Influence of cholesterol screening and nutritional counseling in reducing cholesterol levels in children. The American Heart Association

Serum cholesterol level as a predictive biomarker for prognosis of Neuroblastoma

BACKGROUND

Neuroblastoma (NB), a type of solid tumor in children, has a poor prognosis. Few blood biomarkers can accurately predict the prognosis, including recurrence and survival, in children with NB. In this study, we found that the serum total cholesterol (Tchol) level was associated with the prognosis of patients through a retrospective study.

METHODS

Multivariate Cox regression model was used to identify the independent risk factors in the children with NB. Kaplan-Meier method was used to analyze the correlation between the common biomarkers, including the serum Tchol level, and the prognosis of the patients. ROC curves were used to predict the accuracy of the International Neuroblastoma Staging System (INSS) stage and Children's Oncology Group (COG) risk stratification after adding the serum Tchol level.

RESULTS

Compared with the other patients, serum Tchol level was significantly increased in the relapsed and died patients (P < 0.05). Subsequently, serum Tchol level was found as an independent risk factor to affect the outcome of patients (P < 0.05). Finally, we added serum Tchol level into traditional stage and risk classification system to form the new INSS stage and COG risk classification system. It was found that the areas under the ROC curve (AUC) of recurrence-free survival in the new INSS stage and COG risk classification system were increased to 0.691 (95%CI: 0.535-0.847) and 0.748 (95%CI: 0.622-0.874), respectively. Moreover, the AUC areas of overall survival in the new INSS stage and COG risk classification system were increased to 0.722 (95%CI: 0.561-0.883) and 0.668 (95%CI: 0.496-0.819), respectively.

CONCLUSION

We found that serum Tchol level, a clinical biomarker, is a risk factor for recurrence and death among the children with NB. The serum Tchol level could significantly increase the accuracy of the prediction for NB prognosis.

Routine Cholesterol Tests and Subsequent Change in BMI Among Overweight and Obese Children

INTRODUCTION

In 2011, the National Heart, Lung and Blood Institute and American Academy of Pediatrics concluded that both familial and obesity-associated dyslipidemias increase cardiovascular risk and recommended universal cholesterol testing at ages 9 to 11. It remains unknown whether testing influences body mass index (BMI) trajectory, a key modifiable cardiovascular outcome.

METHODS

This quasi-experimental-matched cohort includes children aged 9 to 11 years completing well visits in a diverse primary care network from 2012 to 2014. Participants had baseline BMI ≥85th% and no prior cholesterol testing. Propensity score matching identified untested children similar to tested children on weight measures, practice site, sex, age, race, ethnicity, insurance, and well visit frequency. Change in BMI z-score was assessed over 18 months. Regression adjusted for residual confounding following matching. Data were analyzed in 2018.

RESULTS

Matching improved balance between tested and untested children for all characteristics. The matched cohort of 1808 children was predominantly non-Latino black (48%) or non-Latino white (33%), and Medicaid insured (39%). Baseline BMI z-score was 1.88 for tested and 1.84 for untested children. Of tested children, 25% had cholesterol levels above the 2011 guideline's "acceptable" range. Two children received cholesterol lowering medications. Adjusted analysis found no difference in change in BMI z-score between tested and untested children (0.02, 95% confidence interval -0.01, 0.04).

CONCLUSIONS

Individual risk assessment in the form of cholesterol testing is not associated with change in BMI trajectory among overweight and obese children. Though testing may identify familial hypercholesterolemia, results suggest testing does not change BMI trajectory, a key strategy to reduce cardiovascular risk.

Cardiovascular Risk Reduction in Preschool Children: The “Healthy Start” Project

OBJECTIVE

To evaluate the impact of a multicomponent cardiovascular health intervention ("Healthy Start") which included a food service modification in a largely minority Head Start preschool population. The primary outcome measure was the change in serum cholesterol from the beginning to the end of the school year.

METHODS

Nine Head Start centers in Upstate N.Y. were assigned to either food service modification or control conditions. In addition, half of the centers assigned to the food service modification received supplemental nutrition education (FS/NU--food service modification/nutritional education), while the remaining centers were provided with supplemental safety education materials (FS--food service modification only). The control preschool centers (CON) also received supplemental safety educational curricula for children but their food services remained unchanged. Children had serum cholesterol, as well as height and weight measured at the beginning and end of the school year. A generalized linear univariate procedure was used with percent change in total serum cholesterol as the outcome variable and intervention group as the primary independent variable.

RESULTS

There was a significant decrease in total serum cholesterol among preschool children in food service intervention groups, (FS/NU and FS), compared to Controls (-6.0 versus -0.4 mg/dL). In addition to the significant difference in group means, children with elevated cholesterol at baseline were significantly more likely to have a cholesterol level in the normal range (<170 mg/dL) at follow-up if they attended a preschool in the food service modification group. There was a 30% reduction in risk of elevated cholesterol in the latter compared to controls. Participation in the dietary intervention did not affect short-term growth.

CONCLUSIONS

A preschool heart health intervention, "Healthy Start," designed to reduce the total and saturated fat content of snacks and meals to recommended levels was effective in reducing serum cholesterol in the study population as a whole and specifically children 'at risk'; i.e., those with initial elevated serum cholesterol.