Screening for Lipid Disorders in Children

• The USPSTF concludes that the evidence is insufficient to recommend for or against routine screening for lipid disorders in infants, children, adolescents, or young adults (up to age 20). This is a grade "I" Statement.

Rationale

Importance: There is good evidence that children with lipid disorders (dyslipidemia) are at risk for becoming adults with lipid disorders.

Detection: For children with familial dyslipidemia, the group most likely to benefit from screening, use of family history in screening may be inaccurate because of variability of definitions and unreliability of information. Serum lipid levels are accurate screening tests for childhood dyslipidemia, although many children with multifactorial types of dyslipidemia would have normal lipid levels in adulthood. Fifty percent of children and adolescents with dyslipidemia will have dyslipidemia as adults.

Benefits of detection and early intervention:^a Trials of statin drugs in children with monogenic dyslipidemia (defined below in clinical considerations) indicate improved total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) measures. For children with multifactorial types of dyslipidemia, there is no evidence that diet or exercise interventions in childhood lead to improved lipid profiles or better health outcomes in adulthood.

Harms of detection and early treatment: Potential harms of screening may include labeling of children whose dyslipidemia would not persist into adulthood or cause health problems, although evidence is lacking. Adverse effects from lipid-lowering medications and low-fat diets, including potential long-term harms, have been inadequately evaluated in children.

USPSTF assessment: The USPSTF was unable to determine the balance between potential benefits and harms for routinely screening children and adolescents for dyslipidemia.