diet therapy in a patient with other risk factors including obesity, hypertension, cigarette smoking, or positive family history of premature CVD
• LDL concentration > 130 mg/dL in a patient with diabetes mellitus (after first abnormal screening test)