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Joyce M. Lee, MD, MPH; Achamyeleh Gebremariam, MS; Paula Card-Higginson, BA, ELS; Jennifer L. Shaw, DrPH, MPH, MAP; Joseph W. Thompson, MD, MPH; Matthew M. Davis, MD, MAPP

Arch Pediatr Adolesc Med. 2009;163(8):716-723.

Objective  To evaluate the test performance of specific body mass index (BMI) percentile cutoffs for detecting children/adolescents with hypercholesterolemia.

Design  Cross-sectional analysis.

Setting  National Health and Nutrition Examination Survey 1999-2004.

Participants  Population-based sample of children (aged 3-18 years) with nonfasting total cholesterol (TC) and high-density lipoprotein (HDL) cholesterol levels and adolescents (aged 12-18 years) with fasting low-density lipoprotein (LDL) cholesterol and triglyceride (TG) levels.

Main Outcome Measures  Individuals were classified as having hypercholesterolemia if they had a TC level greater than 200 mg/dL, HDL cholesterol level less than 35 mg/dL, LDL cholesterol level greater than 130 mg/dL, or TG level greater than 150 mg/dL, and sensitivity, specificity, and likelihood ratios were calculated for specific BMI percentiles. Receiver operating characteristic curves were constructed and area under the curve (AUC) was calculated.

Results  Receiver operating characteristic curves using BMI percentiles to predict abnormal levels of TC and LDL cholesterol had AUC values (0.60 for TC level and 0.63 for LDL cholesterol level) that were less than the threshold of acceptable discrimination (between 0.7-0.8). Body mass index percentiles provided better discrimination for detecting children with abnormal HDL cholesterol and TG levels, with AUC values approaching levels of acceptable discrimination (0.69 and 0.72, respectively), although there are no specific guidelines regarding management of children with these abnormalities.

Conclusions  According to the American Academy of Pediatrics guidelines, abnormal levels of LDL cholesterol are used to determine which children require nutritional and pharmacologic therapy. Because BMI percentiles did not adequately identify children and adolescents with abnormal TC and LDL cholesterol levels, the new recommendations for targeted screening of obese children and adolescents may require further consideration.

Author Affiliations: Division of Pediatric Endocrinology (Dr Lee), Child Health Evaluation and Research Unit, Division of General Pediatrics (Drs Lee and Davis and Mr Gebremariam), Department of Internal Medicine (Dr Davis), and Gerald R. Ford School of Public Policy (Dr Davis), University of Michigan, Ann Arbor; and Arkansas Center for Health Improvement (Ms Card-Higginson and Drs Shaw and Thompson), Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences (Dr Thompson), and Office of the Surgeon General, State of Arkansas (Dr Thompson), Little Rock.

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