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Distinct Lipoprotein Curves in Normal Weight, Overweight, and Obese Children and Adolescents

Interator, Hagar*,†; Lebenthal, Yael*,‡; Hoshen, Moshe§; Safra, Inbar*; Balicer, Ran§; Leshno, Moshe*; Shamir, Raanan*,||

Journal of Pediatric Gastroenterology and Nutrition: December 2017 - Volume 65 - Issue 6 - p 673–680
doi: 10.1097/MPG.0000000000001674
Original Articles: Nutrition

Objectives: Pediatric lipoprotein curves are based on population-based samples. As obesity, may alter lipoprotein levels, cutoffs not adjusted for body mass index (BMI) are potentially inappropriate. We aimed to develop distinct serum lipid curves based on sex- and BMI-percentiles for children and adolescents.

Methods: Cross-sectional analysis included all healthy children and adolescents (age range 2–17 years) with available serum lipid concentrations (n = 152,820 of approximately 1.2 million children and adolescents per study year). These children and adolescents were categorized according to sex- and age-stratified BMI-percentiles: 100,375 normal weight (5th–85th percentile), 26,028 overweight (85th–95th percentile) and 26,417 obese (≥95th percentile) individuals. Excluded were individuals with hyperlipidemia, gastrointestinal disease, thyroid disease and lipid-lowering medications. Lambda-Mu-Sigma, smoothed percentile lipid curves were computed.

Results: Obese children had a lipid profile pattern throughout childhood and adolescence similar to that of normal weight subjects but with a significant upward shift in total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), non–high-density lipoprotein cholesterol (non-HDL-C), and triglycerides (TGs) and a downward shift in high-density lipoprotein-cholesterol (HDL-C). Obese boys had 13 mg/dL higher TC levels (P < 0.001), 11 mg/dL higher LDL-C levels, 15 mg/dL higher non-HDL-C levels, and 5 mg/dL lower HDL-C levels (P < 0.001). Obese girls had 6 mg/dL higher TC levels, 7 mg/dL higher LDL-C levels, 11 mg/dl higher non-HDL-C levels, and 6 mg/dL lower HDL-C levels (P < 0.001).

Conclusions: Across a large, nationally representative cohort of children and adolescents, lipoprotein levels were found to vary in relation to weight status. On the basis of these findings, it is suggested that when evaluating the lipid profile in the pediatric population, in addition to sex-based curves, clinical decision making may require consideration of BMI-stratified curves.

Supplemental Digital Content is available in the text

*Sackler Faculty of Medicine, Tel Aviv University

Dana-Dwek Children's Hospital, Tel Aviv

The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva

§Health Planning and Policy Wing, Clalit Health Services, Tel Aviv

||Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.

Address correspondence and reprint requests to Raanan Shamir, MD, ESPGHAN President, Chairman, Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, 14 Kaplan St., Petah Tikva, Israel, 49202; Professor of Pediatrics, Sackler Faculty of Medicine, Tel-Aviv University, Israel (e-mail:

Received 30 April, 2017

Accepted 19 June, 2017

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (

H.I. and Y.L. contributed equally contributed equally to the article and also are first co-authors.

The authors report no conflicts of interest.

© 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,